COVID-19 & Pain: Acute and Postinfection Manifestations
Pain is a common complication of COVID-19 infection, during the illness and afterwards. Click through this summary of new data on acute pain and risk for persistent pain from COVID-19.
A common complication of coronavirus disease 2019 (COVID-19) that merits particular vigilance from doctors—when their patients have it and after—is pain, according to the authors of a recent review in Pain Reports. In it, they summarize incidences of acute pain during COVID-19, disorders accompanying COVID-19 that increase the risk of persistent pain, and the implications for patients who have chronic pain.
Key points from the Pain Reports article are highlighted in the slides below.
COVID pain has many faces. Acute pain that accompanies infection may be classified as localized (eg, sore throat), remote (eg, headache), or generalized discomfort (eg, body ache). COVID–19-associated pain may result from the neurotropic properties of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) or from an autoimmune response. Chronic pain can be a complication of ICU treatment or secondary diseases associated with infection (eg, Guillain–Barré syndrome, polyneuritis). Disrupted health care and the pandemic’s psychological burden may exacerbate pre-existing chronic pain.
Acute pain may be a clinically relevant manifestation. In the first days of infection with SARS-CoV-2, in addition to the main clinical signs that indicate a respiratory infection (cough, fever, and rhinorrhea), patients often complain about acute pain in proximity to the respiratory tract (sore throat, pharyngalgia) along with remote and generalized pain. Headache and myalgia, the most common acute pain manifestations, occur in up to 71% of patients. Coinfection with SARS-CoV-2 and influenza virus seems to potentiate the occurrence of pain symptoms.
Acute pain with neurologic complications. Some more specific pain symptoms arise from neurologic manifestations in patients with SARS-CoV-2 infection. Pain has been described with peripheral nervous system (PNS) and CNS involvement. In patients hospitalized for COVID-19, CNS disorders were reported in 25% and PNS symptoms in 9%; 5% of PNS symptoms were described as neuropathic pain and 23% had muscle affection. Myalgia has been identified as the fifth most common symptom during COVID-19.
Postinfectious pain and long-term complications. There are few data on the long-term complications of COVID-19. A few months after onset of first COVID-19 symptoms in an Italian cohort, a high proportion still reported pain, mostly joint pain and chest pain. After a mean of 110.9 days in a French cohort, chest pain was the only reported pain symptom from a list of post-discharge persistent symptoms. In a UK cohort 48 days after discharge, pain was the sixth most frequently reported persistent symptom. Pain is common in patients who are seriously ill because of COVID-19 infection.
What impact on chronic pain. Patients with pre-existing chronic pain may experience an exacerbation of symptoms during the pandemic because of disrupted health care services, socioeconomic disadvantages, and psychological stressors. In a German study, chronic pain intensity remained stable or improved within the first 2 weeks after the initial lockdown (though mood worsened), but in another study, 73.2% of patients reported a worsening of their pain disorder in the later pandemic phase.
An eye toward prevention. Pathomechanisms responsible for the pain that accompanies COVID-19 may include viral neurotropic properties, activation of nociceptive sensory neurons by cytokines and chemokines, direct affection of peripheral nerve and muscles, and autoimmune reactions. The social and economic consequences of the pandemic also may have an effect on pain
Support for post-COVID patients. In addition to vigilance from doctors, the authors recommend the establishment of special programs for post–COVID-19 patients to prevent persistent pain and other neuromuscular symptoms.
