Chronic pain is associated with a greater risk of COVID-19-related visits to the emergency department (ED) and hospitalizations, according to results of a retrospective cohort study published in Pain Medicine. This risk was further increased in patients with comorbid chronic pain and opioid use, which also increased the odds of experiencing hepatic and cardiac events.

The relationship between chronic pain, with or without opioid use disorder (OUD), and COVID-19 complications is unclear. Researchers used New York State (NYS) Medicaid claims data to clarify this relationship among an underserved population with high exposure to COVID-19 in 2020.

Claims from March 1, 2019, and December 31, 2020, were evaluated by the researchers. Eligible for inclusion in the study were patients aged 18 to 64 years who were enrolled in NYS Medicaid prior to the COVID-19 pandemic and for at least 10 months between March 2019 and February 2020. Patients were followed from March 1, 2020, (index date) through (1) their first COVID-19-related ED visit or hospitalization, (2) their disenrollment from NYS Medicaid, (3) their death from any cause, or (4) the end of the study period. Patient demographics, history of comorbidities/chronic pain, and baseline health care utilization were recorded. Propensity score matching was used to create a control group of patients with similar confounding covariates but without chronic pain. An exploratory, secondary analysis assessed the risks of COVID-19 complications among those with comorbid chronic pain and opioid use disorder.

A total of 773,880 patients were included in the analysis; 236,391 patients had chronic pain and 537,489 were matched control patients without chronic pain. Demographics, health care utilization, and comorbidities were well-balanced. Results indicated that chronic pain is significantly associated with COVID-19-related ED visits (hazard ratio [HR],1.22; 95% CI, 1.16-1.29) and hospitalizations (HR, 1.19; 95% CI, 1.12-1.27). Patients with both chronic pain and opioid use disorder had an increased risk of COVID-19-related hospitalizations (HR, 1.25; 95% CI, 1.07-1.47) but not ED visits (HR, 0.97; 95% CI, 0.81-1.16). Patients with comorbid chronic pain and OUD had greater odds of acute renal failure (odds ratio [OR], 1.45; 95% CI, 1.00-2.09) and other hepatic- and cardiac-related complications (OR, 1.74; 95% CI, 1.10-2.74).

The main limitation of this study was its focus on adults with NYS Medicaid coverage, in that the results may not be generalizable to other populations. As a retrospective analysis, the study also was limited by accuracy of the diagnostic codes for chronic pain and OUD entered by providers. It is also important that the data analysis was conducted prior to the rollout of COVID-19 vaccines.

The researchers concluded, “The risks posed by chronic pain, and exacerbated by OUD, highlighted an increased vulnerability to colliding public health emergencies affecting a large segment of US adults.” They added, “Results suggest a need to design targeted public health and clinical interventions for these high-risk groups.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Clinical Pain Advisor