Canadian Study Warns That SARS-CoV-2 Infections Lead To New Onset Of Chronic Pain In Post-COVID Stages
: The world was plunged into turmoil with the onset of the COVID-19 pandemic. This global crisis affected multiple facets of human existence, ranging from mental health struggles due to isolation to economic instability and physical health challenges. Among those most profoundly affected were individuals grappling with chronic pain, a burden that became even more complex and distressing in the context of the pandemic. This review study, conducted by experts from Université de Sherbrooke-Canada, Horizon Health Network-Canada and Memorial University of Newfoundland-Canada, delves into the intricate relationship between COVID-19 and chronic pain. The study explores epidemiological facts, risk factors, pathophysiological mechanisms, therapeutic interventions, and strategies for managing chronic pain patients during the pandemic. With an extensive review of existing literature, the study underscores the critical need to comprehend and address the emerging problem of new-onset chronic pain in post-COVID stages.
Identifying Risk Factors
Chronic pain is a debilitating condition that profoundly diminishes an individual's quality of life. To prevent the development of chronic pain, it's crucial to identify the risk factors associated with this condition in COVID-19 patients. Vulnerable populations such as the elderly and those with comorbidities face a higher risk of chronic pain following COVID-19 infection as validated in previous studies and also COVID-19 News
reports. Factors such as prolonged ventilation, immobility, neuromuscular block, and sepsis contribute to chronic pain risk.
Additionally, the psychological burdens of the pandemic, including social isolation and post-traumatic stress disorder, are linked to the development of chronic pain. Acute pain during the infection phase is also a risk factor for chronic pain, exacerbating the overall burden.
Unveiling the Pathophysiological Mechanisms
Understanding the underlying mechanisms is paramount in addressing chronic pain associated with COVID-19. The review identifies three main categories: systemic immune-inflammatory mechanisms, secondary mechanisms due to COVID-19 pathology or treatments, and direct neuropathic mechanisms. COVID-19's neurotropic nature, facilitated by the ACE2 receptors, leads to neuroinflammatory cascades, resulting in joint pain, myalgia, and other tissue pains. The study also suggests the involvement of angiotensin-converting enzyme pathways in pain transmission and modulation.
Exploring Therapeutic Avenues
The study delves into potential therapeutic options based on the pathophysiological mechanisms. Low-dose naltrexone, which influences proinflammatory cytokine secretion, emerges as a promising therapy. However, the study cautions against opioids due to potential side effects on the immune system. Non-steroidal anti-inflammatory drugs (NSAIDs) were initially considered problematic, but later recommendations refuted concerns, advocating for cautious use. Stellate ganglion blocks are proposed for patients with sympathetic nervous system overactivity, while the biopsychosocial model suggests a multidisciplinary approach involving physical therapists, psychologists, and social workers.
Navigating Treatment Strategies
The study outlines a comprehensive approach to treatment, considering urgency and context. Telemedicine
played a crucial role in managing chronic pain patients during the pandemic. Different patient groups require tailored strategies. For those with new-onset chronic pain due to COVID-19, telemedicine visits, virtual prescriptions, and in-person consultations are recommended based on urgency. Patients with pandemic-induced chronic pain require a biopsychosocial model, involving multidisciplinary care.
As the COVID-19 pandemic evolves into a persistent health issue, it's imperative to address the lasting impact on chronic pain. This review study highlights the need for a systematic approach, both in research and clinical management. While comprehensive insights have been garnered from existing literature, primary data studies are necessary for a deeper understanding. Generalizing findings requires a multicenter prospective study to ensure accurate data and effective management strategies.
COVID-19's influence extends beyond its immediate health implications, as chronic pain emerges as a post-pandemic concern. This comprehensive review study sheds light on the multifaceted relationship between COVID-19 and chronic pain. By dissecting risk factors, pathophysiological mechanisms, and therapeutic options, the study equips healthcare professionals with valuable insights to address this burgeoning issue. As the world navigates the post-pandemic landscape, a well-informed and nuanced approach to managing chronic pain becomes paramount. Through a multidisciplinary and patient-centered approach, healthcare providers can strive to alleviate the burden of chronic pain in the wake of the pandemic.
The study findings were published in the peer reviewed journal: Frontiers In Pain Research.
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