Chronic Pain severely compromises patient’s Daily activity, Quality of Life, Sleep and causes sufferings in personal, social, economic life [1]. In the UK, more than 50% of old populations expressed chronic pain as one of the important causal factors for affecting Quality of Life [2].

Elderly patients with comorbidities & chronic pain increase risk of COVID 19 by immune suppression. Almost 88% of chronic pain patients have comorbidities for example cardiovascular diseases, Lung Diseases, Diabetes, Cancers, depression etc. Posttraumatic nervous system sensitisation and Autonomic dysfunction with inflammatory changes causes Complex regional pain syndrome (CRPS) [3-6].

Chronic pain is a common symptom in the elder age group. According to ICD 11, chronic pain puts into 7 categories, Primary pain, Cancer related, Post-surgical, Post-traumatic, Neuropathic, Musculoskeletal, visceral, orofacial. Most chronic pains are Musculoskeletal in nature (e.g., Low back pain, neck pain & joint pain etc) [7-9].

During this pandemic, routine care & follow up and painreducing medications, regular activity, psychosocial, behavioural modifications can improve Chronic Pain management.

1. Infection Control: CDC recommends Temperature check, Face Mask, Gloves, Hand Hygiene, cleaning of surfaces of caregiver areas. Triage and screening of patient for covid-19.
2. Immune suppressor Pain Modulation: Significant ImmunecResponse changes increase the risk of mortality in comorbid patients.
3. Opioids: causes immune suppression, endocrine changes, respiratory suppression and increase secondary infection rate.
4. Steroid: Oral or injections formula widely used for musculoskeletal pain. Steroid causes Adrenal insufficiency, myopathy, osteoporosis, immune response alteration, increased influenza risks etc. Oral has more side effects than topical. Any new addition of steroid medication should be discussed with Infectious disease expert.
5. NSAIDS: should be used if needed, strict stepladder pain modulation, appropriate medications should be used, and monitoring should be done for adverse effects.
6. Neuropathic Pain: Tricyclic antidepressants, Gabapentin, Pregabalin, SNRI (venlafaxine, duloxetine) are used as first line for neuropathic pain and assessed for side effects.
7. Psycho-Social Therapy: Chronic pain increases anxiety, depression, suicidal tendency etc. Patient with chronic pain should be evaluated psychologically, Socially and appropriate action (psycho-social support) should be taken.
8. Follow-up: Follow up visit increase patient’s compliance with the medication and reduces pain burden. Telemedicine and Telehealth play important rule here by avoiding unnecessary hospital visit [10-12].

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