In this study, the effects of changes in lifestyle with COVID-19 and the COVID-19 pandemic were investigated in people with chronic pain, using the data from a large cross-sectional Internet survey. Chronic pain had little effect on physical condition during the COVID-19 pandemic. The factors affecting deterioration of the physical condition were insomnia, poor work/study/housework performance, and anxiety/depression during the COVID-19 pandemic.
The spread of COVID-19 has caused the psychological damage, as well as the physical damage. After the COVID-19 pandemic hit, people felt a daily vague sense of anxiety about “when, where, and from whom” they could become infected with this unknown virus. The variety of information obtained from television and the Internet has greatly affected people due to social isolation. In this study, nearly 30% of respondents said that they felt tension and anxiety from news about the coronavirus.
People have spent more time at home in order to socially isolate, and this has increased their housework and childcare burden. With the exception of those continuing to work at their usual place of work, all of the women surveyed were spending more time on housework and childcare than before the COVID-19 pandemic [14]. Social isolation has led to various restrictions, and the stress from having to perform housework and childcare 24 hours a day is immeasurable. Del Boca et al. reported that most of the additional housework and childcare associated with COVID-19 fell on women, whereas childcare activities were more equally shared within the couple than housework activities [14]. In this study, poor housework performance was related to deterioration of physical condition during the COVID-19 pandemic. We consider that the COVID-19 pandemic has provided an opportunity to reconfirm the necessity and importance of expanding family members’ participation in childcare.
Remote working has become the “new normal” after the COVID-19 pandemic. It is not known what people who are working remotely are feeling and what kinds of effects are being produced. Communication with people in the workplace is insufficient, and email, chats, and web meetings have become more frequently used. As a result, progress on the work they should be doing may be slow, greatly increasing working hours. Using survey data from employees working at home during the pandemic, Wang et al. found that virtual work characteristics are linked to worker’s performance and wellbeing [15]. Specifically, social support was positively correlated with lower levels of all remote working challenges; job autonomy was negatively related to loneliness; and workload and monitoring were both linked to higher work-home interference. Receiving social support during the period of working away from the office, for instance, can help remote workers overcome social isolation [16]. Lopez-Leon et al. recommended that remote workers create routines, be organized, have an adequate home office, enhance productivity, be responsible, avoid extreme multitasking, facilitate communication and networking, be balanced, and use available computer programs [17].
Lack of exercise due to remote work has become a major problem. Social isolation during the COVID-19 pandemic can increase physical inactivity and the global burden of cardiovascular disease [18]. Changes in body weight are inversely correlated with changes in steps per day and moderate or vigorous-intensity exercise during the quarantine [19]. Exercise not only improves physical fitness, but is also associated with higher levels of serotonin [20]. Serotonin has been implicated in the motivational control of behavior. On the other hand, low levels of serotonin due to lack of exercise have been associated with anxiety, depression, and insomnia [21, 22]. Social isolation due to the COVID-19 pandemic may have effects on sleep rhythms, which play an important role in mental health [23]. In the present study, insomnia was one of the factors affecting the deterioration of the physical condition during the COVID-19 pandemic. Therefore, insomnia should be controlled to improve the physical condition. Daniele et al. reported that sleep deprivation increased depressive behavior, and exercise improved it [20]. This effect is explained by exercise reducing serotonin turnover associated with sleep deprivation [20].
Isolation and social distancing are important risk factors related to mental health [24–26]. The prevalence of stress, anxiety, and depression were reported to be 29.6%, 31.9%, and 33.7%, respectively, in the general population during the COVID-19 pandemic [27]. A considerable proportion of workers experience mood and sleep disturbances during this outbreak, stressing the need to establish ways to mitigate mental health risks and adjust interventions under pandemic conditions [28]. Social distancing and isolation “exit strategies” must account for the fact that, although some individuals will voluntarily or habitually continue to socially distance, others will seek high levels of social engagement as soon as possible [29].
Previous reports have explored the mental health status of patients with chronic pain and compared various psychological metrics in patients with acute versus chronic pain [30]. Pincus et al. examined the transition to chronic pain status and reported finding strong evidence for the role of negative mood (distress or depression) [6]. It has also been reported that depression and sleep disorders, which cause functional impairment [31], can lead to reduced pain thresholds [32]. Avoidance of pain leads individuals to minimize or avoid physical and social activities completely [33]. In the current study, chronic pain patients had little deterioration of the physical condition during the COVID-19 pandemic in Japan. These results were considered to be related to the fact that the participants who had chronic pain were originally in a state close to social isolation by the COVID-19 pandemic and their physical condition had already deteriorated. Therefore, physical condition of the participants who had chronic pain was less affected by the social isolation and remote work due to the COVID-19 pandemic.
The present study has some limitations. First, the survey sample was gathered through a Web-based survey and was thus limited to people with access to the Internet. Therefore, there is a possibility that the survey results cannot be generalized. Even so, differences in age, sex, and demographics were minimized by propensity score matching. The results of this survey are therefore thought to be close to national estimates. Second, this study analyzed participants with chronic pain. However, chronic pain in this study included many pain locations, which included the neck, shoulder, lumbar area, hip, knee, and headache. Therefore, the effects on activity of daily living are thought to have differed depending on the site of pain. Third, chronic pain in this study was defined as pain that had continued for at least three months, and it is not clear whether participants were receiving medication for their chronic pain. In cases when participants were receiving medication, there may have been effects from the lack of pain control. Finally, physical condition, which was taken as an outcome in this study, was assessed subjectively by the participants, and an objective assessment tool was not used. Thus, assessments in this study might be influenced by the participants’ mental state.