A contextual-behavioral perspective on chronic pain during the COVID-19 pandemic and future times of mandated physical distancing

For people who struggle with chronic pain, the COVID-19 pandemic poses new challenges in treatment accessibility and may heighten pre-existing anxiety related to their health condition. Likewise, many mental health providers are struggling to adapt to a new way of caring for these individuals. The current paper aims to provide evidence of the ways in which COVID-19 is impacting people with pain and to offer a contextual-behavioral perspective on treatment of patients with chronic pain during the current pandemic and any future periods of mandated physical distancing. Past research shows that adolescents and adults with chronic pain struggle with loneliness and social isolation, which emphasizes the importance of remaining connected with these patients while they are remaining at home. Further, many individuals with chronic pain have physical and mental health comorbidities that may increase the risk of COVID-19 infection and/or morbidity and mortality. Specific functional-contextual and biopsychosocial concepts common in multidisciplinary treatment of chronic pain can be usefully incorporated into a telehealth model of ACT treatment for pain. These include the use of pandemic-related metaphors, modeling acceptance of technical glitches that occur during telehealth sessions, and mindfully observing facial expressions on the computer screen when the patient is in pain. Moreover, powerful experiential exercises that make use of pandemic-related themes (e.g., wearing a mask, washing hands) are described. While barriers to the widespread implementation of ACT-consistent telehealth exist, connecting with patients in new and creative ways will be essential as the field moves forward.

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