In recent years, telehealth has rapidly become more widespread, with the COVID-19 pandemic catalyzing a significant shift in healthcare delivery towards more flexible and remote approaches. The adoption of telehealth services has seen unprecedented growth, with physician utilization of telemedicine surging from 15.4% in 2019 to 86.5% in 2021. This rapid expansion was further evidenced by the increase in telehealth visits from 14 million in 2019 to 62 million in 2020. By late 2020, outpatient telehealth visits were 78 times higher than pre-pandemic levels. Telehealth is often more convenient than and as effective as traditional in-person visits in the settings of simple check-ups, follow-up appointments, and prescribing. However, using telehealth for prescribing becomes complicated for pain medication, which is closely regulated.
The adoption of telehealth in pain management practices was swift, with many centers implementing telemedicine within 1 to 2 weeks after the start of the pandemic. A study conducted from August 2019 to June 2020 evaluated 1398 patients and conducted 2948 video visits for remote pain management care, demonstrating the rapid expansion of telehealth services. The pandemic necessitated a shift from in-person consultations to telemedicine, as recommended by the European and American Societies for Regional Anesthesia and the International Association for the Study of Pain. This transition was largely successful, with 91.4% of patients surveyed reporting satisfaction with their telemedicine experience. Despite initial challenges, telehealth has proven to be an effective tool for pain management, offering benefits such as reduced travel time and costs for patients, while maintaining a high level of care.
Telehealth offers several benefits, including improved access to specialist services and pain rehabilitation programs, reduced travel burden for patients, enhanced communication, and real-time interaction between patients and their healthcare team. Research has demonstrated the efficacy of telehealth in pain management and prescribing medication. A study conducted by the University of California, Los Angeles found that telehealth can effectively replace many in-person visits for people living with chronic pain, with 92% of 327 patients surveyed reporting satisfaction with the telehealth option. While specific studies on telehealth use for pain management in terminally ill patients are limited, the general benefits of telehealth for chronic pain patients can be extrapolated to this population. Telehealth could potentially offer terminally ill patients, such as those with advanced cancer, easier access to pain management services without the burden of frequent travel to healthcare facilities.
Despite its benefits, prescribing opioid pain medication via telehealth presents several challenges and potential risks. These include difficulty conducting thorough physical examinations, increased potential for misuse or diversion of prescribed medications, challenges in monitoring patient progress and medication use, and the risk of profit-driven providers operating exclusively online without proper evaluation or monitoring. To mitigate these risks, healthcare providers must implement robust screening processes and utilize available technologies to monitor patient progress and medication use.
While telehealth offers significant potential for improving access to pain management services, including for terminally ill patients, it requires careful implementation and ongoing monitoring to ensure safe and effective pain management. As the healthcare landscape continues to evolve, striking a balance between accessibility and safeguarding against potential abuses will be crucial in harnessing the full benefits of telehealth in pain management.
References
- Patel S, Hafez D, Janevic M, et al. Optimizing telehealth pain care after COVID-19. Pain. 2020;161(11):2437-2445. https://doi.org/10.1097/j.pain.0000000000002025
- Sangalli BC, Schwartz RC, Gomes JM, et al. Telehealth increases access to brief behavioral interventions in orofacial pain clinic during COVID-19 pandemic – A retrospective study. J Oral Facial Pain Headache. 2022;36(1):3-11. https://doi.org/10.11607/ofph.2945
- Scriven H, Doherty DP, Ward EC. Evaluation of a multisite telehealth group model for persistent pain management for rural/remote participants. Rural Remote Health. 2019;19(1):4710. https://doi.org/10.22605/RRH4710
- Pronovost PJ, Johns MME, Palmer S, et al. Recommendations for improving health care delivery: A call to action. JAMA. 2022;327(24):2409-2410. https://doi.org/10.1001/jama.2022.9035
- Jones CM, Shoff C, Hodges K, et al. Receipt of telehealth services, receipt and retention of medications for opioid use disorder, and medically treated overdose among Medicare beneficiaries before and during the COVID-19 pandemic. JAMA Psychiatry. 2023;80(4):370-379. https://doi.org/10.1001/jamapsychiatry.2022.4796