COVID-19 Pandemic Shown to Increase Anxiety, But Not the Intensity of Chronic Pain
The authors sought to investigate the consequences of the coronavirus disease-2019 (COVID-19) pandemic on pain and well-being for individuals with chronic pain, and the impact on the health of young adults with chronic pain.
A longitudinal study compared pain, psychological functioning, and substance use before and during the pandemic. The study included 196 young adults, ages 18 to 24 years (79.6% females) with chronic pain.
Participants reported on pain, anxiety, depression, and substance use before the pandemic (October 2018 to August 2019) and during the pandemic (October 2020 to November 2020). Participants also reported on their assessment of COVID-19 exposure and its impact.
Pre-pandemic, young adults experienced mild-to-moderate pain intensity [mean = 3.75, standard deviation (SD) = 2.33] and pain interference (mean = 3.44, SD = 2.69). Pain intensity, pain interference, and depression symptoms remained stable during the pandemic. However, anxiety symptoms increased significantly (mean = 8.21, SD = 5.84 vs mean = 8.89, SD = 5.95, P = 0.04).
Tobacco, alcohol, and cannabis use were also unchanged. Mixed linear models revealed that COVID-19 exposure and impact were not associated with changes in pain intensity or interference, with female sex associated with increased pain intensity ([beta] = 0.86, P = 0.02) and pain interference ([beta] = 0.87, P = 0.02).
The researchers added that the increase in anxiety highlights the need to facilitate treatment access for mental health services to mitigate downstream impact. (See Tham SW, Murray CB, Law, Slack F, et al. The impact of the COVID-19 pandemic on pain and psychological functioning in young adults with chronic pain. Pain. 2022;163(10):e1095-e1101. doi:10.1097/j.pain.0000000000002618.)
Cannabidiol Does Not Reduce Opioid-Induced Hyperalgesia
Opioids in general-and remifentanil in particular-can induce hyperalgesia. The authors of a recent study investigated whether cannabidiol might have the capacity to reduce opioid-induced hyperalgesia (OIH).
The authors looked at the effect of oral cannabidiol on OIH in 24 healthy volunteers in a randomized, double-blinded, crossover study.
Participants received either placebo or a 1600-mg single-dose oral cannabidiol. Hyperalgesia, allodynia, and pain were induced by intracutaneous electrical stimulation. To provoke OIH, participants received an infusion of 0.1 [mu]g/kg/min remifentanil over a time frame of 30 minutes, starting 100 minutes after oral cannabidiol ingestion.
Results included measurement of the area of hyperalgesia (in square centimeters) up to 60 minutes after remifentanil administration. The area of allodynia (in square centimeters) and pain (numeric rating scale) were also assessed.
The study showed that when compared to placebo, cannabidiol had no significant effect on hyperalgesia, allodynia, or pain at any time point of measurement. The area of hyperalgesia after remifentanil administration significantly increased compared with baseline [17.0 cm2 (8.1-28.7) vs 25.3 cm2 (15.1-39.6); P = 0.013].
Mean cannabidiol blood levels were 4.1 [alpha] 3.0 [mu]g/L (mean [alpha] SD) at 130 minutes after ingestion and were 8.2 [mu]g/L [alpha] 6.9 [mu]g/L (mean [alpha] SD) at 200 minutes. Cannabidiol was well tolerated. The authors concluded that a high single-oral dose of 1600-mg cannabidiol is not effective in reducing OIH. (See Dieterle M, Zurbriggen L, Mauermann E, et al. Pain response to cannabidiol in opioid-induced hyperalgesia, acute nociceptive pain, and allodynia using a model mimicking acute pain in healthy adults in a randomized trial (CANAB II). Pain. 2022;163(10):1919-1928. doi:10.1097/j.pain.0000000000002591.)