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Telehealth has the potential to transform pain care, and changes made during the COVID-19 pandemic may offer a glimpse of the future, researchers said at the American Academy of Pain Medicine virtual meeting.

"There was an immediate need to pivot to telemedicine to continue care and education for our patients, and generally I believe this was quite successfully achieved," said Mary Ann Fitzcharles, MD, of McGill University and Montreal General Hospital in Canada, at the meeting. "We have learned that healthcare professionals can step up and can adapt rather rapidly."

To continue virtual pain care beyond the pandemic, the field needs to harness strategies that were successful, she noted. "We must remember that one size does not fit all, and we have to bear in mind that we must provide secure, efficient, and equitable ongoing care to our patients."

During COVID-19, telemedicine provided time and cost savings for many, Fitzcharles noted. "We were able to triage new patients and at least do an initial evaluation by telehealth in preparation for an in-person visit," she said. "The followup of stable patients was mostly efficient, and patients generally are fairly satisfied." Importantly, telehealth gave patients in outlying regions access to pain specialists, she observed.

But there have been challenges for both patients and providers. "On the patient side, there is clearly the digital divide, which is related to age and socioeconomic status," Fitzcharles said. "Not all of our patients have access to a digital platform, particularly those in rural areas. We also know that high speed broadband is not available everywhere and there can be technical glitches when we use audiovisual platforms."

"And we must also think of those special needs," she added, including the young person who may need interpersonal contact, socially disadvantaged or homeless people, people with cognition, vision, or hearing problems, and elderly people.

Telehealth during COVID-19 also presented problems for clinicians. "We have really been taught in medicine to look at nuances in body language, those nuances that are projected to us during an in-person interview, and this has been lacking," Fitzcharles said.

"There have been considerable challenges with trying to manage a physical examination. We've also, at times, felt insecurity regarding a diagnosis or treatment. And for healthcare professionals, we've really had a year of relative isolation and loneliness."

Several factors need to be considered as telehealth is used in the future, especially surrounding privacy and confidentiality. Many patients choose to have virtual visits at work and some work settings may not be appropriate for a medical appointment, Fitzcharles noted. "Even if a patient is at home, there might be a child sitting and doing homework in the corner of the room. We have to be very careful when we are discussing issues that might be sensitive," she said.

Reimbursement rules, which were relaxed during the COVID-19 public health emergency, may change and "we always have to keep in consideration the medicolegal implications of telehealth," Fitzcharles said. "I'm quite sure these are going to arise and we have to be really diligent and vigilant in our delivery of healthcare this way."

"As healthcare providers, we must know our personal limitations, the limitations of a patient's self-reporting, and the limitations of a visual assessment when we just have a screen in front of us," she emphasized.

"We will lack those traditional cues, that top-to-toe evaluation that is so important in medicine," she said. "I would strongly advocate that we must have a low threshold for in-patient visits when we're insecure about an assessment, make important changes to treatment, or when we have questions about the patient's reliability or even a need for a urine drug screen."

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