As the African tale goes, one day a raging fire broke out in a forest. All the animals feeling discouraged and powerless ran out of the forest believing there was nothing they could do, except for one little hummingbird. This particular hummingbird picked up a few drops of water from the nearby stream and put them on the fire. Again and again… The other animals watched in disbelief. Then one animal challenged the humming bird: “What do you think you are doing?” The hummingbird without wasting any time replied: “I am doing what I can.”

Chronic pain is one of the leading causes of disability in the modern world. This is why access to pain management services constitutes a fundamental human right. The COVID19 pandemic has created a big challenge. Physicians should at the same time treat their patients and limit the spread of contagion. In these difficult times, it is essential for all physicians to have a framework to balance the conflicting goals of risk mitigation, access to pain management infrastructures, and conservation of resources (1). In this way, we can all do what we can – safely.

Below one can find a variety of links (recommendations, webinars, articles) which could be of interest not only for pain practitioners but for all physicians and patients as well. Of course, the list is not (and cannot be) complete, since new resources are steadily being published. For the colleagues who don´t have much time to spare, the NSUKI recommendations should be enough to get a good overview of the suggested path of decisions in the COVID-19 era. Hopefully, the readers will find the provided information helpful. It goes without saying that all listed frameworks/guidance are only, as the words state, frameworks or guidance. Our clinical judgment should be our compass for every clinical decision, taking into consideration various factors such as resource availability, hospital directives, and regional peculiarities.

Let´s become the hummingbird of the tale. Let´s do what we can. We owe it to ourselves, to our families, and to our society.  As the famous physicist and chemist Marie Skłodowska Curie (1867-1934) once said: “each of us must work for his own improvement and, at the same time, share a general responsibility for all humanity, our particular duty being to aid those to whom we think we can be most useful.” We should not fall short of effort and willingness in such a time of crisis.

RESOURCES:

Handbooks

• Liang T (ed.). Handbook of COVID-19 Prevention and Treatment. The First Affiliated Hospital, Zhejiang University School of Medicine, China (2020): https://video-intl.alicdn.com/Handbook%20of%20COVID-19%20Prevention%20and%20Treatment%20%28Standard%29.pdf?spm=a3c0i.14138300.8102420620.download.6df3647frylZUY&file=Handbook%20of%20COVID-19%20Prevention%20and%20Treatment%20%28Standard%29.pdf (assessed April 9, 2020)

Articles

• Altiparmak et al. Regional anesthesia in patients with suspected COVID-19 infection. Reg Anesth Pain Med 2020 DOI: 10.1136/rapm-2020-101477 https://rapm.bmj.com/content/early/2020/04/03/rapm-2020-101477.long (First published: April 3, 2020)
• Atluri et al. Expanded Umbilical Cord Mesenchymal Stem Cells (UC-MSCs) as a Therapeutic Strategy In Managing Critically Ill COVID-19 Patients: The Case for Compassionate Use. Pain Physician 2020;23:E71-E83 https://asipp.worldsecuresystems.com/COVID-19/Expanded-Umbilical-Cord-Mesenchymal-Stem%20Cells-Manuscript.pdf
• Calton et al. Telemedicine in the Time of Coronavirus. J Pain Symptom Manage 2020 DOI: 10.1016/j.jpainsymman.2020.03.019 https://www.jpsmjournal.com/article/S0885-3924(20)30170-6/pdf (accepted: March 23, 2020)
• Cohen et al. Pain Management Best Practices from Multispecialty Organizations during the COVID-19 Pandemic and Public Health Crises. Pain Med 2020 DOI: 10.1093/pm/pnaa127 https://academic.oup.com/painmedicine/advance-article/doi/10.1093/pm/pnaa127/5817092?searchresult=1 (First published: April 7, 2020)
• Eccleston et al. Managing patients with chronic pain during the Covid-19 outbreak: considerations for the rapid introduction of remotely supported (e-health) pain management services. Pain 2020 DOI: 10.1097/j.pain.0000000000001885 https://journals.lww.com/pain/Citation/publishahead/Managing_patients_with_chronic_pain_during_the.98431.pdf (First published April 2, 2020)
• Scuccimarri et al. Hydroxychloroquine: a potential ethical dilemma for rheumatologists during the COVID-19 pandemic. J Rheumatol 2020 DOI: 10.3899/jrheum.200369 http://www.jrheum.org/content/jrheum/early/2020/04/01/jrheum.200369.full.pdf (First published: April 2, 2020)
• Shanthanna et al. Caring for patients with pain during the COVID-19 pandemic: Consensus recommendations from an international expert panel. Anaesthesia 2020 DOI: 10.1111/anae.15076 https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.15076 (First published: April 7, 2020)
• Wu & McGoogan. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China. Summary of a Report of 72,314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242 https://jamanetwork.com/journals/jama/fullarticle/2762130

Websites

• American Academy of Physical Medicine and Rehabilitation (AAPM&R). Physiatrist Member Support and Resource Center: COVID-19: https://www.aapmr.org/news-publications/covid-19 (updated March 20 & 30, 2020)
• American College of Surgeons (ACS). COVID-19 and Surgery. https://www.facs.org/covid-19 (assessed April 9, 2020)
• American Heart Association (AHA). Coronavirus (COVID-19) Resources: https://www.heart.org/en/coronavirus/coronavirus-covid-19-resources (updated April 7, 2020)
• American Medical Association (AMA). A Physician's Guide to COVID-19: https://www.ama-assn.org/delivering-care/public-health/physicians-guide-covid-19 (updated March 23, 2020)
• American Society of Interventional Pain Physicians (ASIPP). Is Hydroxychloroquine Safe? With Dr. Laxmaiah Manchikanti, MD: https://youtu.be/Pu_FXXbJEHs (April 7, 2020)
• American Society of Interventional Pain Physicians (ASIPP). Update on Covid-19 Pandemic: https://asipp.worldsecuresystems.com/COVID-19/ASIPP-Update-on-COVID-19-March-23.pdf (updated March 23, 2020)
• American Society of Pain & Neurosciences (ASPN). COVID-19 Taskforce Newsletter Issues #1 & #2: https://aspnpain.com/covid-19-taskforce-newsletters/ (assessed April 9, 2020)
• American Society of Regional Anesthesia and Pain Medicine (ASRA). Recommendations on Chronic Pain Practice during the COVID-19 Pandemic. A Joint Statement by American Society of Regional Anesthesia and Pain Medicine (ASRA) and European Society of Regional Anesthesia and Pain Therapy (ESRA) (March 27, 2020): https://www.asra.com/page/2903/recommendations-on-chronic-pain-practice-during-the-covid-19-pandemic & https://www.asra.com/content/documents/asra_esra_covid-19_and_chronic_pain.pdf
• British Society for Stereotactic and Functional Neurosurgery (BSSFN). COVID-19: https://www.bssfn.org/covid-19 (assessed April 9, 2020)
• Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM). Coronavirus SARS-CoV-2: https://www.bfarm.de/DE/Service/Presse/Themendossiers/Coronavirus/_node.html (updated April 7, 2020)
• Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM). Ergänzende Empfehlungen zum Europäischen Dokument "Guidance on the Management of Clinical Trials during the COVID-19 (Coronavirus) pandemic" (Version 1.0): https://www.bfarm.de/SharedDocs/Downloads/DE/Arzneimittel/KlinischePruefung/Erg%C3%A4nzende%20Empfehlungen%20zur%20Europ%C3%A4ischen%20Guidance%20zur%20COVID-19-Pandemie.pdf?__blob=publicationFile&v=2 (updated March 26, 2020)
• Centers for Disease Control and Prevention (CDC). Interim Additional Guidance for Outpatient and Ambulatory Care Settings: Responding to Community Transmission of COVID-19 in the United States: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ambulatory-care-settings.html (updated April 7, 2020)
• Centers for Disease Control and Prevention (CDC). Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19): https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html (updated April 6, 2020)
• Centers for Medicare & Medicaid Services (CMS). Non-Emergent, Elective Medical Services, and Treatment Recommendations: https://www.cms.gov/files/document/cms-non-emergent-elective-medical-recommendations.pdf (updated April 7, 2020)
• European Medicines Agency (EMA). Guidance to sponsors on how to manage clinical trials during the COVID-19 pandemic: https://ec.europa.eu/health/sites/health/files/files/eudralex/vol-10/guidanceclinicaltrials_covid19_en.pdf (Version 2, March 27, 2020)
• Faculty of Pain Medicine of the Royal College of Anaesthetists (UK). COVID-19: FPM response to concerns over safety of injected steroids for pain procedures: https://fpm.ac.uk/sites/fpm/files/documents/2020-03/FPM-COVID-19-Steroid-Statement-2020-v2.pdf (updated March 17, 2020)
• M3 Global Research. The Effect of COVID-19 on Healthcare Market Research Participation: Feasibility: https://www.m3global.com/m3_original_research/M3OriginalResearch_Effect_of_COVID-19_in_MR.pdf (assessed: April 9, 2020)
• Neuromodulation Society of the United Kingdom and Ireland (NSUKI). Recommendations for the Management of Implanted Neurostimulation & Intrathecal Drug Delivery Devices During the COVID-19 Pandemic: https://nsuki.memberclicks.net/assets/docs/NSUKI%20COVID-19%20recommendation.pdf (assessed April 9, 2020)
• North American Neuromodulation Society (NANS). NANS Covid-19 Resource Guide for Practitioners: https://neuromodulation.org/NANSWorkingforYou/Newsroom/COVID-19Resources.aspx (assessed April 9, 2020)
• Pacific Spine Pain Society (PSPS). Covid-19 Updates: https://www.pacificspineandpainsociety.com/ (assessed April 9, 2020)
• Painweek. Opioid Use Disorder During the Coronavirus: https://www.painweek.org/media/news/opioid-use-disorder-during-coronavirus (March 30, 2020)
• Royal College of Obstetricians & Gynaecologists & The Royal College of Midwives (UK). Coronavirus (COVID-19) Infection in Pregnancy (Version 6: published April 3, 2020): https://www.rcog.org.uk/globalassets/documents/guidelines/2020-04-03-coronavirus-covid-19-infection-in-pregnancy.pdf 
• Spine Intervention Society (SIS). COVID-19 Resources. https://www.spineintervention.org/page/COVID-19 (updated April 8, 2020)

Webinars

• American Society of Interventional Pain Physicians (ASIPP). Surviving the Coronavirus Pandemic: Protecting Family and Employees and Managing Financial Issues and Burnout: https://asipp.freestonelms.com/viewer/daZTRe44gTJnF47tWHrhJqi5PRXv3kvZRrRfbJUc5ifFr (April 3, 2020)
• American Society of Interventional Pain Physicians (ASIPP). Surviving the Coronavirus Pandemic: Practical Advice Every Pain Physician Needs to Know: https://paincast.com/video/surviving-the-coronavirus-pandemic/ (requires login) (March 27, 2020)
• American Academy of Neurology (ANN). Telemedicine and COVID-19: https://youtu.be/Pw-Jdy3-T9g (March 27, 2020)
• American Academy of Physical Medicine and Rehabilitation (AAPM&R). Lessons Learned: How to Navigate the COVID-19 Crisis in an In-Patient Setting: http://me.aapmr.org/diweb/catalog/item/id/5072352/q/t=50377&c=141  (assessed April 9, 2020 – requires login)
• American Academy of Physical Medicine and Rehabilitation (AAPM&R). Lessons Learned: How to Navigate the COVID-19 Crisis in an Out-Patient Setting: http://me.aapmr.org/diweb/catalog/item/id/5072361/q/t=50377&c=141  (assessed April 9, 2020 – requires login)
• American Academy of Physical Medicine and Rehabilitation (AAPM&R). Critical Conversations: Private Practice Experiences during the COVID-19 Pandemic: http://me.aapmr.org/diweb/catalog/item/id/5078632/q/t=50377&c=141  (assessed April 9, 2020 – requires login)
• American Academy of Physical Medicine and Rehabilitation (AAPM&R). Telehealth/Telemedicine Live Q&A: Get Your Telehealth Questions Answered by Our Regulatory & Physiatry Experts: https://register.gotowebinar.com/register/8509713530237789195 (April 16, 2020 – requires registration)
• American Academy of Physical Medicine and Rehabilitation (AAPM&R). Critical Conversations: How to Manage Chronic Pain and Opioids in an Outpatient Setting During the COVID-19 Pandemic: https://register.gotowebinar.com/register/7139661568889329931 (April 15, 2020 – requires registration)
• American Society of Pain & Neuroscience (ASPN) & Pacific Spine and Pain Society (PSPS). COVID-19 and its impact on fellowship training: https://youtu.be/wd7OeF18Tks (April 2, 2020)
• American Society of Pain & Neuroscience (ASPN) & Pacific Spine and Pain Society (PSPS). Focusing on COVID-19 and its impact on Pain Medicine: https://youtu.be/zdmlbmUewS4 (March 25, 2020)
• Centers for Disease Control and Prevention (CDC). Healthcare Systems Preparedness for COVID-19: https://youtu.be/p_llGsYMy3k (February 18, 2020)
• College of Family Physicians of Canada (CFPC). Protecting Patients and Physicians during the Pandemic: https://youtu.be/8npP2VS4-DU (April 2, 2020)
• Faculty of Intensive Care Medicine, Intensive Care Society, Association of Anaesthetists and Royal College of Anaesthetists (UK). Association of Anaesthetists webinar “Surviving COVID-19: keeping the carers caring”: https://icmanaesthesiacovid-19.org/webinar/surviving-covid19-keeping-the-carers-caring (March 30, 2020)
• Faculty of Intensive Care Medicine, Intensive Care Society, Association of Anaesthetists and Royal College of Anaesthetists (UK). Association of Anaesthetists webinar “COVID-19 update: what you need to know on the frontline”: https://icmanaesthesiacovid-19.org/webinar/what-you-need-to-know-on-the-frontline (March 17, 2020)
• International AIDS Society. COVID-19 and HIV: What you need to know: https://youtu.be/25ve6LevLpY (April 3, 2020)
• Johns Hopkins School of Medicine. COVID-19 Best Practices Pain Management: https://youtu.be/m_P17TvZQNA (April 5, 2020)
• National Consortium of Telehealth Resource Centers (NCTRC) (USA). Telehealth and COVID 19: https://youtu.be/HtMYM9zdqM0 (March 19, 2020)
• New York Society of Interventional Pain Physicians (NYSIPP). Business Essentials during the COVID-19 Pandemic: https://www.nysipp.org/ (requires registration) (Coming… April 11, 2020)
• SmartTRAK Life Sciences and Analysis Blog. A Critical Crossroads for COVID-19: An Interview with Krishnan Chakravarthy: https://blog.smarttrak.com/a-critical-crossroads-for-covid-19-an-interview-with-krishnan-chakravarthy (March 23, 2020)

Infographics

• American Society of Regional Anesthesia and Pain Medicine (ASRA). Covid Chronic Pain Best Practice Guidelines: https://www.asra.com/content/documents/paingdlnsinfograph04070444p.pdf (assessed April 9, 2020)
• American Society of Regional Anesthesia and Pain Medicine (ASRA) & European Society of Regional Anesthesia and Pain Therapy (ESRA). Joint statement: Practice Recommendations on Neuraxial Anesthesia and Peripheral Nerve Blocks during the COVID-19 Pandemic: https://www.asra.com/content/documents/covid_guidance_ra_r5_final.pdf (March 31, 2020)
• American Society of Regional Anesthesia and Pain Medicine (ASRA) & European Society of Regional Anesthesia and Pain Therapy (ESRA). Joint statement: Recommendations on Chronic Pain Practice during the COVID-19 Pandemic: https://www.asra.com/content/documents/covid_guidance_cpv1.pdf (March 27, 2020)
• Centers for Disease Control and Prevention (CDC). Get Your Clinic Ready for  Coronavirus Disease 2019 (COVID-19): https://www.cdc.gov/coronavirus/2019-ncov/downloads/Clinic.pdf (assessed April 9, 2020)