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At the end of 2019, a series of patients affected by lung infection of initially unknown aetiology with clinical presentations very similar to viral pneumonia were registered in China. Sequencing analysis of samples from the lower respiratory tract identified a new type of virus from the family Coronaviridae called SARS-CoV-2 as the causative agent of the outbreak; the agent responsible for the disease that was renamed COVID-19.1 Since then, millions of cases have been identified around the world. The World Health Organization (WHO) initially declared the infection to be a Public Health Emergency of International Concern, and later classed it as a pandemic.2, 3 The vast majority of coronaviruses are responsible for mild upper respiratory tract infections in immunocompetent adults, and can cause more serious conditions, such as severe acute respiratory distress syndrome (ARDS) and sepsis in patients with risk factors, namely, cardiovascular disease (10.5%), diabetes (7.3%), chronic respiratory disease (6.3%), high blood pressure (6%) and cancer (5.6%).1, 2 Person-to-person transmission occurs mainly by respiratory droplets and by contact with contaminated material through mucosa (oral, ocular and nasal). It can also be transmitted by aerosols in aerosol-generating therapeutic procedures. The average number of secondary cases produced from 1 case has been estimated at between 2 and 3,2, 4 while the average incubation period is between 5.2 and 12.5 days, although in some cases it can be as long as 24 days.1 The potential repercussions of the disease have led international, regional and local health organizations to adopt a series of measures to deal with COVID-19 and try to reduce its impact5 not only in society as a whole, but also in healthcare. These measures include changing guidelines and promoting strategies such as telemedicine,6 a service that has been introduced in different specialties, including Pain Treatment Units. Telemedicine is basically applicable in routine, elective, non-urgent medical consultations (clinical evolution, start and follow-up of medical treatments, psychological intervention techniques, etc.).6 In certain cases, however, such as patients with chronic pain refractory to medical treatment who need invasive therapeutic procedures, telemedicine services are ineffective because they exclude direct patient-doctor contact, and with it, the risk of virus transmission. In this context, intrathecal drug infusion (IDI) pumps and both spinal cord (SCS) and peripheral nerve (PNS) stimulation device are now frequently used as part of the treatment strategy in patients with chronic pain refractory to other therapies.7 SCSs have now been approved by the US Food and Drug Administration (FDA) for the treatment of chronic neuropathic pain of the spine and limbs, post-surgical spine syndrome, and complex regional pain syndrome. However, they have also been used successfully in many other indications, including chronic intractable angina, peripheral arterial disease, peripheral neuropathic pain, and in the treatment of visceral pain.7, 8, 9 In IDIs, the intrathecal administration of baclofen is approved by the FDA for the treatment of spasticity, and the intrathecal administration of morphine and ziconotide is approved for the treatment of chronic, refractory, nociceptive, neuropathic or mixed cancer or non-cancer-related pain.7, 10 In light of the current situation, we believe it is important to establish guidelines for the management of patients with suspected or serious infection by Coronavirus SARS-CoV-2 scheduled for implantation of electronic systems for the control of chronic pain (IDIs and SCSs). The purpose of these recommendations is to reduce the spread of COVID-19 among both medical personnel and the general population, and they may be updated as the pandemic progresses and new evidence emerges. |
Full Text from ScienceDirect