Interventional pain management during SARS-CoV-2 pandemic

Abstract

Background: SARS-CoV-2 virus resulted in a sudden dreadful outbreak, posing a serious global public health problem consuming most of the healthcare resources. Requirement to allocate the existing resources for SARS-CoV-2 management during the pandemic has led to significant challenges in pain management as well as in other healthcare services. Objectives: This study aimed to report the outcomes of an interventional pain management unit of a COVID-free hospital, where a fraction of medical services is being provided through telemedicine, and where patients and healthcare workers are screened periodically, in addition to the implementation of guideline-recommended key precautions. Study design: Retrospective chart review. Setting: Pain clinic of a private COVID-free hospital. Methods: A total of 83 patients asymptomatic for SARS-CoV-2 and scheduled for interventional pain management (epidural injection, epidural neuroplasty, peripheral nerve and sympathetic ganglion block, and radiofrequency interventions for non-malignant pain; celiac-splanchnic impar ganglion neurolysis and epidural-spinal port catheter implantation for malignant pain) were screened using reverse transcriptase polymerase chain reaction (RT PCR), Immunoglobulin G and Immunoglobulin M antibodies, and computerized tomography (CT) imaging prior to the intervention and were then followed-up for a minimum duration of 30 days. All healthcare workers of the hospital as well as the staff in the pain management center were monitored with RT-PCR tests performed every 5 days. The efficacy of pain management interventions was assessed using a 10-point visual analogue scale (VAS), while a 5-point post-intervention questionnaire was used to measure the patient satisfaction regarding telemedicine practices, where 5 indicates maximum satisfaction. Results: Patients were finally diagnosed as follows: 2 (2.4%) patients, PCR-confirmed SARS-CoV-2 infection; 3 (3.6%) patients, previous SARS-CoV-2 infection; 13 (15.7%) patients, suspected SARS-CoV-2 infection; and 65 (78.3%) patients, no SARS-CoV-2 infection. Three out of the 517 healthcare workers (0.6%) had PCR positivity in routine screening performed throughout the study, and all these three subjects were asymptomatic. Following interventional treatment, VAS scores were significantly reduced at 2 weeks when compared to baseline (3.9 ± 1.3 vs. 8.6 ± 1.0, P < 0.001), and this reduction was maintained until month 1. Mean satisfaction scores for the communication with the physician using telemedicine methods and for the follow-up management using telemedicine methods were 3.0 ± 0.9 and 3.7 ± 0.6, respectively. None of the patients had steroid-related side effects and none developed new-onset SARS-Cov-2 confirmed or suspected infection throughout the study. Limitations: Retrospective design and relatively small sample size. Conclusion: Our findings suggest that effective diagnostic tests/imaging studies aimed at detecting infected patients and healthcare workers, and telemedicine practices contribute to the provision of safe and feasible pain management practices during the SARS-CoV-2 pandemic.