Table 1.

Chronic pain patients' features and challenges of pain treatment outside and during COVID-19 pandemic.

Features of patients with chronic pain	Usual therapeutic challenges	Challenges during COVID-19 pandemic
Elderly patient	Pain assessment and treatment Greater risk of side effects with NSAIDs and opioids	Greater risk of infection Caution using opioids or steroids NSAID and non-NSAIDs (paracetamol, dipyrone), can mask fever and myalgias COVID-19 related
Disabled patient	Need of a caregiver to take him to the hospital	Risk of infection for him and his caregiver
Multi-morbidity	Risk of side effects or less pain control	Difficulties with multi-disciplinary team’ evaluation
Multi-treatments	Risk of side effects or less pain control	Drugs prescription and storage
Cognitive disorders	Pain assessment and treatment evaluation	Difficulty in remote treatment
Emotional disorders	Needing of a biopsychosocial model of pain management. Patient compliance and adherence to therapy	Worsening of emotional disorders Worsening compliance to therapy Adding pandemic-related disorders
High dosages and long-term opioids	Risk of endocrine imbalance Risk of immunosuppression Risk of respiratory depression	Drugs prescription and storage Greater risk of infection Greater risk of respiratory depression during lung infection and with fentanyl patch during fever
Intrathecal Drug Delivery System (ITDDS)	Programming pump refill to avoid opioid abstinence syndrome.	Need to pump refill to avoid abstinence or to optimize infusion therapy
Neurostimulation implants	Periodic checks and programming	Need to change exhausted internal battery or surgery for complications or for stage 2 of implant of external leads