COVID-19 and Pain

What do you wish the general public knew and really understood about this topic?

It is really important for both patients and healthcare professionals to be aware that pain is also a long COVID problem. It’s a very common symptom. When the first wave of the pandemic hit, we realized that months later many discharged patients had fatigue and breathing problems. But we didn’t expect so many to have musculoskeletal pain. But it kept coming up as the third most frequent long-term problem. It is to some degree a neglected issue because, in the beginning, not many people were aware of it. Since then we’ve had workshops and published papers and tried to make some noise around COVID-19 and pain. 

What observations have you made in regard to this topic?

The first thing we observed was that many patients – nearly 60% of those hospitalized with COVID – came in and had myalgia, or musculoskeletal pain, which was very pronounced. We later figured out that those who had severe myalgia during the hospitalization turned out to have more long COVID problems and more chances of developing long term musculoskeletal pain.

The other thing we observed was that those who had a previous musculoskeletal pain condition – for example osteoarthritis, neck and shoulder pain, back pain – they experienced that during the long COVID period or had an aggravation or facilitation of those pre-existing pain conditions. So this virus seems to trigger a much more aggressive immune response and fundamentally a more aggressive attack on the pain system. I think that’s why we see all these problems or these pre-existing conditions flare-ups up to a year later. 

We also observed that many patients had headaches during the hospitalization, and about 8% of the patients are still suffering from headaches a year later. And we also figured out that if you have had a pre-existing migraine, you are more vulnerable to develop more headaches, post-COVID.

What new knowledge about this topic do you hope is carried forward into the future?

We need to keep up our awareness. Because if you can say one good thing about this pandemic, it’s that we have thousands and maybe millions of people who have had the exact same viral infection. Some of those patients are developing pain. And some of those patients are not. Why? We have a unique research opportunity to try to disentangle the reasons. What are the fundamental mechanisms for why that's happening? And why is that important? We have so many other conditions where we don't understand why some patients with the exact same disease have pain and someone else doesn’t. So this type of inquiry can give us a lot of fundamental knowledge. If you look into the literature and data, they think that some of these mechanisms going on here can actually pave the way for developing new analgesics. It may trigger an entire new field of research, which will be helpful in the future.