Office-based Interventions for acute pain crisis in a palliative care setting during the COVID-19 Pandemic: A Case Series

ABSTRACT

Background: Healthcare services were overwhelmed by the COVID-19 pandemic. Inpatient admissions for every pain crisis was not feasible owing to the scarcity of beds. This audit was conduced to explore the outcome of office-based interventions in managing pain crisis in a palliative care unit (PCU). Methods: An audit of electronic records of office-based interventions performed in adult patients for pain crisis in a PCU. Results: Thirteen office-based interventions were performed using appropriate measures in nine patients over a six month period (Table 1). The median pain score at presentation (after analgesic titration) was 8. Four patients with unilateral facial pain underwent trans-nasal sphenopalatine ganglion block (SPGB) and five patients with myofascial pain syndrome (MPS) underwent trigger point injection (TPI). All patients had satisfactory pain relief ( at least 50% post procedure pain relief) and none required inpatient admission for pain management. One patient each undergoing SPGB and TPI required repeat block after 3 and 2 weeks respectively. One patient underwent SPGB thrice. Except for 2 patients, all patients had medium to long term pain relief (range 14-150 days). None of the patients experienced any adverse effect. Majority of patients had significant improvement in sleep, mood, range of motion and activities of daily living. Analgesic doses were reduced in four patients and stopped in one. Conclusion: Office based interventions were feasible and effective in managing pain crisis and averted inpatient admission during the COVID pandemic.