Chronic primary pain in the COVID-19 pandemic: how uncertainty and stress impact on functioning and suffering.

Indeed, research during the first COVID-19 lockdown showed that individuals with chronic pain were more adversely affected compared with pain-free people, showing greater increase in anxiety, depression, loneliness, as well as self-perceived pain.[30] Undeniably, individuals with CPP are increasingly prone to suffer severe consequences from both COVID-19 and the taken containment measures, which may culminate into augmented levels of stress. Contemporary pain models assign a key role to psychosocial factors in the development and maintenance of chronic pain and augmented levels of disability and distress.[18] Among others, health anxiety,[42]cognitive-processing biases for pain and pain-related information, particularly attention [27] and interpretation biases,[56] and proneness towards negative outcome expectancies[101] (eg, overgeneralization [65] and catastrophic worry [103]) have often been considered vulnerabilities contributing to pain-related disability in CPP.[102] Indeed, a wealth of research has shown that negative outcome expectancies are associated with poor pain outcomes. We used CPP as a prototypic pain diagnosis, but this model may be extended or applied to other chronic pain diagnoses (eg, arthritis, cancer, and diabetes) and even to subacute or new-onset pain. People suffering from chronic pain may be at risk of disease severity when infected with SARS-CoV-2 because the prevalence of chronic pain in elderly is higher and they also have increased levels of comorbidity,[23] both known risk factors for COVID-19. [Extracted from the article]