Pain in Covid Era

Abstract

The COVID19 pandemic has impacted the lives and health of persons worldwide and although majority of COVID19 patients present with respiratory symptoms, pain emerges as an important feature of COVID19 infection. About 15–20% of patients progress to a severe condition that requires hospitalization. Although the disease was initially reported as a respiratory syndrome, other systems such as cardiovascular, renal, and nervous systems may be affected in the acute stages, increasing the need for continuous support to treat multiple sequelae caused by the disease. Due to the severity of the disease, damages found after discharge should also be considered. Providing multidisciplinary interventions promoting physical and psychological recovery in the first stages of hospitalization can minimize these damages. Cognitive, physical and psychological dysfunction reported by COVID19 patients after discharge can have profound effects on quality of life. Pain is usually part of this dysfunction, but it is still poorly understood how it affects survivors of COVID19 infections. There is limited information about the clinical characteristics, treatment and outcome of maintenance of pain in COVID19 patients. The purpose of this narrative review is to provide an overview of the implications of COVID19 on acute and chronic pain states.

Covid-19 Hastalarında Başvuru Şikayetleri

“…Like most viral infections where pain is a very common symptom, COVID-19 patients commonly show headaches, sore throats, myalgia, arthralgia, or peripheral neuralgias, and pain is considered to be an important symptom (23). Recognizing that COVID-19 triggers chronic pain and exacerbates pre-existing chronic pain will be of great importance for a better understanding of the disease (24). COVID-19 does not limit itself to just a simple lower respiratory tract infection, but can cause serious systemic disease and affect the nervous system (25).…”

The pain in the Emergency Department: Choosing and treating wisely before and during the COVID-19 era

“…As most of the viral infections, pain is quite common also in COVID-19 infected patients, who can differently complain myalgias, arthralgias, abdominal pain and headache. 114 As reported in two recent reviews by Widyadharma et al 115 and Alonso-Matielo et al, 116 muscle pain or myalgia is one of the most frequent symptoms among COVID-19 infected patients, while neuropathic pain is rarely reported, do not respond well to different therapies, and can be associated with psychiatric disorders, e.g., depression, which can significantly decrease the patient's quality of life. 117 COVID-19 patients can be admitted to the ER for acute abdominal pain, 118 or complaining gastrointestinal symptoms, such as vomiting and diarrhea.…”

Coexisting Substance Use Disorder and Chronic Pain During COVID-19

“…Vulnerability to severe to COVID-19 infection. The COVID-19 pandemic created vulnerabilities in populations of older adult, racial/ethnic minority, those with lower income, and those with chronic co-morbidities, such as persistent pain, resulting in more severe COVID-19 infection (Eccleston et al, 2020;Alonso-Matielo et al, 2021). Increasingly appreciated are how the social determinants of health and stress of social injustice may also play a role in vulnerabilities.…”

“…In fact, 90.5% of patients complain of headache, and 36% of patients complain of myalgias. These pain conditions appear to originate from inflammatory mechanisms or from immune-mediated processes in the central nervous system and the peripheral nervous system, respectively (Drozdzal et al, 2020;Alonso-Matielo et al, 2021). Specific to headache, the effects of the viral infection on pulmonary tissue activates an immune cell and pro-inflammatory response creating central cytokine overexpression.…”

“…Elective surgeries and outpatient procedures which could relieve chronic pain, such as epidural steroid injections (ESI) or facet joint injection, have been reduced (Carrillo-de-la Pena et al, 2021;Eccleston et al, 2020). Acute pain management service teams have been diverted into the intensive care units, and available chronic pain services have decreased (Alonso-Matielo et al, 2021). During the peak of pandemic, there were medication shortages and a scarcity of resources such as ventilators or ECMO, with only emergency services available (Eccleston et al, 2020;Manchikanti et al, 2021).…”