Manifestation of Borderline Personality Symptomatology in Chronic Pain Patients Under Stress: An Understated and Exacerbated Consequence of the COVID-19 Crisis
Hannah Shapiro, 1 Ronald J Kulich, 2, 3 Michael E Schatman 3, 4 1Department of Biopsychology, Tufts University, Medford, MA, USA; 2Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA; 3Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 4Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USACorrespondence: Michael E Schatman Tel +1 425 647-4880Email Michael.Schatman@tufts.eduTo the best of our knowledge, no one has ever suggested that it is “easy” to suffer from intractable chronic pain, with some subgroups impacted more than others. This burden has had a particularly strong impact in the United States, where the chronic pain treatment system has demonstrated failings with respect to access to care1–8 Because chronic pain is so poorly treated in the United States, patients have struggled not only with their pain and its sequelae but also with mounting frustration and downstream psychological consequences. Depression and suicidality have been linked to poorly controlled pain,9,10 and the authors of a recent study11 noted that these phenomena are a concern within the context of opioid tapering. Similarly, Lembke has recently acknowledged that even mention of tapering can trigger severe anxiety in chronic pain patients,12 with data supporting the relationship between undertreated chronic pain and anxiety.13,14 Although myriad investigations have supported the existence of a reciprocal relationship between chronic pain and depression15–17 as well as between chronic pain and anxiety,18–20 detailed discussion of causality is beyond the scope of this analysis.