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media and internet communication can be used for broad updates or for issues that do not fall under HIPAA regulations, suggests Gabriel Sella, MD, who holds a master’s of public health and works in preventive medicine at the Ohio Valley Medical Center.

Telemedicine also offers a means for providers to connect with and consult patients when office visits are limited and to reduce the risk of exposure, notes Anita Gupta, PharmD, DO.

Adds David Cosio, PhD, a pain psychologist at the Jesse Brown VA Medical Center, “Many providers are moving toward using telehealth, however, caution should be given regarding the laws surrounding using telehealth across state lines,” he says. “It is not wise for a provider to offer telehealth if they have no experience in doing so as this practice is different from face-to-face communication.”

Jeffrey Fudin, PharmD, and Carrie Chitsey shares how they are using virtual healthcare consulting to help pain patients and providers during this time.

Patients on opioid therapy, with rheumatologic diseases, or orofacial/neck/back pain may need to take extra precautions. (Image: iStock)

Unique Considerations Regarding Pain Conditions and Coronavirus

If a patient has a chronic pain condition tied to back, neck or orofacial pain, excessive coughing caused by the coronavirus may worsen their pain, says Dr. Fudin. In these cases, it is best to work with them (and perhaps their primary care provider) on reducing the cough. For patients who often experience joint or muscle pain, remember that the virus (just like influenza) may come with its own set of aches and pains as well. At the same time, noted Dr. Fudin, assuming there are no serious complications, patients will need to understand that they have to let the virus run its course.

For those patients on prescribed opioid therapy and who take their opioids via a transdermal patch (eg, buprenorphine or fentanyl), it is important to note that increased absorption may occur with a fever. Says Dr. Fudin, “This, coupled with a respiratory illness could potentially elevate the risk of opioid-induced respiratory depression and be a very good reason to consider prescribing emergency naloxone for the patient.”

For those undergoing cancer treatment or who are immuno-suppressed due to rheumatological diseases such as Lupus or rheumatoid arthritis, patients may need to seek extra guidance from infectious disease specialists. They should be advised to take precautions regarding social distancing/avoiding crowds and maintaining personal hygiene seriously. “Most patients with conditions impacting the immune system know this already,” says Dr. Fudin, but simple reminders may help.

Helping Patients with Increased Anxiety

Remind your patients that you are available for them even during these stressful times, and that you are able to refer them to a mental health provider if needed, and if not already part of their care team. Make telephone lines and office portal communications easily accessible.

If they are concerned about pain medication specifically, talk to them about options for early but limited refills, pharmacy deliveries, e-scripts, and more. At the same time, remind them that non-essential treatments may be delayed but will be rescheduled for a later time.

“Anxiety over the virus should not be relieved with anti-anxiety drugs,” advises Dr. Sella. Instead, propose that patients exercise daily and practice meditation and/or relaxation activities.

“Regarding renewals of medications, the present laws apply and one should not deviate from DEA regulations unless those regulations change for the duration of the pandemic,” he adds.

Keeping Practice Offices and Clinics Sanitized

  • Clean common spaces daily, including door handles, light switches, and keyboards with chlorine products; if possible, use ultraviolet lights.
  • Have hand sanitizer readily available
  • Consider having non-essential staff work remotely.
  • Limit the amount of touching and practice waving as opposed to handshakes.