Best Practices for Chronic Pain Fellows During the COVID-19 Pandemic

doctor using laptop in hospital
Recommendations for addressing mental health among pain management fellows during the COVID-19 pandemic.

A letter to the editor1 published in Pain Medicine expanded upon a previously published article2 which listed recommendations for addressing mental health among health care workers during the coronavirus disease 2019 (COVID-19) pandemic.

A strategy for addressing clinician mental health during the pandemic should include maintenance of daily routines, contact with friends and family, meaningful leisure activity, avoidance of sensationalized news content, and identification of transparent coverage of COVID-19 information. In the work setting, the authors recommended developing proactive work from home approaches, utilizing available institutional support, and mitigating concerns about causing additional work for coworkers.

To address the specific stressors faced by chronic pain fellows, Orhurhu and colleagues contacted 16 clinicians located across the United States. Participants were surveyed over the phone and asked to respond to 3 questions: What were they concerned about? What message should leaders be making? What support would be most helpful?

The participants had 15 major concerns. The foremost concern was the reduced supply of personal protective equipment, followed by reductions in fellowship training especially for advanced procedures, uncertainty of graduation or certification board exam dates, concerns over an uncertain job market and the possibility of hiring freezes, unease over being deployed to intensive care units or field hospitals without preparation, inconsistent messaging from institution leadership, the feeling of abandonment by the Accreditation Council for Graduate Medical Education (ACGME), concerns for exposing loved ones to the virus, and uncertainty of available resources if they are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

The participants expressed a desire for institutional leaders to acknowledge these concerns. They recommended for fellow representatives to be included in pandemic response planning within their departments. The participants would appreciate if leaders expressed an interest in the unique needs of chronic pain fellows during the pandemic and to provide additional support if they contract the disease, like lodging support, childcare, or additional paid time off. Finally, participants would like for ACGME to make a statement about protective measures that have been implemented to protect their residents and fellows.

The participants acknowledged 4 beneficial aspects during the pandemic, which were the implementation of telemedicine for the care of chronic pain, a webinar series produced by the American Society of Pain and Neuroscience and the Pacific Spine and Pain Society, the availability of at-home lectures, and video conferencing for emotional support.

The letter concluded that “additional support measures addressing truncated training duration, future pain certification, employment after fellowship, and immediate resources for those caring for COVID-19 patients will go a long way in mitigating the deleterious impact of the COVID pandemic.”


  1. Orhurhu V, Owais K, Urits I, et al. Pain management best practices during the COVID-19 pandemic: the well-being perspectives of chronic pain fellows. Pain Med. 2020;pnaa195. doi:10.1093/pm/pnaa195.
  2. Cohen S P, Zafeer B B, Buvanendran A, et al. Pain management best practices from multispecialty organizations during the COVID-19 pandemic and public health crises. Pain Med. 2020;21(7):1331-1346. doi: 10.1093/pm/pnaa127.