The COVID‐19 pandemic and its consequences for chronic pain: a narrative review

Abstract

Summary The COVID‐19 pandemic transformed everyday life, but the implications were most impactful for vulnerable populations, including patients with chronic pain. Moreover, persistent pain is increasingly recognised as a key manifestation of long COVID. This narrative review explores the consequences of the COVID‐19 pandemic for chronic pain. Publications were identified related to the COVID‐19 pandemic influence on the burden of chronic pain, development of new‐onset pain because of long COVID with proposed mechanisms and COVID‐19 vaccines and pain interventions. Broadly, mechanisms underlying pain due to SARS‐CoV‐2 infection could be caused by ‘systemic inflammatory‐immune mechanisms’, ‘direct neuropathic mechanisms’ or ‘secondary mechanisms due to the viral infection or treatment’. Existing chronic pain populations were variably impacted and social determinants of health appeared to influence the degree of effect. SARS‐CoV‐2 infection increased the absolute numbers of patients with pain and headache. In the acute phase, headache as a presenting symptom predicted a milder course. New‐onset chronic pain was reportedly common and likely involves multiple mechanisms; however, its prevalence decreases over time and symptoms appear to fluctuate. Patients requiring intensive support were particularly susceptible to long COVID symptoms. Some evidence suggests steroid exposure (often used for pain interventions) may affect vaccine efficacy, but there is no evidence of clinical repercussions to date. Although existing chronic pain management could help with symptomatic relief, there is a need to advance research focusing on mechanism‐based treatments within the domain of multidisciplinary care.

Sleep Quality Mediates the Effect of Sensitization-Associated Symptoms, Anxiety, and Depression on Quality of Life in Individuals with Post-COVID-19 Pain

“…The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, responsible for coronavirus disease 2019 (COVID- 19), is primarily considered a virus affecting the respiratory system; however, a multisystemic affection including neurological, gastrointestinal, and cardiological manifestations, as well as multiple organ failure, have been seen in severe COVID-19 patients [1]. The affectation of different systems leads to a plethora of symptoms during the acute phase of the infection such as fever, dyspnea, throat pain, diarrhea, chest pain, confusion, and others [2].…”

“…Others have reported incidence rates ranging from 1.7% to 33.9% for headache, from 1.5% to 61% for myalgia or arthralgia, from 1.6% to 17.7% for chest pain, and from 1.9% to 14.5% for abdominal pain [ 17 ]. The most accepted theory explaining post-COVID-19 pain is that the systemic inflammatory–immune response (i.e., long-lasting cytokine storm) can lead to an excitability of peripheral/central nervous systems throughout direct/indirect pain pathways [ 18 , 19 ]. A prolonged excitability of the nervous system could promote the presence of sensitization mechanisms in these patients.…”

Prevalência e interferência da dor crônica em idosos que vivenciaram a COVID-19: estudo transversal

“…Outras regiões apresentaram a mesma porcentagem (9,1%) sendo elas: a região do peito direito, abdômen inferior direito, coxa direita, região lombar esquerda/direita e perna direita. enfrentamento da dor crônica podem ser importantes aliados na recuperação e promoção dos níveis da capacidade funcional nas atividades diárias nesta população 10 .…”

An analysis of neuropathic pain, vasomotor manifestations, and sympathetic skin reactions in post-COVID-19 patients relative to healthy individuals

“…[6] Pain associated with COVID-19 infection may originate from 1 of 3 sources: systemic inflammatory immune mechanisms, primary neuropathic mechanisms, or secondary mechanisms stemming from COVID-19 pathology or its treatment. [7][8][9] Neuroinflammation could be attributed to direct viral penetration into the central nervous system via the neuropilin-1 receptor located in the olfactory cavity or due to the blood-brain barrier disruption. [10] Whether the autonomic nervous system is affected post-COVID-19 remains uncertain.…”