Adverse effects of COVID-19-related lockdown on pain, physical activity and psychological well-being in people with chronic pain

  1. Nicholas Fallon
  2. Christopher Brown
  3. Hannah Twiddy
  4. Eleanor Brian
  5. Bernhard Frank
  6. Turo Nurmikko
  7. Andrej Stancak

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Abstract

Countries across the world imposed lockdown restrictions during the COVID-19 pandemic. It has been proposed that lockdown conditions, including social and physical distancing measures, may disproportionately impact those living with chronic pain and require rapid adaptation to treatment and care strategies. Using an online methodology, we investigated how lockdown restrictions in the United Kingdom impacted individuals with chronic pain (N = 431) relative to a healthy control group (N = 88). Data were collected during the most stringent period of lockdown in the United Kingdom (mid-April to early-May 2020). In accordance with the fear-avoidance model, we hypothesised lockdown-related increases in pain and psychological distress, which would be mediated by levels of pain catastrophising. Responses indicated that people with chronic pain perceived increased pain severity, compared to their estimation of typical pain levels prior to lockdown (p < .001). They were also more adversely affected by lockdown conditions compared to pain-free individuals, demonstrating greater self-perceived increases in anxiety and depressed mood, increased loneliness and reduced levels of physical exercise (p ⩽ .001). Hierarchical regression analysis revealed that pain catastrophising was an important factor relating to the extent of self-perceived increases in pain severity during lockdown (β = .27, p < .001) and also mediated the relationship between decreased mood and pain. Perceived decreases in levels of physical exercise also related to perceptions of increased pain (β = .15, p < .001). Interestingly, levels of pain intensity (measured at two time points at pre and during lockdown) in a subgroup (N = 85) did not demonstrate a significant change. However, individuals in this subgroup still reported self-perceived pain increases during lockdown, which were also predicted by baseline levels of pain catastrophising. Overall, the findings indicate that people with chronic pain suffer adverse effects of lockdown including self-perceived increases in their pain. Remote pain management provision to target reduction of pain catastrophising and increase health behaviours including physical activity could be beneficial for this vulnerable population.

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  1. Version published to 10.1177/2049463720973703
  2. ScreenIT

    SciScore for 10.1101/2020.06.04.20122564: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Firstly, participants read an information sheet and gave informed consent using a tick box procedure.
    IRB: Ethics and data sharing: The study was conducted in line with the recommendations of the Declaration of Helsinki and was approved by the local University of Liverpool Research Ethics Committee.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableThis total comprised 470 females, 45 males, and 4 participants who selected ‘other’.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The present research has some limitations. Firstly the chronic pain group were more adversely affected on all included measures of interest, although we could not practically include every clinically relevant measure available. For example, pain acceptance and perceived self-efficacy could be important factors not captured here. The relevant tools to capture these contributors typically include items that discuss lifestyle capability in the context of pain (e.g., ‘I lead a full life even though I have chronic pain’) in the Chronic Pain Acceptance Questionnaire [32]. There was a high risk that the validity of such items would be negatively impacted by the confounding effect of lockdown restrictions on lifestyle. The decision to focus on pain catastrophizing in the present study also reflects the fact that negative thought patterns have been shown to be more closely related to outcomes of perceived pain severity than positive factors such as pain acceptance [44]. Finally, as a cross sectional design, it is not possible to infer the causal nature of relationships between the many biopsychosocial factors which could be impacted during the current pandemic. In light of this, it is worth highlighting that this study reports on the first phase of data in a longitudinal design. Current respondents will continue to report on these measures regularly across coming months. Longitudinal data will permit more complex analyses to consider causality of the relationship between pain severity...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.06.04.20122564v1 on medRxiv