In a review article published in the journal Pain, Karos et al.1 explore some of the changes brought about by the COVID-19 pandemic that affect patient with chronic pain.

To contain viral spread, societies have enforced social distancing, with limitations on the use of public transportation, public spaces, and work, education, and recreational facilities. Access to vital, but nonurgent, health care services (including pain management services) has been restricted.

These changes have affected people differently. For some, opportunities have been presented. For others, these social changes can represent significant threats to health and wellbeing, disproportionately affecting individuals with long-term painful conditions, threatening needs for autonomy (agency or independence), belonging (social connection), and justice (fairness). Experiencing heightened social threat can maintain and exacerbate chronic pain.

The authors consider such issues as the negative effects of social disconnection and loneliness. Conversely, the pandemic might also bring on increased social proximity as families move in together. Such enforced contact may challenge autonomy and independence. Access to high quality health care and pain management may be decreased both by transportation limitations and by overburdening of the system by patients with COVID-19. There may also be an exacerbation of social injustice and social inequalities.

Strategies for mitigating the social impact of COVID-19 on those living with chronic pain might include learning from the resilience demonstrated by people in pain who have found ways to deal with social threat and the increased use of online technology.

The authors also suggest several time-critical, high-impact research questions for further investigation. For example, they note that to prevent a population-level increase in the severity and impact of chronic pain, it is critical to devote scientific attention to the assessment, mitigation, and prevention of sources of social threat for people with chronic pain.

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