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News — An estimated 50 million adults in the United States suffer from chronic pain, including 20 million with high-impact pain that affects their work or lives most days or every day. Due to the COVID-19 pandemic, many more people are now struggling to manage their chronic pain.

Regents Professor John C. Licciardone is a board-certified physician in Public Health and Preventive Medicine and Director of the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) at the University of North Texas Health Science Center. He discusses recent published in the Journal of Alternative and Complementary Medicine in light of the COVID-19 pandemic.

What are the common treatment options for people with chronic pain?

Clinical practice guidelines from such organizations as the Centers for Disease Control and Prevention (CDC) and the American College of Physicians (ACP) generally recommend starting with non-pharmacological treatments, and then progressing to drug treatment. Patients who have not adequately responded to these treatments may be considered candidates for opioids, if the potential benefit outweighs the risk.

Which treatments for chronic pain may be adversely impacted by the COVID-19 pandemic?

Our research published immediately prior to the COVID-19 pandemic found that non-pharmacological treatments were not being used by patients with chronic low back pain as often as recommended in the CDC and ACP guidelines. Common examples of these underutilized treatments that may be further impacted by the pandemic include massage therapy, spinal manipulation, yoga, and acupuncture. It will be interesting to see if this phenomenon results in greater reliance on drug treatment, including opioids, during the pandemic.

Are there patient subgroups that may be disproportionately affected during the pandemic and shutdowns?

Our research found that older Americans and African-Americans were least likely to use non-pharmacological treatments for chronic low back pain prior to the pandemic. Out-of-pocket costs for these treatments may be a possible explanation for this finding, as they are not universally covered by many health insurance plans, including Medicare and Medicaid.

Access to these non-pharmacological treatments will be further diminished during the pandemic and related shutdowns because treatment providers may not be available, or the treatments may require close personal contact that is not compatible with current social distancing guidelines.

How important are these non-pharmacological treatments in the overall management of chronic pain?

In our study, patients who had used at least one of these non-pharmacological treatments (massage therapy, spinal manipulation, yoga, or acupuncture) reported significantly lower levels of pain intensity and back-related disability than patients who had not used any of these treatments. Thus, they appear to be very important components in the management of chronic pain.

How is PRECISION functioning during the pandemic and shutdowns?

Fortunately, the impact of the pandemic has been minimal. Our registry uses digital technology to conduct all aspects of its research. People with chronic low back pain who live in the 48 contiguous states and the District of Columbia may screen to see if they qualify for the study. More information about the PRECISION Pain Research Registry may be found at .