Spanish Pain Society (SPS). Healthcare recommendations for pain units in the face of progressive normalization of activity during the COVID-19 pandemic

Abstract

Introduction: SARS-CoV-2 infection is a new viral infection that has emerged in the form of a pandemic, with a respiratory and multisystemic clinical spectrum, which causes high morbidity and mortality. Its rapid expansion is dependent on the absence of previous exposure and immunity, the absence of a vaccine and specific treatments, as well as its mechanism of air transmission and contact with mucous membranes, including asymptomatic individuals. The need for protection on the population and its health professionals requires the establishment of exposure and prevention protocols. One of the new situations generated is the need for a safe return to normal healthcare activities, which in many cases are specific to each specialty. Objective: To elaborate a document of clinical and management recommendations to guide managers and staff of pain units on how to face the staggered return to normal care with the best available evidence. The document takes into account the safety of patients and professionals in the context of the SARS-CoV-2 pandemic, although we recognize that the changing environment may change the recommendations in the near future. Methodology: After a narrative review of the literature on PubMed , Google Scholar, and recommendations of competent authorities and scientific societies, The Spanish Pain Society published a first document (V1.0) on April 21st 2020 into its WEB (www.sedolor.es), which was shared with the members of the society as well as the presidents of the Spanish autonomous pain societies, leaving open the possibility for improvement through an email posicionamiento.covid.sed@sedolor.es, where suggestions have been received up to Version 2.1 published on May 13th, 2020. Some partners have also addressed the board of directors directly and their contributions have also been evaluated and incorporated when possible. This document is based on this latest version. Results: The document offers a series of general recommendations and others adapted to the different healthcare settings, from telematic assistance to the organization of physical consultation spaces, hospital care, interventional rooms and operating theaters. The recommendations cover from the hygienic measures and protection, to the diagnosis of the disease, risk categorization, the potential modifications in the pharmacological options and available analgesic techniques, as well as an accompanying document to the informed consent. Conclusions: A new healthcare reality is prevailing. This reality not only goes through security standards adapted to the contagiousness and other consequences of the virus, but also a new healthcare model that incorporates telematic tools with technological security and an adequate legal framework. The deleterious biological and psychological consequences of the virus on pain patients have not yet been fully clarified, so we must be vigilant, preventing and treating this possibility.