Steroids, Opioids, and COVID-19
Are You Taking Steroids or Opioids for Chronic Pain? You Could Be Vulnerable to COVID-19
The COVID-19 pandemic is a global health crisis. It’s the greatest challenge humankind has faced in recent times. Countries around the world are racing to slow the spread of the SARS-CoV-2 virus by testing, treating, tracing contacts, and quarantining citizens. The new catchphrases that define 2020 are “social distancing” and “flatten the curve.” Where do people who take steroids or opioids for chronic pain fit into this picture?
In this article, we discuss why patients receiving pain treatment with steroids and opioids may be more susceptible to COVID-19. We also talk about the recommended evidence-based treatment for chronic pain and how it can be delivered safely via a biometric telehealth platform during the pandemic.
Chronic Pain and Immunity
Many patients with work-related injuries suffer from chronic pain. Chronic pain patients have a higher risk of contracting aggressive infections like the SARS-CoV-2 virus. And if they get infected, they are at risk of becoming severely ill from the virus. There are several reasons for this. A significant number of patients with chronic pain are elderly. Many have other underlying health conditions. These are risk factors for COVID-19. Also, some patients are receiving pain treatment with long-term steroid or opioid therapy, which can lead to immunosuppression. In general, these patients are considered to have compromised immunity. Due to their weak immune system, they have a reduced ability to fight infections like COVID-19 and recover from them.
Opioids and COVID-19
Opioids are often prescribed to treat chronic pain from conditions such as fibromyalgia, CRPS, and RSD, among others. However, the long-term use of these medications for the treatment of non-cancer pain is controversial due to concerns about effectiveness, safety, and the potential for abuse.
This group of medications can have several side effects, such as nausea, respiratory depression, confusion, and opioid-induced hyperalgesia. 1
- Opioids have the potential to suppress the immune system. This increases the risk of getting infections like the SARS-CoV-2 virus. 1
- Long-term pain treatment with opioids can lead to a reduction in respiratory reserves. 2
- Opioid-induced respiratory depression can increase the risk of mortality in infected patients. 2
- Some opioids are administered via the transdermal route, such as buprenorphine and fentanyl. There may be increased absorption of these drugs when the patient’s body temperature is elevated during a viral illness. This can potentially lead to an overdose. 2
People who manage their chronic pain with opioid therapy need to be especially careful during the COVID-19 pandemic. It is not advisable to suddenly stop opioid treatment. However, now more than ever, patients receiving pain treatment should explore evidence-based modalities that can be delivered effectively in-clinic and through biometric telehealth rehab programs. These programs can effectively treat many coexisting conditions, such as chronic pain and sleep problems, weight gain, depression, and opioid dependence. Telehealth reduces the need for hospital and emergency room visits for pain treatment. Keeping vulnerable patients safe at home is critical in controlling a pandemic like COVID-19.
Steroids and COVID-19
Employees with a workers’ compensation claim often require pain treatment. People affected by COVID-19 may need more intense pain management for several reasons. COVID-19 is a viral disease that affects the respiratory system. The excessive coughing and muscle aches and pains associated with the infection can aggravate underlying or longstanding pain. Also, chronic pain patients may be unable to attend physical therapy sessions during the pandemic to manage their pain, leading to an increased reliance on medications.
The use of certain medications that are used to treat chronic pain, such as corticosteroids, can alter the immune response and increase the risk of COVID-19. Steroids are often used as adjuvant therapy for chronic pain, sometimes in combination with opioids. 3 People who have recently received an intervention with steroid medication may be at higher risk of a viral respiratory infection. Studies have shown that corticosteroid joint injections are associated with an increased risk of influenza. 4 Oral steroid medications may reduce the effectiveness of the flu vaccine. 4
The biopsychosocial model of pain management avoids the risks associated with steroid medications. This is a multi-dimensional systems approach to understanding and treating pain which has been proven useful in chronic pain conditions. 5 At the Institutes of Health, we practice this approach both on-site in our clinic as well as through an immersive biometric telehealth program.
Telehealth for Pain Treatment
During the COVID-19 pandemic, patients with chronic pain can benefit significantly from telehealth consultations and pain treatment on a biometric-enabled platform. Such a platform is much more than a simple video consultation. It allows healthcare providers to complete a comprehensive evaluation of the patient. This includes remote physical examination of the patient’s heart, lungs, abdomen, ears, throat and skin, enabling continued treatment without the need to visit a clinic or hospital. Visits to already overburdened healthcare environments during a pandemic increase the risk of exposure to the virus. This risk is particularly avoidable in patients who have compromised immunity, such as those with chronic pain and opioid dependence.
Effective Treatment for Chronic Pain Syndrome
Chronic pain is not merely a physical phenomenon. It is influenced by genetic, developmental and behavioral factors. The psychosocial contexts of a patient’s pain, for example, their cultural beliefs, play a substantial role in pain behavior. Also, the contribution of psychological factors, such as a mood disorder, can have a significant impact on pain. That’s why two patients with nearly identical degenerative disk disease can report a very different severity of pain.
At the Institutes of Health, we believe it is important to recognize the patient’s cognitive and emotional responses to pain. It is also critical to encourage self-management in addition to medical management. The biopsychosocial pain model includes a multi- dimensional approach to understanding and treating pain. Now more than ever, when appropriate, it is critical to get chronic pain patients off treatments like opioids and steroids that can cause immune suppression and increase the risk of COVID-19. 6
The evidence-based and interdisciplinary biopsychosocial pain model is considered best practice in reversing a chronic pain syndrome. It is regarded by most states as the treatment of choice and is positioned, as such, in the evidence-based compendiums of the American College of Occupational and Environmental Medicine (ACOEM), the Official Disability Guidelines (ODG), and MTUS. During the COVID-19 pandemic, biopsychosocial treatment can be given most effectively through an Immersive Biometric Telehealth platform.
The Institutes of Health is a leader in specialty occupational medicine and evidence- based biopsychosocial rehabilitation programs for chronic pain, PTSD, brain injuries and sleep problems. We offer a full range of services on-site in our clinic and through our Biometric Telehealth Platform.
Access to Pain Treatment
Between work commitments and family life, most health workers have a busy lifestyle with little time to spare. Besides lack of time, barriers such as cost of treatment, transportation problems, and inability to access evidence-based treatments can prevent health providers from getting treatment for chronic pain.
Biometric telehealth is an option providing an innovative health platform that makes pain treatment accessible to healthcare workers in the comfort of their homes.
Biometric Telehealth: Effective and Accessible Pain Treatment
Telehealth has many well-known benefits. It provides access to specialist services and saves both time and cost (there is no need to travel to the doctor’s office). There is improved continuity of care and the treatment is confidential and private.
Biometric telehealth takes remote care to the next level. It is much more than a simple video consultation. It is an immersive telehealth system that recreates the patient- healthcare team interaction available at the clinic. It allows evidence-based biopsychosocial pain treatment to be delivered to healthcare workers at home or in the workplace. For example, the platform includes a remote physical exam solution that allows the doctor to examine the patient’s heart, lungs, abdomen, ears, throat, and skin.
Other treatment modalities for chronic pain that can be delivered through the Biometric Telehealth Platform include:
- Behavioral Pain Medicine
- Sleep Medicine
- Anti-inflammatory Nutrition
- Medication Management
- EEG-based Neurofeedback
- Fitness Rehabilitation and Functional Restoration
- Physical therapy, Occupational Therapy and Vocational therapy
- Clinical and Neurological Psychology
At the Institutes of Health, we are innovators and leaders in Immersive Biometric Telehealth. We provide a full range of telehealth services for chronic pain rehabilitation and functional restoration, medication management, PTSD, brain injuries, sleep problems, and neuropsychological evaluations. Contact us today to find out more about how our clinic and biometric telehealth programs can help healthcare workers obtain effective pain treatment.
5. MTUS 2016 Chronic Pain Guidelines