Managing Back Pain During COVID-19
COVID-19 has made life harder and more uncertain for everyone – but those struggling with chronic back pain find themselves in a particularly difficult situation. You might want to go see your doctor, but you know that some hospitals can be overwhelmed right now.
This confronts you with a tough decision. Do you cancel your procedure, stay home and try to manage your back pain as best you can? Or do you reach out to your doctor and stay on schedule for your treatment?
As it turns out, patients aren’t the only ones grappling with these decisions. Doctors are as well. The Centers for Medicare and Medicaid Services (CMS) recently issued guidance to doctors and hospitals on how to handle surgery during the COVID-19 pandemic.
To keep ventilators and other key supplies available for patients battling the novel coronavirus, the CMS urged medical practitioners to postpone all non-essential surgeries and procedures until the pandemic is under control.
To help doctors determine which procedures qualify as “essential,” the CMS created three tiers, with each tier ranked by the urgency of a procedure and linked with a recommended course of action. Doctors can use this system to figure out which procedures merit the use of a hospital’s limited supply of equipment and available bedding.
So you may be wondering – which category does your own back condition fall under?
Before we continue, it’s important to note that not every hospital is facing the same load of COVID-19-positive patients. While some, namely those in large metropolitan areas or those serving an older population, are more likely to be at capacity, others have space and staff available. This being the case, talk with your neurosurgeon about the COVID-19 load at their hospital.
All Tier 1 procedures are considered non-essential. Procedures that fall under this category are known as “low acuity surgeries” – surgeries for conditions that aren’t especially acute. Surgeries in this category include cataract removal, colonoscopies, carpal tunnel release and endoscopies. While all of these surgeries are important for long-term health and healing, very rarely are they particularly urgent.
No one likes to be kept waiting, particularly for something as high-stakes as surgery. But delaying your procedure until things have returned to normal will allow hospital staff to reserve supplies for COVID-19 patients. And if you yourself are in a high-risk group for COVID-19 – which includes demographics like the elderly, the immunocompromised, and those with kidney, lung or liver conditions – it’s better to avoid hospitals altogether if at all possible.
Tier 3 procedures are at the other end of the spectrum: high-acuity procedures so urgent that it’s worth the risk of being exposed to COVID-19. Traumatic injuries fall under this category, as do organ transplants and any surgeries that combat cancer. The CMS placed neurosurgery in the 3a category: Even if a patient is otherwise healthy, neurosurgery cannot and should not be delayed because of COVID-19. The only possible exception is if the condition is longstanding or congenital, in which case a delay of a few months may not make a big difference.
Tier 2 cases fall somewhere in the middle: In some instances, the procedure can be postponed, but in other instances, it’s best to act as quickly as possible. There is a large gray area where a surgeon must use his or her best judgment to assess whether or not it’s best to postpone surgery. The CMS put spinal surgeries in this category – which means that many Americans struggling with back pain will need to do some long, hard thinking about their next step.