Chronic Non-Cancer Pain (CNCP) in the COVID-19 Context

Technology options: When deciding on the best format to provide remote care, consider audio and video quality, background distractions, and lighting. If possible, maintain contact with patients on a regular basis (e.g. once a week or once a month) and avoid switching to PRN contact only. See Primary Care Operations in the COVID-19 Context > Delivering patient care remotely for more information on providing remote care.

Troubleshoot technical issues: If technical issues occur during a session, use this opportunity to model and practice effective problem-solving skills with the patient. Have a backup option agreed upon with the patient in advance.

Scheduling appointments: Ask patients to schedule appointments at a time and place that is free of distractions, so that they will be able to focus on your discussion. In the case of child or adolescent patients, help to structure the session to allow time with both the child and parent. Whenever multiple people are in the room, ask for introductions of all present.

Complementary resources: Identify remote self-help interventions that the patient may use in combination with remote sessions with their healthcare provider. These may include online self‐management programs, books, online materials, smartphone apps, etc.

Positively reinforce patient’s self-management efforts: One of the best ways to do this is to ask for details about strategy use (e.g. what strategies seem to work, where and when did you use the strategy, and what was the outcome). Ask patients about how they motivated themselves to use that strategy and how things went different when they used it. If patients are using self-help online intervention, ask patients specifically what part of the online program or app they have reached and how they have been using the strategies.

Problem solve: Work with the patient to problem solve around difficulties in managing pain. Use a patient-centered approach that encourages them to identify barriers and implement potential solutions. The current context of COVID-19 brings specific challenges to problem solving, and potential anxiety behaviour should be accounted for.

Experiential learning: If possible, include some experiential learning in the session, i.e. work with the patient on a task that may help them in managing pain. This might take the form of helping them develop a daily schedule for their pain management efforts (i.e. taking medication, doing physical exercises, and engaging in physical activities that are meaningful to them). Or it might involve guiding the patient through a brief imagery, meditation, or relaxation exercise. Try to enhance patient mastery of the task by asking the patient what about the task or exercise was easier for them (and why) and what challenges they experienced and how they might address them.

Setting goals: At the end of the session, work with the patient to identify specific goals that are meaningful to them and doable that they should complete before your next session. Let them know you will start the next session by going over the goals with them.

Self-help activities: Integrate self-help activities into the overall treatment goals. At the end of the session, assign patients a specific self-help task to complete before their next session (e.g. download app, work through the first exercise).

Remember the context: Always be flexible: this is a stressful time for everyone, but particularly for those with long-term conditions. Each patient will be dealing with extra pressures (e.g. financial, childcare, and health of others) that may influence their pain and ability to cope.