key: cord-347135-g2hx32xa authors: Miller, Elaine title: Dealing with Uncertainty: Lessons Learned from COVID-19 date: 2020-06-10 journal: Pain Manag Nurs DOI: 10.1016/j.pmn.2020.06.001 sha: doc_id: 347135 cord_uid: g2hx32xa nan The COVID pandemic turned our world upside down and altered routines and priorities. We took many things for granted and now suddenly faced a new situation that changed how we performed customary activities such as going to the grocery store, going to work, keeping scheduled doctors' visits, going to the dentist, and socializing with family, colleagues and friends. Framed within this new set of circumstances have been increased stress, anxieties, and for some, loss of family, friends, income, and home. On the other hand, several positives have emerged such as the expanded use of telemedicine and many of us becoming more adept in using technology to participate in online school activities, church services, work related and civic meetings, and family events. As a result of social isolation, altered connectivity, and disruption of normalcy, we now have greater insights into how the lives and circumstances of individuals with chronic or acute pain may be temporarily or permanently altered. Even in normal circumstances, chronic pain management affects over 116 million US adults (IOM 2011), is the most frequent reason individuals seek healthcare, and is challenging to treat even in the best of circumstances (Daubresse et al., 2013) . Although there are many factors to consider as we provide care during disaster or emergency situations, several critical elements must remain in the forefront of our thinking: • In large scale disasters or emergency situations, whether natural (e.g., pandemic, hurricanes), environmental (e.g., Deepwater Horizon oil spill) or traumatic (e.g., mass shootings, World Trade Center attack), there are increases in depression, loneliness, anxiety, posttraumatic stress disorders, substance abuse, along with behavioral disorders such as child abuse and domestic violence (Neria, Nandi, & Galea, 2008; Galea, Merchany, & Lurie, 2020) . Unfortunately, the impact of these events often affects mental health in the short-term and general quality of life in the long-term (Galea, Merchany, & Lurie, 2020) . As a result, mechanisms must be put in place to address the signs/symptoms of mental health disorders while monitoring the successes of our interventions. • During the COVID pandemic, numerous individuals experienced difficulties obtaining the necessary resources to survive such as prescribed and over-the-counter medications, supplies and food. For those with limited transportation, economic hardships, and reduced social support systems, there were even greater difficulties obtaining basic necessities. These sudden new challenges contributed to the deterioration of the physical, mental and pain status of individuals experiencing pain. • Another stressor exhibited by many was fear of seeking professional care and if admitted to a facility, of being isolated from family and friends. As we look to the future of similar situations, how can we creatively address these concerns? • Research further indicates that community dwelling adults with more severe or poorly managed pain often have impaired attention capacity, diminished decision-making capabilities and memory impairment (Nadar, Jasem, & Manee, 2016; van der Leeuw, Eggermont, Shi, Millerg, Gross et al. 2016) . In conditions such as a pandemic or other disaster/emergency situations, consistently monitoring these individuals and finding ways to provide care are critical. What have we learned that will help clients experiencing pain survive pandemics or other disaster or emergency situations? It is evident that planning for potential disaster/emergency situations is essential. Moreover, planning is critical for persons with chronic and disabling conditions including pain, mobility, sensory, or cognitive issues (Barth, 2019; Owens, Stidham, & Owens, 2013; FEMA, 2004 · Disaster and emergency supplies must be ready and in one place prior to an actual disaster or emergency. Supplies should last at least 3 days and be placed in easy to carry containers (e.g., backpack) with ID tags displaying name and contact information. Label all equipment such as wheelchairs, canes, walkers with the client's name, address, phone number and significant others. Make sure the disaster kit is up-to-date, and review contents every 6 months. It is vital that individuals have disaster or emergency plans, escape routes, and designated meeting places. In addition, it is important to keep in the forefront how vision, hearing, mobility, and cognitive or emotional impairments may affect preparation and outcomes. Families should have their own communication plans and carry information in their wallets, listing out-of-town contact persons as a main contact, and these out-of-town contact persons must be aware of these plans. Keep emergency contact numbers near the telephone or in phone number listings, make plans for those with disabilities, as well as for pets or service animals. Know what the community warning system is for disaster or emergencies and what services are offered. Determine if SMART911 is available in your community and sign up so emergency responders are aware of the clients' location and specific needs. For more information about the types of disaster or emergencies (e.g., hurricanes, earthquakes, tornadoes, floods, chemical spills) possible in your community, visit www.ready.gov (http://www.ready.gov) or call 1800-BE-READY. Once this information is obtained, it is essential to adapt this information to an individual's personal circumstances and make every effort to follow instructions given by local authorities. Adults with disabilities should know the community warning system and how residents are to be notified of a potential disaster or emergency situation. Disaster and/or emergencies situations are never ending. In 2020, there have already been 181 Disaster declarations made by FEMA (2020). It is imperative that we are prepared for the next disaster and work with our clients to take action now. Meeting the needs of people with physical disabilities in crisis settings Ambulatory diagnosis and treatment of nonmalignant pain in the United States FEMA 2020 Disaster Declarations Preparing for disaster for people with disabilities and other special needs The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention Relieving pain in America: A blueprint for transforming prevention, care, education and research The cognitive functions in adults with chronic pain: A comparative study Post-traumatic stress disorder following disasters: systematic review Disaster evacuation for persons with special needs: a content analysis of information on YouTube Pain and cognitive function among older adults living in the community Preparedness for natural disasters among older US adults: a nationwide survey