Question of the Month – May 2020 Amber Borucki, MDAssistant Professor, AnesthesiologyUCSF Benioff Children’s Hospital You are the sole pediatric pain physician who is part of a small multidisciplinary clinic that includes a part time pain psychologist, physical therapist, and a nurse. You see patients on a thrice weekly regular basis. Your clinic provides the sole pain care to pediatric patients in a 100 mile radius for pain conditions ranging from musculoskeletal pain to oncologic pain. Your clinic is going well and your patients are expertly taken care of using a multidisciplinary approach with local medical community support to provide physical therapy, psychological therapy, procedural intervention (when necessary), integrative medicine, and social work. Your clinic has a stable patient list consisting of around 150 patients that you see in your clinic office, and you do about 5 interventional pain procedures per month. Unexpectedly, a novel coronavirus begins to infect thousands of people in a foreign country and creates a public health crisis. Eventually the virus spreads to your country, state, and finally your city. Due to concern for infection containment and to “flatten the curve”, your clinic must be closed to physical visits for an uncertain amount of time. You have been informed by your health administrators that your staff will now be advised to work remotely. Your patients are very concerned about how they will continue to receive care during your office closure and look to you for reassurance that you will continue to see them. You would like to continue to provide high level outpatient care to your patients to prevent acute pain exacerbations and emergency room visits, especially as you are the sole pediatric pain physician in your area. You begin to research your options regarding how to proceed with pediatric chronic pain care during the COVID-19 public health crisis. Which of the following statements is TRUE? A.) You are interested in providing video telemedicine visits by your multidisciplinary provider group, but can only offer this service to patients who are in your state due to restrictive federal licensing laws present in all states. B.) You have a couple of patients on chronic opioids, and must see them in person to refill prescriptions due to current restrictive legislation. C.) You have some patients on who are on chronic nonsteroidal anti-inflammatory medications. You can advise them to continue these medications, as there currently is not enough evidence that there are worsened outcomes with these medications D.) Pain procedures that are considered urgent based on ASRA’s COVID19 Guidance for Chronic Pain Patients include epidural steroid injections, trigger point injections, and radiofrequency ablation procedures.