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19 MAR 2020

These are troubling times. The whole world appears to be caught in the anxious web of this viral crisis, and all we can do is follow the trusted sources of advice to ensure we can assist with the public health effort to change the trajectory of the rising toll of cases. 

As hard as the unravelling situation is for almost everyone, it’s undoubtedly harder for the 4% of people with serious and debilitiating conditions that place them at increased risk of being impacted.  People with chronic conditions including those living with chronic pain are more likely to be adversely impacted by a virus such as COVID 19.

We already know that everyday millions of people battle with the physical, mental and emotional toll of chronic pain impacting every facet of their lives including mental health. Much evidence shows that chronic pain does not exist in a vacuum, but has varied co-morbidities and far-reaching consequences.

For a number of people who are living with chronic pain conditions, such as inflammatory arthritis, fibromyalgia etc., a compromised immune system adds to not only the risk of contracting infections but managing them. Where treatment with immunosuppressive medications is necessary, there may be a greater infection risk as immunosuppressive agents inhibit the body’s natural immune response.

Being immunocompromised over the regular cold and flu season is already quite a challenge for many people living with chronic pain, and many consumers have reported feeling particularly concerned by the issues COVID-19 presents.

With the ongoing strict criteria in Australia for testing limited only to people who have been overseas or in direct contact with a confirmed case, we have pulled together some general advice for people looking for information on how best to navigate the unknown.  The one factor that is clear is that limiting stress can also limit the effect of pain on your immune system.

Social Distancing:

Social distancing saves lives by slowing the spread of infection over a longer period of time and includes ways to stop or slow the spread of infectious diseases. It means less contact between you and other people. Social distancing is important because COVID-19 is most likely to spread from person-to-person through:

• direct close contact with a person while they are infectious or in the 24 hours before their symptoms have first appeared
• close contact with a person with a confirmed infection who coughs or sneezes, or
• touching objects or surfaces (such as door handles or tables) contaminated from a cough or sneeze from a person with a confirmed infection, and then touching your mouth or face (Department of Health).

The fundamental rule of social distancing is to maintain six feet (1.5 metres) between you and other people and avoid mass gatherings, according to the Centres for Disease Control and Prevention (US). So, the more space between you and others, the harder it is for the virus to spread.

Work from home if you can and avoid public transportation when possible, don’t shake hands, limit nonessential travel and skip social gatherings. Don’t go to crowded gyms or restaurants. You can (and probably should) go outside, so long as you keep to the 1.5 metre  rule, avoid touching public surfaces and wash your hands after going back inside.

Looking after your health:

Begin your planning by talking with your health practitioners. Some of the questions you may seek to ask are: 

• In the event of widespread contagion and quarantines, will the doctor’s office be open?
• Ask your pharmacist if you can you get medicines delivered if you are not able to leave your home?
• What if your doctor is ill? Will they have someone who can fill in for them?
• How much medicine will you need to ride out a community-wide quarantine?

If you need medication to manage your chronic pain condition or related flare-ups, have your prescriptions for important medicines filled now – ask your pharmacist and GP to assist as there are reports that shortages are occurring in some areas, but please remember to not purchase more than you need.

If you are infected, the virus may affect your ability to breathe. If you are currently on opioid medications to manage your chronic pain condition, it is important to remember that opioids can add to breathing difficulties caused by viral infections, so be prepared to reduce the amount of your medication. Discuss with your doctor how to decrease your dose to remain safe.  

If you currently take anti-inflammatory NSAIDs like ibuprofen to manage your chronic pain condition, please note that despite earlier reports of avoiding medicines like ibuprofen, based on currently available information, the World Health Organisation does not recommend against the use of of ibuprofen. Again, never make any changes to your medication regimen without first discussing them with your doctor.

Monitor your chronic pain conditions closely and stay on the lookout for symptoms that could flag more serious complications like high fever or difficulty breathing. Contact your doctor for more guidance if things don’t get better.

Now is also a good time to consider your vaccination plans for influenza and pneumonia, and others as your doctor advises, to avoid developing other conditions that can be confused with coronavirus (such as flu).

Postpone non-urgent medical appointments or procedures - or consult your healthcare professional by phone or ‘telehealth’ instead, which has now been added as a bulk billed service to the MBS.

It is also important to stay healthy and do the things that will keep your immune system working well: practice good hygiene, eat well, stay hydrated, keep your home well ventilated, get enough sleep and follow exercise regimens as advised by your healthcare professionals

Looking after your mental health

Social distancing comes at a cost to our mental health, as most people living with chronic pain conditions already know all too well. Unfortunately, right now the paradox is that social distancing is required to slow the spread of the virus, but loneliness can make us sick, increasing our sense of isolation.  So it is important to keep calm and carry on. If you live alone, think about low-risk activities you can do to socialise, such as meeting a friend outdoors for a walk.

The Australian Psychological Society (APS) has advice about maintaining positive mental health during the outbreak. Beyond Blue also has some great information, including a forum  on Coping during the coronavirus outbreak.

As the APS notes, exposing yourself to a constant stream of negative information takes a huge psychological toll. Avoid reading social media posts that warn of an apocalypse and don’t get drawn into doomsday discussions. Sticking to the facts and relying on scientific sources for your information is the best way to maintain perspective and manage your emotions.

There are helpful, evidence based sources of information on the outbreak, like the Department of Health website as well as the ABC radio’s Coronacast by Dr Norman Swan.

Some other great resources available online include virtual activities. Virtual activities are being provided to support communities that have become socially isolated, so take advantage of some excellent offerings like New York’s famous Metropolitan Opera which will be streaming free. The Louvre which offers a tour through its Egyptian antiquities department, the recently restored Galerie d'Apollon, and Madrid's Museo Nacional Thyssen-Bornemisza, which has its Rembrandt and Portraiture in Amsterdam, 1590-1670 exhibit on virtual view. The Vatican Museums offer 360-degree tours of the Sistine Chapel, Raphael's Rooms and more, and the Smithsonian also has a self-guided tour of the National Museum of Natural History in New York.  There are some local virtual activities emerging too – do share with us or on our social media sites those you think might be helpful to others living with chronic pain. 

Above all, be kind and considerate to yourselves and everyone else around you. These are challenging times, but also an unprecedented opportunity for us all to work together to advance positive health outcomes for everyone.

Carol Bennett
CEO 

Edit: This article was edited on 20 March to reflect updated advice from the World Health Organisation regarding the use of ibuprofen to manage COVID-19.