1204 — COVID-19 Pandemic and Chronic Pain Experiences among U.S. Military Veterans on Long-Term Opioid Therapy

Lead/Presenter: Elizabeth Goldsmith,  COIN - Minneapolis
All Authors: Goldsmith ES (Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System; University of Minnesota Medical School), Hammett PJ (Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System; University of Minnesota Medical School) Martinson BC (Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System; University of Minnesota Medical School) Noorbaloochi S (Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System; University of Minnesota Medical School) Clothier BA (Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System) Jensen AC (Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System) Krebs EE (Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System; University of Minnesota Medical School)

Objectives:
The COVID-19 pandemic may influence chronic pain outcomes through pandemic effects on systems and communities as well as through COVID-19 illness. We evaluated associations of COVID-19 illness and pandemic disruptions with pain-related functional interference within a cohort of Veterans treated with long-term opioid therapy for chronic pain.

Methods:
The Effects of Prescription Opioid Changes in Veterans (EPOCH) study is a longitudinal national cohort study that enrolled 9053 Veterans prescribed long-term opioid therapy for chronic pain in 2016. Since 2016, participants have completed yearly surveys to assess patient-reported measures over time. The primary outcome measure is pain interference with function, assessed by the Brief Pain Inventory-Interference scale (BPI-I, 0-10 score, higher = worse; clinically important change defined as +/- > = 1 point). Year 4 questionnaires (June 2020 - February 2021) included the NIH-VA-DOD Pain Management Collaboratory COVID-19 Measures, which ask about COVID-19 illness and assess pandemic-related disruptions in access to healthcare, social support, finances, ability to meet basic needs, and mental or emotional health. We compared pandemic indicators by subgroup using chi-square tests and estimated binomial logistic regressions with BPI-I change from year 3 to year 4 (improvement vs. stable/worsening) as the dependent variable and pandemic experience indicators as independent variables, applying survey design weights and inverse probability weighting to adjust for confounding.

Results:
Of 5132 responses, 68% (3503/5132) were returned between June and November 2020, prior to the late 2020 US COVID-19 peak. The mean BPI-I was 6.4 (SD 2.2) at both year 3 and year 4. Six percent (n = 239) of respondents to pandemic questions (N = 4227) reported believing they had been sick with COVID-19 before returning the survey. 60% (n = 2519) reported the pandemic worsened their healthcare access, with higher prevalence under 65 years old (67%) than 65+ (56%) (p < 0.001). 54% (n = 2327) reported the pandemic worsened their mental/emotional health, with higher prevalence of worsening among those under 65 (62%) vs 65+ (51%) (p < 0.001), among Black (59%) vs non-Black veterans (54%) (p = 0.023), and among urban (57%) vs rural (51%) residents (p < 0.001). Self-reported COVID-19 illness was not associated with BPI-I change (OR 1.00, 95% CI 0.61 – 1.66). Self-reported pandemic-related worsening of healthcare access was associated with lower odds of improving BPI-I vs. remaining stable/worsening (OR 0.73, 95% CI 0.55 – 0.96). Self-reported pandemic-related worsening of mental/emotional health was associated with lower odds of improving BPI-I (OR 0.57, 95% CI 0.42 – 0.78). Other pandemic-related psychosocial impacts had less clear associations with BPI-I improvement (worsened social support OR 0.78, 95 CI 0.60 – 1.01; worsened finances OR 0.86, 95% CI 0.65 – 1.14; worsened ability to meet basic needs OR 0.92, 95% CI 0.56 – 1.52).

Implications:
In the first year of the COVID-19 pandemic, reported negative pandemic effects on healthcare access or mental/emotional health were associated with worse pain outcomes, whereas reported COVID-19 illness was not. This suggests that indirect effects of the COVID-19 pandemic may have been more problematic than direct effects of COVID-19 illness among Veterans with chronic pain.

Impacts:
Results underscore the need to ensure health care access and support for mental/emotional health are maintained during health emergencies.