Pain as clinical manifestations of COVID-19 infection and its management in the pandemic era: a literature review

Abstract

Coronavirus disease 2019 (COVID-19) is a current global pandemic. The case number has increased since December 31, 2019. It has been reported that COVID-19 patients have been giving pain complaints, one of which is muscular pain. Other types of pain that have also been reported by COVID-19 patients are joint pain, stomach pain, and testicular pain. Neuropathic pain is the rarest case among others. COVID-19 mechanisms in the nerve and musculoskeletal damage are believed to be caused by the expression and distribution of angiotensin-converting enzyme 2 (ACE-2). Patients with pain, especially neuropathic pain, normally do not respond well to various therapies, and experience psychiatric disorders such as depression, which leads to a decrease in the patient’s quality of life. Important considerations for health professionals in terms of pain management during this pandemic include ensuring treatment continuity, painkillers, utilization of telemedicine, biopsychosocial management approach, and modifying therapy needs to reduce the risks of COVID-19 complications.

Depression and COVID-19 patients with chronic pain: practical considerations

“…We read with interest the literature review by Widyadharma and colleagues on pain as clinical manifestations of coronavirus disease 2019 (COVID-19) and its management in the pandemic era. The authors highlight the association of psychiatric disorders such as depression to pain in these patients, which leads to a significant decrease in the quality of life [ 1 ].…”

“…In their review, the authors also make reference to the use of opioids, non-steroidal anti-inflammatory drugs, and corticosteroids in patients with COVID-19 [ 1 ]. Taking into account the assumptions made, are any special recommendations necessary regarding the use of antidepressants in these patients?…”

“…Taking into account the assumptions made, are any special recommendations necessary regarding the use of antidepressants in these patients? We are aware that most clinical practice guidelines concur that tricyclic antidepressants (amitriptyline) and serotonin and noradrenaline reuptake inhibitors venlafaxine and duloxetine are first-line drugs for the treatment of peripheral neuropathic pain [ 7 ], which may also be present in patients with COVID-19 [ 1 ]. In the event that the patient is undergoing treatment with drugs for COVID-19 which prolong the QTc interval, normally under clinical trial, we must check that they do not interact with the antidepressants.…”

Efectos a largo plazo de la COVID-19: una revisión de la literatura

“…La expresión de la ECA-2 en las células del sistema nervioso periférico (SNP) y músculo liso, así como la TMPRSS2 en las células del músculo esquelético y la membrana sinovial, permiten la entrada del SARS-CoV-2, una vez infectadas, hay replicación viral, muerte celular, respuesta inmune alterada y liberación de citocinas proinflamatorias que inducen proteólisis de las fibras musculares, evitan su proliferación y diferenciación mientras aumentan la proliferación de fibroblastos musculares, provocando debilidad muscular y atrofia, también inducen la liberación de prostaglandina E2, mediador álgico conocido que actúa sobre los receptores periféricos causando mialgias y artralgias. [50][51][52][53]…”

Coronavirus Disease and Abdominal Pain: Mechanism, Diagnostic, and Treatment

“…According to Widyadharma et al [1], the mechanism of pain in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients "is associated with two-way communication between the gut microbiota and the brain, namely, between the endocrine (cortisol), the immune system (cytokines), and nerves (vagus nerve and enteric nervous system)." Namely, ACE2 receptors which are the target of SARS-CoV-2, in humans, are found on the luminal surface of the redifferentiated small intestinal epithelial cells and in crypt and colon cells [1], [2]. It is implied that the described mechanism is the reason for presentation of abdominal pain without respiratory symptoms in some, atypical, SARS-CoV-2positive patients.…”