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TwitterLinkedInEmailWebsiteAACIPM is Promoting Pain and Self Care Awareness Month in September Health Care Includes Self Care™ To promote both Pain Awareness Month and Self Care Awareness Month, AACIPM will be collaborating with many partners to spread awareness and deepen connections and understanding across the stakeholders. Join us in our efforts to build awareness by registering for the webinars included within this newsletter, by sending us relevant resources on pain and self care for our repository, and by sharing the information (more to come soon!) with your interested networks. We’ll be participating in IM4US 2021 Conference on September 24, co-moderating an amazing panel of people making positive differences in the lives of people who are underserved. We’ll share more details in coming issues about our presentation Advancing Integrative Pain Management Through Collaboration and Advocacy. We have also developed a webinar, Bridging Self Care and Comprehensive Pain Management in Program and Payment Designs, to be held on September 28 from 1-2pm ET (free registration). Read the summary below for more information about this important webinar designed in collaboration with Midwest Business Group on Health, The Pain Community, and University of Vermont Comprehensive Pain Program hosted on KnoWEwell Live. Also, to keep connecting those dots, read Duke’s case study on University of Vermont Medical Center, which you’ll find below in this newsletter. There are several people from the UVMMC team and Blue Cross and Blue Shield of Vermont who will be participating! Lastly, we are also building a new repository of resources and kindly request any resources you can share that would be relevant. Watch your inbox for more information coming soon!Register for Sept. 28 WebinarUniversity Improves Care in Rural Communities with New Integrative Pain Management Curriculum  AACIPM director talked with Dr. John Maye, Professor and Pain Management Concentration Director for the University of South Florida, College of Nursing. While Dr. Maye was serving as the Director of Research for a pain management clinic and providing care to wounded warriors at Walter Reed National Military Medical Center, his thoughts and knowledge related to pain management and opioid administration were transformed. These experiences became the driving force behind the creation of the Advanced Pain Management Fellowship and the Integrative Pain Management Graduate Certificate at USF. Given the deficit of specialized pain management providers in rural America, health care providers employed in these areas may find the program particularly beneficial. Dr. Maye, you’ve been involved with AACIPM efforts for many years.  What does integrative pain management mean to you? “Integrative pain management is when an individual or institution can move beyond the traditional views of pain as an interpretation or modulation of a nociceptive impulse. Pain evolves not only from tissue damaging stimuli, but may also serve as a consequence of the way stress, sleep, and central autonomic nervous system tone impact brain function. Pain is a complex phenomenon that is mediated through mechanisms that involve more than the traditional views of tissue damage. These traditional views of aligning pain only with tissue damaging stimuli are limiting and may be the driving force behind economic costs associated with the treatment of pain to be estimated at $560-635 billion annually.” “In 2011, the Institute of Medicine (IOM) recommended the government support substantial improvements in patient and professional education regarding pain. This recommendation included both undergraduate and graduate curricula change to improve pain management education for all health care professionals. To date, there has been some movement toward improving pain education in health care, but there is still a huge deficit with regard to appreciating that the pain experience for a patient is greater than the sum of its parts.” Click button below to read more about this program, anticipated to greatly improve the quality of life and access to pain management to underserved patients in rural communities.  Read MoreDuke Releases Case Study on Comprehensive Pain Program Using Unique Bundled Payment Arrangement  AACIPM is pleased to share that the Duke-Margolis Center for Health Policy and the Duke Department of Orthopaedic Surgery have released the second of four case studies emanating from their 2020-21 Roundtable on Integrated Pain Management. Their second case study features the University of Vermont Medical Center’s Comprehensive Pain Program (CPP), which was established in 2017 to improve treatment options for patients struggling with opioid use for musculoskeletal pain conditions. The program developed a customized intensive outpatient program that includes an array of integrative therapies to optimize patients’ function and maximize their well-being, supported by a unique bundled payment arrangement developed in partnership with Blue Cross and Blue Shield of Vermont. The case study details the program’s novel bundled payment arrangement, highlights the program’s history and implementation, and describes key factors that have contributed to the program’s success. Duke will be releasing the remaining two case studies in the coming months.   Duke’s in-person Roundtable that spurred the creation of this series of case studies took place in February 2020 and included participation from numerous AACIPM leaders and experts. Further background on this Roundtable can be found on Duke’s website and AACIPM’s website, including reflections from AACIPM’s Advisory Committee member, Adam Seidner, MD, MPH, Chief Medical Officer, The Hartford.Read Duke’s Case Study on UVMMCNational Updates from Congress and HHS CARA 3.0 Begins Long Journey Toward Passage The House of Representatives has begun work on the third iteration of the Comprehensive Addiction and Recovery Act, known this time around as the CARA 3.0 Act of 2021. The House introduced CARA 3.0, also known as HR 4341, in July, and the bill already has 47 cosponsors and has been referred simultaneously to six different committees for consideration. While the Senate introduced their own version of CARA 3.0 (S 987) in March, almost no action has been taken on that version of the bill.NIH HEAL Initiative Introduces New Community Partner CommitteeA subcommittee of Multidisciplinary Working Group The NIH HEAL Initiative, a trans-NIH effort to improve prevention and treatment strategies for opioid misuse and addiction and to enhance pain management, has announced the creation of the HEAL Community Partner Committee made up of people with lived experience, advocates, and/or family members of someone with pain or addiction. A subcommittee of the HEAL Multidisciplinary Working Group, who advises the initiative on research directions and activities, the new committee will provide input on key issues faced by individuals affected by pain conditions or opioid use disorder to ensure the relevance and generalizability of HEAL-supported research. The Community Partner Committee includes Christin Veasley of the Chronic Pain Research Alliance, a long-time AACIPM partner, as well as representatives from Family and Medical Counseling Services, the Addiction Policy Forum, the Georgia Council on Substance Abuse, Faces & Voices of Recovery, and two additional advocates representing people living with pain. NIH HEAL Initiative Multi-Disciplinary Working Group Meets September 1-2On September 1 and 2, the NIH HEAL Initiative will convene a meeting of the Multi-Disciplinary Working Group (MDWG) to share updates, progress, and activities of the initiative, as well as trends in opioid misuse, overdose, and addiction. A discussion with members of the MDWG will follow these presentations.A videocast link will be available to view the open session of the meeting on September 1 (day 1). Please visit the NIH HEAL Initiative website for the meeting agenda and videocast link.  NAM Releases Podcast on Racism and the American Opioid Epidemic Aimed at combatting the fractured approach to addressing the opioid crisis, which often targets small portions of the crisis rather than taking a holistic view, the National Academy of Medicine and the Aspen Institute launched the Action Collaborative on Countering the U.S. Opioid Epidemic in early 2021. Through convenings, publications, strategic partnerships, webinars, this podcast, and other outlets the experts who comprise the Action Collaborative aim to uplift established evidence, promote best practices, identify research gaps, and identify collaborative approaches to countering the opioid crisis. In August, the Collaborative focused on the intersection of systemic racism, policy, and healthcare. Previous episodes have explored the interplay between the opioid epidemic and COVID-19 pandemic and the role of stigma in treating substance use disorder. You will find the audio podcasts, as well as written transcripts, here.CMS Still Accepting Comments on 2022 Physician Fee Schedule As announced last month, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining changes to the Medicare Physician Fee Schedule (PFS) and other Medicare Part B payments for Calendar Year (CY) 2022. The proposed rule contains many pain-specific provisions and presents an exciting opportunity for advocates to provide information that could substantially impact CMS payment structure in regard to pain management. Comments to the proposed rule change will be accepted through September 13, 2021. AACIPM is currently drafting a group sign-on response to this proposal, coordinating with the many groups and individuals who expressed interest after receiving our initial alert. If you have interest in reviewing and signing on to our letter, please contact Amy Goldstein no later than September 6th.Partner Educational Opportunities New Study Proves Benefits of Teaching Patients Self Care, Provider Education Available A recent study of 263 adults with chronic low-back pain has shown that patients who take a single 2-hour pain relief skills class show clinically meaningful reductions in pain catastrophizing scores at their three-month follow-up visits. The course, Empowered Relief™, includes pain neuroscience education, mindfulness principles, and CBT skills (identifying distressing thoughts and emotions, cognitive reframing, a relaxation response exercise, and a self-soothing action plan). Empowered Relief™ is an evidence-based, single-session pain class that rapidly equip patients with self-care pain management skills. An online workshop will be held on October 8-9, 2021 to certify practitioners to provide this type of patient education. Developed by pain psychologist Beth Darnall, PhD, this program has been embedded into clinical care pathways at Stanford University since 2013 and was recently expanded after initial successes thanks to funding from the National Institutes of Health. The program is open to clinicians of all disciplines and is intended to enable participants to immediately implement their new skills into their clinic or research study. Register for the October 8-9 workshop. MassPI to Hold Pain Education Webinar on Today’s Changing Tide On October 14, 2021, MassPI will hold their fall pain education webinar, Steering the Course of Pain Management in Today’s Changing Tide. Featuring Keynote Speaker Lynn Webster, MD, in addition to experts focusing on opioid moderatism, pathways for innovation in pain treatment, and leveraging technology to enhance equitable access, the conference offers four nationally certified continuing education credits to physicians, nurses, pharmacists, psychologists, and social workers. Register here for the October 14 webinar. AIHM Wellness Webinar – Whole Body Approach to Low Back Pain On September 3, AIHM will present Whole Body Approach to Low Back Pain, from their Wellness Webinar series. Joshua Rubinstein, MD, Clinical Sciences chair of the naturopathic medicine program at Bastyr University, will look at some of the major factors contributing to low back pain. This will include an overview of some of the major biomechanical and postural reasons folks develop low back pain.  Dr. Rubinstein will review some of the major exercises he recommends to address these contributing factors. We will also look at nutritional strategies to support connective tissue (joints and skin) throughout the body. Register for free for the September 3 webinar.Message from the Director I hope this issue finds everyone well as many of us are experiencing back to school along with the busy transition into an even busier fall calendar.  I am really excited for AACIPM to be sharing our focus on Pain and Self Care Awareness Month in September – and beyond. Most of us engaged with AACIPM understand that health care includes self care. It’s not something separate but is becoming increasingly more understood as part of Whole Health Care.  Our aim is to do what we’ve always done best – Connect the Dots!  There are so many evidence-informed self management activities for pain, and there are more and more examples in program and payment designs showing the efficacy and value of this approach to care for people with pain. Join us in our efforts to bridge deeper understanding and build awareness across the many stakeholders invested in whole person, comprehensive integrative pain management. You can do this by registering for the Sept. 28 webinar with Midwest Business Group on Health (see the first entry above), and watching your inbox for more additions to the repository for pain and self care on our website (under development). We’ll also be at IM4US 2021 on Sept. 24, co-moderating an amazing panel, titled, Advancing Integrative Pain Management Through Collaboration and Advocacy. Onward and Upward! AmyRelevant Reading This Drug Helped My Chronic Pain – But It’s Also Killing People, Vice, August 26 How to Exercise for Psoriatic Arthritis Pain Relief, Self, August 25 Association Between Sleep Quality and Pain Intensity in Mild Patients with COPD: A Community Study, DovePress, August 25   Psychosocial and cardiometabolic predictors of chronic pain onset in Native Americans, Pain, August 24   The pain switch, MIT Technology Review, August 24 Delta opioid receptor regulation of calcitonin gene–related peptide dynamics in the trigeminal complex, PAIN, August 2021 Psychotropic Medications May Significantly Reduce Chronic Pain in Pediatric Patients, Clinical Pain Advisor, August 19   CME – Fibromyalgia: What It Is and How to Treat It, Psychiatric Times, August 18   Efficacy of Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome, Annals of Internal Medicine, August 17   The Pain Medicine Fellowship Telehealth Education Collaborative, Pain Medicine, August 17   Chronic Pain Among Service Members, Rand Corp., August Pain Perception Training May Help With Back Pain in Hypermobile EDS, Ehlers-Danlos News, August 9   Why Migraine Sufferers May Want to Eat More Fish, New York Times, August 7   4 Things the Chronically Ill Wish Others Understood, Psychology Today, August 5   Hierarchical clustering by patient-reported pain distribution alone identifies distinct chronic pain subgroups differing by pain intensity, quality, and clinical outcomes, PLOS One, August 4   Chronic pain sufferers silenced by pandemic, Hippocratic Post, August 3 CDC Opioid Prescribing Guideline Updates Are in the Works: Will the Changes be Enough?, Practical Pain Management, August 3   Peripheral nerve stimulation for chronic low back pain may reduce pain, disability, Orthopedics Today, August 2 Association between widespread pain and dementia, Alzheimer’s disease and stroke: a cohort study from the Framingham Heart Study, Regional Anesthesia & Pain Medicine, August 2   Women’s chronic pain is often dismissed as being ‘dramatic’ – which can ruin health and lives, Insider, July 31 Study: 7 in 10 chronic pain sufferers delayed seeking medical advice during the pandemic, News Medical Life Sciences, July 31   90% of US primary care offers lower pain relief doses to Black patients, Medical News Today, July 30   What to Expect in Thoracic Outlet Syndrome Physical Therapy, Very Well Health, July 30   90% of US primary care offers lower pain relief doses to Black patients, Medical News Today, July 30   How Virtual Reality Is About to Revolutionize Healthcare, Bloomberg, July 30   Podcast: HOW TO COMBINE PAIN NEUROSCIENCE WITH YOGA FOR EFFECTIVE PAIN CARE WITH NIAMH MOLONEY, PHD, PT AND MARNIE HARTMAN, DPT, RYT, Integrative Pain Science Institute, July 30   Patient Preference and Risk Assessment in Opioid Prescribing Disparities, JAMA Netw Open, July 29 US service members suffer chronic pain at rate much higher than civilian population, report says, Stars and Stripes, July 6Feedback We welcome your input! What do you like? Do you have a contribution for an upcoming newsletter? Send us your comments, suggestions, or contributions.SUBSCRIBE TO THIS NEWSLETTER

https://www.webmd.com/sleep-disorders/ss/slideshow-fatigue-causes-and-remedies?ecd=wnl_spr_083121_remail&ctr=wnl-spr-083121-remail_lead_cta&mb=X9BGobA7BYgwk8%2FQ26MRUWdEpmNqbUHL5ZWpoSEk9GU%3D

• Sleep Disorders 
•  Slideshows

Slideshow: Causes of Fatigue and Sleepiness and How to Fight Them

Medically Reviewed by Jennifer Robinson, MD on February 17, 2020

Fatigue Cause No. 1: Not Enough Sleep

1/16

It may seem obvious but you could be getting too little sleep. That can negatively affect your concentration and health. Adults should get seven to eight hours every night. 

Fix: Make sleep a priority and keep a regular schedule. Ban laptops, cell phones, and televisions from your bedroom. Still having trouble? Seek help from a doctor. You may have a sleep disorder.

Fatigue Cause No. 2: Sleep Apnea

2/16

Some people think they’re sleeping enough, but sleep apnea gets in the way. It briefly stops your breathing throughout the night. Each interruption wakes you for a moment, but you may not be aware of it. The result: you’re sleep-deprived despite spending eight hours in bed. Your doctor may order a sleep study to check for this. 

Fix: Lose weight if you’re overweight, quit smoking, and you may need a CPAP device to help keep your airway passages open while you sleep.
 

Fatigue Cause No. 3: Not Enough Fuel

3/16

Eating too little causes fatigue, but eating the wrong foods can also be a problem. Eating a balanced diet helps keep your blood sugar in a normal range and prevents that sluggish feeling when your blood sugar drops.

Fix: Always eat breakfast and try to include protein and complex carbs in every meal. For example, eat eggs with whole-grain toast. Also eat small meals and snacks throughout the day for sustained energy.

Fatigue Cause No. 4: Anemia

4/16

Anemia is one of the leading causes of fatigue in women. Menstrual blood loss can cause an iron deficiency, putting women at risk. Red blood cells (shown here) are needed because they carry oxygen to your tissues and organs.

Fix: For anemia caused by an iron deficiency, taking iron supplements and eating iron-rich foods, such as lean meat, liver, shellfish, beans, and enriched cereal, can help.

Fatigue Cause No. 5: Depression

5/16

You may think of depression as an emotional disorder, but it contributes to many physical symptoms, as well. Fatigue, headaches, and loss of appetite are among the most common symptoms. If you feel tired and “down” for more than a few weeks, see your doctor.

Fix: Depression responds well to talk therapy and/or medication.

Fatigue Cause No. 6: Hypothyroidism

6/16

The thyroid is a small gland at the base of your neck. It controls your metabolism, the speed at which your body converts fuel into energy. When the gland is underactive and the metabolism functions too slowly, you may feel sluggish and put on weight.

Fix: If a blood test confirms your thyroid hormones are low, synthetic hormones can bring you up to speed.

Fatigue Cause No. 7: Caffeine Overload

7/16

Caffeine can improve alertness and concentration in moderate doses. But too much can increase heart rate, blood pressure, and jitteriness. And research indicates too much actually causes fatigue in some people.

Fix: Gradually cut back on coffee, tea, chocolate, soft drinks, and any medications that contain caffeine. Stopping suddenly can cause caffeine withdrawal and more fatigue.

Fatigue Cause No. 8: Hidden UTI

8/16

If you’ve ever had a urinary tract infection (UTI), you’re probably familiar with the burning pain and sense of urgency. But the infection does not always announce itself with such obvious symptoms. In some cases, fatigue may be the only sign. A urine test can quickly confirm a UTI.

Fix: Antibiotics are the cure for UTIs, and the fatigue will usually vanish within a week.

Fatigue Cause No. 9: Diabetes

9/16

In people with diabetes, abnormally high levels of sugar remain in the bloodstream instead of entering the body’s cells, where it would be converted into energy. The result is a body that runs out of steam despite having enough to eat. If you have persistent, unexplained fatigue, ask your doctor about being tested for diabetes.

Fix: Treatments for diabetes may include lifestyle changes such as diet and exercise, insulin therapy, and medications to help the body process sugar.

Fatigue Cause No. 10: Dehydration

10/16

Your fatigue can be a sign of dehydration. Whether you’re working out or working a desk job, your body needs water to work well and keep cool. If you’re thirsty, you’re already dehydrated.

Fix: Drink water throughout the day so your urine is light colored. Have at least two cups of water an hour or more before a planned physical activity. Then, sip throughout your workout, and afterward drink another two cups.

Fatigue Cause No. 11: Heart Disease

11/16

When fatigue strikes during everyday activities, such as cleaning the house or weeding the yard, it can be a sign that your heart is no longer up to the job. If you notice it’s becoming increasingly difficult to finish tasks that were once easy, talk to your doctor about heart disease.

Fix: Lifestyle changes, medication, and therapeutic procedures can get heart disease under control and restore your energy.

Fatigue Cause No. 12: Shift Work Sleep Disorder

12/16

Working nights or rotating shifts can disrupt your internal clock. You may feel tired when you need to be awake. And you may have trouble sleeping during the day.

Fix: Limit your exposure to daylight when you need to rest. Make your room dark, quiet, and cool. Still having sleep issues? Talk with your doctor. Supplements and medications may help.

Fatigue Cause No. 13: Food Allergies

13/16

Some doctors believe hidden food allergies can make you sleepy. If your fatigue intensifies after meals, you could have a mild intolerance to something you’re eating — not enough to cause itching or hives, just enough to make you tired.

Fix: Try eliminating foods one at a time to see if your fatigue improves. You can also ask your doctor about a food allergy test.

Fatigue Cause No. 14: CFS and Fibromyalgia

14/16

If your fatigue lasts more than six months and is so severe that you can’t manage your daily activities, chronic fatigue syndrome or fibromyalgia are a possibility. Both can have various symptoms, but persistent, unexplained exhaustion is a main one.

Fix: While there’s no quick fix for CFS or fibromyalgia, patients often benefit from changing their daily schedule, learning better sleep habits, and starting a gentle exercise program.

Fast Fix for Mild Fatigue

15/16

If you have mild fatigue that isn’t linked to any medical condition, the solution may be exercise. Research suggests healthy but tired adults can get a significant energy boost from a modest workout program. In one study, participants rode a stationary bike for 20 minutes at a mild pace. Doing this just three times a week was enough to fight fatigue.

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https://www.practicalpainmanagement.com/resources/news-and-research/covid-long-haulers-prescribed-opioids-higher-rates?utm_source=ppmmonitor&utm_medium=email&vhid=5e5c5673ee8057797a4a68e9

COVID Long Haulers Prescribed Opioids at Higher Rates

August 23, 2021

With multisystem symptoms and no clear treatment path, post COVID syndrome continues to challenge clinicians. Could the resulting prescribing exacerbate the existing opioid crisis?By Jennifer Lutz

with Lillie Rosenthal, DO

Opioid-related overdoses have drastically risen during the COVID-19 pandemic, in some moments outpacing deaths caused by the virus itself.¹ And while these illnesses ravage communities, another chronic concern looms: a growing number of COVID survivors are being identified as long haulers, and those suffering from this post COVID syndrome are experiencing a constellation of symptoms.²

To further complicate matters, researchers recently found that that COVID long haulers are being prescribed opioids at higher rates than those without a previous COVID-19 diagnosis.³ The unknown outcomes of post COVID syndrome and the increased propensity of providers to prescribe opioids to these individuals could push the opioid crisis to the brink.

COVID long haulers are being prescribed opioids at higher rates than those without a previous COVID-19 diagnosis. (Image: iStock)

Post COVID Syndrome, Pain, and Opioids

The new research, published in Nature, used VHA electronic databases to identify 6-month outcomes after incidence of COVID-19 infection. The study is one of the largest to date and incorporated 379 diagnostic categories, 380 medication categories, and laboratory abnormalities from 62 different lab tests. Concerning medication, the researchers found an increase in the prescription of both opioids and benzodiazepines. Opioids were prescribed to COVID long haulers at an extra 9 times per 1,000 patients. Benzodiazepines were prescribed an extra 22 times per 1,000 patients. It is also well known that co-prescribing of benzodiazepines and opioids can present risks to the patient and that drug monitoring must be part of the treatment plan.

This prescribing-up trend contrasts with nationwide decreases in opioid prescriptions among the general patient population⁴ (as well as decreased benzodiazepine prescribing). “Providers really don’t know what long-haulers syndrome is, what causes it, or how to treat it. Unfortunately, when we don’t know, we generally do the most because we’re at a loss. We tend to think more is better, but often, it isn’t,” says Lillie Rosenthal, DO, a board-certified physical medicine and rehabilitation physicianwho has been treating people with chronic pain and post COVID syndrome.

Treatment options are often best assigned to a specific diagnosis but post COVID syndrome encompasses a broad range of symptoms, including but not limited to: shortness of breath, coughing, brain fog, joint pain, body aches, headache, sleep difficulties, anxiety, depression, chest pain, and gastrointestinal problems.^5,6 Without available resources or directives, clinicians may more readily resort to higher risk treatments, such as opioids and benzodiazepines. “Doctors are trying to be compassionate but potentially doing harm,” says Dr. Rosenthal.

Such compassion could soon lead to a spike in opioid use disorder (OUD). When looking at population size, an April 2021 analysis by the UK Office of National Statistics (ONS) reported that 13.7% of patients who tested positive for the novel coronavirus reported at least one symptom of post-COVID syndrome 12-weeks after initial infection.⁷ An early prevalence analysis in the US, published by researchers at Columbia University Medical Center in New York, reported that among those people who had been hospitalized for COVID-19, between32.6% and 87.4% of themreported at least one symptom persisting after several months.²And while the VHA data review noted above had its limitations (including a mostly male population, despite more women suffering as long haulers), it highlights an important issue. It is hoped that this new information on opioid and benzodiazepine prescribing will alert providers before the problem outpaces the solution.

Treating Chronic Pain in COVID Long Haulers and Limiting Opioid Prescriptions

When it comes to pain, individuals with post COVID symptoms face a particular challenge. Not only can the cause of pain vary based on the individual response to COVID and what systems the virus affected but intensive care is shown to increase pain incidence after infection.⁸ Additionally, comorbidities (which are more common in COVID survivors) can further complicate pain.⁸

Clinicians who are not pain specialists should be aware that the chronification of pain involves neurological, hormonal, and neurochemical changes in both the central and peripheral nervous systems. In other words, the experience of COVID long haulers may not be much different than that of other people living with chronic pain.

“Let’s take the COVID factor out for a moment and treat the pain in a similar way to other chronic pain,” suggests Dr. Rosenthal. “We need to get more granular as to where exactly the pain is coming from.” Long haulers may share a common precipitating (or worsening) factor, but pain management should involve comprehensive treatment in response to the patient profile. “We need to stick with basics and start with a comprehensive nonpharmacological approach,” she notes.

When treating chronic pain in general or due to post COVID infection, it’s important for clinicians to approach the problem systematically.⁹ For instance, consider:

• Where is the pain coming from? Is it headache pain, joint pain, specific muscle pain, back pain, neurogenic pain, or all-over muscle pain, such as in fibromyalgia?
• How does the pain feel? Different pain sensations should be treated differently. Is the pain aching, shooting, burning, squeezing, stiffness, stinging, or throbbing?
• How frequent is the pain? Is the pain persistent or does it come and go? Do certain activities increase or alleviate pain?
• What treatments/medications has the patient tried in the past? Understanding what treatments have and have not helped before, can point providers in the right direction – including where to refer if a specialist is needed.

Opioids can be like “nuclear arms and should be used thoughtfully with a consideration of the side effects,” suggests Dr. Rosenthal. In the case of chronic pain, a biopsychosocial approach continues to show efficacy across a broad patient population.¹⁰ Adds Dr. Rosenthal, “It’s not just a COVID patient in front of you, it’s a person and this is an opportunity to optimize their health. We can be as specific as possible to the type of pain, and still be multifactorial.”

While post COVID syndrome is new and remains without formal diagnostic criteria, chronic pain is not – and the lessons learned on treating pain, when it comes to opioids for instance, are not, says Dr. Rosenthal. When faced with such unchartered waters, focusing on what is known may just separate compassionate care from compassionate harm.View SourcesLast updated on: August 23, 2021