WHO declared COVID-19 outbreak as a global pandemic on 11th March 2020. One year on and we are still haunted by the mysteries of this virus as more and more evidence accumulates supporting COVID-19 as a complex multisystem disease rather than just being restricted to the lungs.
The widespread perception is that COVID infection has the following probable outcomes – recovery in two to three weeks, hospital admission or mortality is severe cases. For some patients however, COVID 19 is not a discrete infection lasting a few weeks but marks the start of a long-term illness with ongoing and often debilitating symptoms. This is addressed as Long COVID. This diagnosis brings more uncertainty into picture and challenges the clinical, governmental assumptions about COVID.
Long COVID is perhaps the first illness name to be coined by patients themselves through social media. Persisting pain and fatigue is one of the prominent symptoms of Long COVID. This blog explores the relationship between COVID-19 infection and pain, including the pains related to acute infection and those persisting after the infection.
What type of pains does one experience at the time of acute COVID-19 infection?
Muscle pain and fatigue are commonly seen in acute COVID -19 infection with an incidence of approximately 44%. COVID-19 associated pain is described by most as a diffuse ache or soreness, similar to that one experiences after exercise. The difference being that these pains are not localised to one body part and take a longer time to resolve. Compared to the joint pains, muscle pains are more commonly seen in the acute phase.
Even the so called “mild COVID-19” cases can be troubled by miserable, debilitating symptoms such as headaches, body aches and extreme fatigue. Pains associated with acute COVID-19 infection and their incidence range are as follows
- Muscle & Joint pain 1.5 – 61 %
- Headaches 1.7 – 33.9%
- Sore throat 0.7 – 47.1%
- Chest pain 1.6 – 17.7%
- Abdominal pain 1.9 – 14.5%
What is the cause of COVID-19 infection associated pains?
The exact cause behind these pains remains unknown but generalise soreness, pain and fatigue are not uncommon with viral infections and most of us have experienced these with seasonal flu. Multiple mechanisms are postulated to be contributing to these pains such as
- Virus triggered inflammation and body’s immune response
- Direct muscle damage
- Blockage of blood vessels by clots leading to the poor blood supply to the muscles etc.
The relative contribution of these factors remains unknown. Besides these, stress and low mood play a role in modulating the pain perceived by an individual.
How can we manage these pains?
For most people these pains respond to simple painkillers such as paracetamol. If this is not sufficient then other pain killers can be used after consulting a specialist, as these need to be chosen carefully depending on your current health status, organ function and severity of COVID infection. Simple measures such as ensuring adequate hydration, nutrition and adequate rest may be helpful in reducing the pain.
How long do these pains last for?
For most individuals these will get better as one recovers in 2-3 weeks. However, in some patients it may persist for longer periods.
What is Long-COVID and what are its symptoms?
A study conducted in Italy evaluated 143 patients for persisting symptoms, 60 days after the initial onset of COVID-19 symptoms. In this study joint pains and chest pain were present in 27.3% and 21.7% of patients respectively. Other commonly present symptoms included fatigue (53.1%) and dyspnoea (43.4%).
Another study from China, involving 1733 patients found that six months after discharge 76% of patients had at least one of the these symptoms- fatigue/weakness (63%), difficulty sleeping (26%), hair loss (22%), altered smell and taste (11 and 9%), and mobility issues (7%).
These persisting symptoms are addressed as Long COVID with as incidence of around 10% (varying between 10- 70 % in different studies). These studies highlight the impact of COVID even after the resolution of the acute phase. Other commonly observed symptoms include inability to concentrate, impaired memory, anxiety, and depression.
Why do some people get long lasting symptoms?
There is uncertainty regarding the underlying mechanisms responsible for Long COVID. Some of the possible causes include
- A reduced response/ lack of immune response or long lasting changes in the immune system
- Relapse or reinfection of the virus
- New or relapsing inflammatory
- Injury to multiple organs
- Treatment side effects
- Post-traumatic stress.
What are the management options for Long-COVID?
Currently due to limited research and evidence, no specific treatments that can be offered as a cure. As the number of patients recovering from COVID-19 grows and research evidence accumulates, we may be able to answer this question better. Many patients, however, recover spontaneously with
- Holistic support
- Balancing rest with activity
- Symptomatic treatment and gradual increase in activity
- Individualized rehabilitation plans
- Controlling other comorbidities such as diabetes, blood pressure, heart and breathing conditions etc.
One can make sensible lifestyle changes such
- Following a healthy diet with weight management
- Not smoking
- Limiting alcohol and coffee
- Getting quality sleep
- Managing depression, anxiety and stress.
Protective role of supplements such as vitamins, if any remains unclear although maintaining normal levels is sensible.
Can Covid-19 infection cause flare-up of pre-existing arthritis?
Joint pains or arthritis after viral infections is not a new phenomenon with viral arthritis responsible for 1% of acute arthritis cases worldwide. In India joint pains after viral infections such as dengue and chikungunya are common. Concerns have been expressed regarding increase in severity of certain types of arthritis with COVID-19 infection, and how this unfolds in the future remains to be seen. Currently there are many published case reports with arthritic symptoms in lower limb and small joint of hand developing after COVID-!9 infection. Some of these patients have benefited from the use of anti-inflammatory medications and local joint injections.