Cross-sectional study of psychosocial and pain-related variables among patients with chronic pain during a time of social distancing imposed by the coronavirus disease 2019 pandemic

Abstract

The COVID-19 pandemic has had a tremendous impact, including on individuals with chronic pain. The social distancing policies necessary to slow the spread of SARS-CoV-2 have involved increased levels of social isolation. This cross-sectional survey study examined pain severity and interference among individuals with chronic pain during an early phase of social distancing mandates and identified characteristics of individuals who were most impacted. Approximately 4 to 8 weeks after social distancing mandates commenced in the state of Massachusetts, 150 patients with fibromyalgia, chronic spine, and postsurgical pain completed demographic, pain, social distancing, and validated psychosocial questionnaires. Patients self-reported an overall significant increase in pain severity and pain interference, compared with before social distancing, although both pain severity and interference were quite variable among individuals under conditions of social distancing. Several demographic, socioeconomic, and psychosocial factors were associated with greater pain severity and interference during social distancing. Multivariable linear regression demonstrated that female sex, nonwhite race, lower education, disability, fibromyalgia, and higher pain catastrophizing were independently associated with greater pain severity, while female sex and pain catastrophizing were independently associated greater pain interference. The findings suggest that individual differences among patients with chronic pain should be considered in the planning, development, and prioritization of interventions to improve pain care and to prevent worsening of symptoms during the continuing COVID-19 pandemic.

Figure 1.

Study timeline in relation to COVID-19 pandemic in Massachusetts. All study surveys were completed between April 28 and May 22. The timeline includes key dates relevant to social distancing mandates in Massachusetts around the time of survey administration.

Figure 2.

Study flow chart.

Figure 3.

Effects of social distancing on isolation and social contact methods. (A) compares participants' recalled perceived social and physical isolation before social distancing to perceived isolation at the time of survey completion under conditions of social distancing. (B) depicts reported changes in how often participants use various social contact methods since they started distancing, compared with how often they recall using the method before social distancing.

Figure 4.

Participants' average pain severity and pain interference under social distancing conditions. (A) shows the distribution of current pain severity scores amongst participants during social distancing. (B) shows the distribution of current pain interference scores amongst participants during social distancing. (C) reports proportion of patients with changes in perceived pain severity since starting social distancing compared with their recalled pain. (D) reports proportion of patients with change in perceived pain interference since starting social distancing.

Figure 5.

Effects of social distancing on utilization of pain management strategies, access to treatments, and quality of life. (A) shows what physical and behavioral pain management resources patients recalled using before social distancing and whether utilization of the resource has been affected since social distancing. (B) shows what self-management techniques for pain participants recalled engaging in before social distancing and how usage of each technique has been affected by social distancing. (C) depicts the extent participants attribute social distancing changes to factors contributing to changes in reported pain.