The treatment of pain in recovered COVID patients poses unique challenges, said a pain expert presenting at the American Academy of Pain Medicine virtual meeting.
“A lot of these patients are going to need rehabilitation” or physical therapy, noted Natalie Strand, MD, of the Mayo Clinic in Scottsdale, Arizona, at the meeting. “There can be quite a bit of deconditioning that occurs, especially after a prolonged ICU stay. Neuropathic pain is also quite common.”
Post-COVID neuropathy may be viral or else possibly related to patient positioning, including prone positioning. Some patients “may need short-term opioids or gabapentinoids and they may experience aggravation of prior underlying pain, either due to direct physical causes or to the increase in anxiety and depression that can accompany a COVID infection,” Dr Strand said.
A study that followed 143 patients two months after acute COVID showed a high proportion reported persistent symptoms — including fatigue (53%), joint pain, (27%) and chest pain (22%) — that often results in patients going to a pain clinic for care, she noted.
Persistent pain remains prevalent, following any ICU admission, ranging from 28% to 77%, according to Dr Strand.
Chronic neuropathic pain after a COVID patient’s ICU stay can include muscle pain related to joint contractures or muscle atrophy, and pain due to critical illness myopathy or polyneuropathy. In addition, peripheral nerve injuries have been associated with prone positioning for COVID–related acute respiratory distress syndrome, Dr Strand added. Complications from traumatic procedures like placement of chest tubes or tracheotomy can also cause chronic neuropathic pain.
Dr Strand noted that pain can persist after discharge of COVID patients, as indicated by follow-ups. In China, three-quarters of patients previously hospitalised with COVID continued to report at least one symptom 6 months later, with fatigue or muscle weakness by far the most common symptoms (63%). “Compared with 2-month follow up, 6 months later we see the same trends,” she pointed out.
In that study, “13% of the patients who did not develop an acute renal injury during their hospital stay and presented with normal renal function exhibited a decline in GFR at follow up,” Dr Strand noted. This may signal caution about using NSAIDS to manage pain in some patients, she said: “Normal renal function at discharge does not necessarily mean it will remain this way 6 months afterwards.”
There may be a relationship with the SARS-CoV-2 virus and chronic neuropathic pain, Strand observed. In a recent article in Pain Reports, “the authors concluded it could be direct or indirect effects of the virus on the nervous system that can cause neuropathic pain,” she noted. “We know that there are neuropathic symptoms involved with the famous loss of taste and loss of smell with presentation,” she continued. “But also in the acute phase, we commonly see headache, dizziness, muscle pain, ataxia, and in hospitalized patients we see stroke, meningitis, encephalitis, and autoimmune disorders like Guillain-Barré syndrome and acute disseminated encephalomyelitis.”
Psychological stressors can also be related to the emergence of chronic pain, added Dr Strand. “Anxiety and depression often follows COVID-19 infection,” she said. “It may be wise to screen our patients for anxiety and depression after infection to see if we can further control these components to help manage their pain overall.”
Source: MedPage Today
Presentation information: Strand NH “Treating the COVID-Recovered Patient: An Evolving Understanding” AAPM 2021.
