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Papers of the Week

Papers: 25 Nov 2023 - 1 Dec 2023

2023 Nov 27

J Pain


Effects of lockdown restrictions and impact of anxiety and depression symptoms in people with chronic pain during the Covid-19 pandemic: A 13-wave longitudinal study.


Krahé C, Brown C, Twiddy H, Frank B, Brian E, Nurmikko T, Stancak A, Fallon N


In early 2020, countries across the world imposed lockdown restrictions to curb the spread of the Covid-19 coronavirus. Lockdown conditions, including social and physical distancing measures and recommended self-isolation for clinically vulnerable groups, were proposed to disproportionately affect those living with chronic pain, who already report reduced access to social support and increased isolation. Yet, empirical evidence from longitudinal studies tracking effects of prolonged and fluctuating lockdown conditions, and potential psychological factors mediating effects of such restrictions on outcomes in chronic pain populations is lacking. Accordingly, in the present 13-wave longitudinal study, we surveyed pain intensity, pain interference, and tiredness in people with chronic pain over the course of 11 months of the Covid-19 pandemic (April 2020 – March 2021). Of N = 431 participants at baseline, average completion rate was ~50% of timepoints, and all available datapoints were included in linear mixed models. We examined the impact of varying levels of lockdown restrictions on these outcomes, and investigated whether psychological distress levels mediated effects. We found that full national lockdown was related to greater pain intensity, and these effects were partially mediated by depressive symptoms. No effects of lockdown level were found for pain interference and tiredness, which were instead predicted by higher levels of depression, anxiety, pain catastrophising, and reduced exercise. Our findings are relevant for improving patient care in current and future crises. Offering remote management options for low mood could be particularly beneficial for this vulnerable population in the event of future implementation of lockdown restrictions. PERSPECTIVE: This longitudinal study demonstrates the impact of Covid-19 lockdown restrictions on people with chronic pain. Findings suggest a complex interaction of psychosocial factors which impacted various aspects of pain experience in patients, which offer potential to inform clinical strategies for remote medicine and future crises.