“Chronic pain has always been one of the more neglected areas within the health care system. Within the context of the pandemic, we didn’t expect that to improve – rather, the opposite.”
Dr. Gabrielle Pagé is an assistant professor in the Department of Anesthesiology and Pain Medicine at the Université de Montréal. She is also a clinical psychologist working out of the Montreal General Hospital specializing in chronic pain conditions. When COVID-19 struck, Dr. Pagé and her team decided now was the time to move more toward an advocacy role, to inform the public about chronic pain, and to make this a larger part of the overall health care discussion.
They began by launching a Canada-wide survey of people experiencing chronic pain, and found out that over the first few weeks of the pandemic and the lockdown, 2/3 of them reported that their pain was getting worse. This was in April-May, right as the first wave was rising across all provinces. The idea that most people’s chronic pain would get worse at this time was an expected result given the magnified difficulties to access pain treatment, increased stress and social isolation.
What was less expected – and almost shocking for Dr. Pagé and her team – was that a small group, 5-10% of respondents, actually reported that their pain had been lessened during this time.
Stress is a big predictor of the severity of chronic pain. When patients are stressed out, they experience more pain – more pain leads to more stress, which leads to…well, you get the idea. So it was very surprising that such a large number of people reported an improvement. Maybe they were going for walks, taking the time to connect with family members, or were laid off from a job that had been causing the bulk of their stress. Dr. Pagé can’t say what the cause is, or was, but she is determined to find out.
As I’m speaking with Dr. Pagé, her team is wrapping up a follow-up study to the one they conducted in May. Will the outcomes be similar, or will something new present itself? They should know soon enough. Also, as we’re speaking, Montreal is entering Day One of the big winter lockdown. Curfews in place, all non-essential businesses closed, and the multidisciplinary pain clinic in the Montreal General Hospital is deciding how to move forward.
Dr. Pagé’s clients, for the most part, have been receptive to virtual therapy. Even the group therapy programs which were a concern seem to have adapted well.
“The social bond, the connection that they make and just being around other people who get what it’s like to have pain every day, is one of the central elements of group psychotherapy in chronic pain. So we were wondering how that would translate into a virtual format, being able to see people only through a screen. We’re doing a qualitative research study around this. And while it’s very preliminary, so far it appears that the screen is not a barrier for them to create bonds between one another.”
Because of the nature of the work, however, many of Dr. Pagé’s clients either don’t have access to computers, phones, or tablets – or are unable to use them. For this reason, the clinic has moved to a more hybrid form of care. Group sessions and many individual meetings are still conducted online, but for those who are unable, or uncomfortable doing so, the clinic remains open for in-person masked and distanced visits. While it`s great to be able to offer this service, it`s quite a challenge to demonstrate presence and empathy during therapy through a mask and face shield!
This means Dr. Pagé still goes into the hospital, in one of Canada’s COVID hotspots. She gets screened for symptoms at the door goes through the protocols every time and then she goes home to an 8-year-old who is, at the time of this writing, doing virtual schooling, and a 4-year-old boy going to daycare.
It can be a demanding situation. Thankfully, Dr. Pagé does not experience chronic pain herself. But she is doing everything she can to collect data and get the message out. It’s stressful to have pain. And it`s painful to be stressed. There is a vicious cycle there, and one that is under-recognized in the overall health care system. A system that is starting to realize, more than ever before, where all those gaps lie.