COVID-19 and chronic pain: FAQs

Written by: Dr Shankar Ramaswamy
Published: | Updated: 22/06/2020
Edited by: Robert Smith

When you suffer from chronic pain, the idea of experiencing flu-like symptoms from coronavirus could cause some anxiety. Many fibromyalgia patients have also been wondering how their usual treatment may be impacted.

Fibromyalgia and COVID-19


We recently spoke to Dr Shankar Ramaswamy, a leading pain management specialist based in London and Kent. He let us know the answers to some of your FAQs about living with chronic pain during the COVID-19 pandemic.

What can you advise someone who lives in chronic pain and who is displaying symptoms of coronavirus?

In terms of how they should manage coronavirus, in theory it shouldn’t be any different with patients who do not suffer from chronic pain.

Government advice is to self-isolate if you have symptoms of COVID-19, in England you’re advised to call the 111-coronavirus service. Those suffering from pain should avoid going to the GP or a hospital unless they feel quite unwell. Of course, they shouldn’t avoid going to hospital if it’s needed, especially if they have breathing symptoms, but not for some trivial symptoms.

Can coronavirus worsen pre-existing chronic pain symptoms?

Patients with chronic pain, on top of continuing to suffer from their usual symptoms, are also more likely to experience discomfort due to the flu-like symptoms. The focus is to manage the symptoms as opposed to just increasing the painkillers, which can in fact only mask the symptoms.

There are groups of people who are vulnerable or at high risk due to their underlying medical problems. But, in a reassuring way, chronic pain alone doesn’t put individuals at greater risk of contracting the virus unless they are on medications that would suppress their immunity levels or have other co-morbidities such as diabetes.

It is possible that patients with chronic pain have heightened symptoms. I would advise to focus on educating the patients about their condition and its symptoms and encourage them to seek advice to self-manage their condition, as well as using treatment options for prevention.

As mentioned, COVD-19 can cause muscle pain, fever, dry cough and other flu like symptoms. If you have chronic pain, it can feel heightened. Every time you cough you can have an increased amount of pain whilst you have COVID-19 symptoms.

For people living with chronic pain conditions, such as fibromyalgia, how might the crisis affect their pain management plan?

As mentioned, the widespread muscular pain and flu like symptoms that you can get from coronavirus can exacerbate fibromyalgia symptoms. Patients with fibromyalgia should be able to differentiate its symptoms with COVID-19’s, in the same way they can differentiate the flu from fibromyalgia. There is a possibility the widespread pain will get worse if someone with fibromyalgia contracts coronavirus.

There’s a lot of restriction in access for doctors in the hospital, especially in the case of non-urgent and non-cancerous conditions during the pandemic phase. Although there’s a lot of suffering from chronic pain, the timeline for the management of patients with chronic pain is not the same as cancer or other life threatening conditions. Of course this does not mean the symptoms of fibromyalgia or similar conditions are being trivialised.

In this unprecedented time, we need to have a more global perspective. The majority of pain consultants are also practicing anaesthetists, and many have been redeployed and are managing coronavirus patients in intensive care or are now working as emergency anesthetists.

Fibromyalgia patients will have restricted access to face to face consultants and they may feel left out without support. However, e-Consultations, telephone and video calls, throughout the pandemic have been extremely useful. I work in a team that includes physiotherapists. Where possible, we have used video calls to treat patients.

You can still get the same high-quality service via a video call. The majority of patients’ history can be obtained by questioning them and we get lot of information from looking at their posture, mobility, which we can gauge from the video call. We also ask patients to do specific maneuvers/exercises, under our instructions via video consultation, as part of the treatment process.

I think the shift to video conferencing tools is a reality check for many of us as we have always presumed that we have to do things face to face. We have now found out that we can actually achieve a lot of things without face-to-face contact.

Through e-Consultation we can advise and prescribe, and I have been sending prescriptions by post and to GPs. There are also some very good psychology/ mindfullness apps such as Headspace that may help manage the condition through the lockdown period.

How are you still treating your patients?

Whilst treating them via video consultations, what people have realised is that the lockdown and pandemic has given them more time for reflection and encouraged many to change practice. With video consultations, it gives me time to think “out of the box” to help patients.

We are fortunate that video consultations are also supported by all insurance companies. I’m still operating/ injecting at some of the selected private hospitals as usual but we have implemented safety protocols to screen patients who are having interventions.

How can patients who have symptoms of coronavirus get their pain medication refills?

I have been continuing to see patients via video calls, telephone and have advised GPs about medications so patients can contact their GP to renew medication as per my advice.

I’ve also been sending prescriptions by post in some circumstances. Often, I have left prescriptions with the hospital pharmacist, especially for controlled drug refills as it’s a secure way of dispensing these drugs.

Sometimes if the pain increases, we may have to increase the patients’ medication dosages and it is important that they are monitored closely. In those cases I have been calling them at shorter intervals to ensure their safety.

If you suffer from chronic pain and would like some assistance from a leading pain management specialist, feel free to visit Dr Shankar Ramaswamy’s profile for more information. You can book an e-Consultation so that you can be seen in the comfort of your own home.

Dr Shankar Ramaswamy

By Dr Shankar Ramaswamy
Pain medicine

An important note with regard to the COVID-19 pandemic: We are offering video consultations to all patients at flexible times and at short notice. This is authorised by all insurance providers. Our team also offers physiotherapy via video consultation and we are able to offer interventions quickly for 'low risk' patients at safe premises in London. We will risk-assess all patients prior to this.

Dr Shankar Ramaswamy is a leading consultant in anaesthesia, pain management and neuromodulation based in Central London, Southeast London and Kent. Among the wide range of conditions that he manages are neck and back pain, headache and facial pain, cancer pain, neuropathic pain, musculoskeletal pain including fibromyalgia and joint pain, abdominal and pelvic pain, sports injury and trauma and accident-related pain including whiplash injury.

He is the clinical lead for the busy inpatient pain service at the Royal London Hospital and also the lead for pain management for the Newham MSK Collaboration. He is also the lead for education in pain management for Barts Health and QMUL and a course director and honorary senior lecturer for MSc Pain Management, University of Edinburgh.

His first qualifications and training in the field of anaesthesia were earned in India, including at one of the most prestigious medical and research institutions in India, the PGIMER. Once in the UK, he continued his anaesthetic training and then underwent the Advanced Pain Fellowship at the renowned Imperial Healthcare, London.

Over the duration of his career, he has garnered extensive experience that he uses to provide care of the highest quality to his patients. He commits to providing comprehensive pain management plans that are centred on each patient's individual needs. He uses a variety of techniques including self-management advice, pharmacotherapy, and cutting-edge (X-ray-guided and ultrasound-guided) interventions such as epidural, facet joint injections, peripheral joint injections (e.g. hips, knees, shoulder), radiofrequency, laser disc therapy, regenerative medicine (PRP) and neuromodulation. He is part of a large multi-disciplinary team to facilitate and individualise pain management approach.

Dr Ramaswamy has also received training in medico-legal report writing and is familiar with civil procedure protocols including CPR part 35 and PD 35 protocol. He can provide detailed insights into causality, prognosis, assessing capacity to work understanding specific roles, assess the ability to function and also comment on the prospect of achieving pain relief. He also offers medicolegal appointments at short notice and can produce a report with a quick turn around time. He sees patients for personal injury claims and criminal negligence claims.

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