Pain can be a symptom of PASC, especially pain in the joints, pain while breathing, muscle pain, and chest pain. Pain is your body’s way of signaling to you that something may be wrong. Pain can vary widely in severity, from being a mildly uncomfortable sensation to becoming a debilitating condition. Pain also varies widely in feeling; it may be felt as a throbbing, aching, cramping, stabbing and many more sensations.
There are three different ways that your body experiences pain. The first is called nociceptive pain which warns you of danger and is an example of your body correctly signaling to you that something is wrong. This pain is generally short-term and can include pain from injury, tumors, inflammation, and pain after surgery.
Neuropathic pain is the type of pain associated with damage to the nervous system, either peripheral or central. When your nervous system is damaged, normal messages of nociceptive pain may be fired excessively or abnormally. This pain differs from nociceptive pain in that the sensation of pain has lost its function of letting you know something is wrong. This is a disorder of the pain warning system itself. This type of pain includes but is not limited to neuropathy, severed nerves, and damage to the nerve cells in the brain or spinal cord.
Nociplastic pain occurs when the processing of nociceptive signals is augmented by the brain resulting in “normal” nerve signals being interpretated as painful. This is also known as “centrally augmented pain.” Contributing factors include genetics, hormone abnormalities, trauma, and stress.
The mechanism of COVID-19 in causing pain as a symptom of PASC is unknown, although it is thought that inflammation and viral infection may play a role. It is known that inflammation can cause pain because as body tissues swell, they begin to put pressure on your nerves which signal to your brain that something is wrong. Your brain then signals to you that something is wrong through the feeling of pain. COVID-19 is known to cause inflammation, so this may be a mechanism for how COVID-19 increases risk of pain. The presence of pre-existing conditions known to cause inflammation, such as obesity and diabetes, may also increase your risk of developing this symptom.
Stress and anxiety may also play a role in the development of pain from PASC. It is known that the COVID-19 pandemic has caused widespread stress and anxiety, so the conditions are right for stress to play a role in the onset or exacerbation of pain as a symptom of PASC.
Seeing a Doctor for Pain
When deciding to seek professional care for pain associated with PASC, the first healthcare provider to see is a primary care physician. A primary care provider may be able to diagnose and treat your pain, but they also may decide to refer you to a specialist, such as a neurologist.
When diagnosing pain, a healthcare provider will likely ask you the location and severity of your pain, as well as how often it occurs, how it affects your quality of life, if anything makes it better or worse, if you experience a lot of stress, and if you have had any illnesses, such as COVID-19. Other diagnostic tests may include blood tests, electromyography, X-ray, MRI, nerve studies, reflex and balance tests, lumbar puncture, or urine test. The goal of these tests is to identify the cause of the pain and ensure your pain is not caused by something unrelated to COVID-19.
When managing pain, certain medications may be helpful, including over the counter and prescribed drugs. These include acetaminophen, gabapentinoids, antidepressants, anti-anxiety drugs, cannabinoids, muscle relaxers, opioids, and NSAIDs. Various types of therapies can also be helpful in managing pain, including cognitive-behavioral therapy, acupuncture, acceptance and commitment therapy, physical therapy, occupational therapy, emotion awareness and expression therapy, and massage and spa therapy. Your doctor also might prescribe devices to assist in managing your pain, like braces, traction, biofeedback, light therapy, ultrasound, and transcutaneous electrical neuromuscular stimulation. Your doctor can give you detailed explanations of these tests and treatments, so you can make an educated decision on which treatment may be best for you.
Tingling or numb sensations can be felt all over the body but are commonly experienced in the arms, hands, legs, and feet. Called parasthesia, these sensations are generally painless but can be very uncomfortable.
Causes of paresthesia are known to include many viral infections and their post-virus syndromes, so it is possible that the nature of COVID-19 and PASC, in that they occur from a virus, can increase risk of the onset of paresthesia. Paresthesia is also known to be partially caused by inflammations in the body. A systemic effect of COVID-19 infection and PASC is inflammation, so it is possible that this inflammatory response to the virus may induce the onset of paresthesia.
Factors that increase the risk of developing paresthesia include nervous system disorders, post-infection syndromes, infections, autoimmune diseases, vitamin imbalances, diabetes, tumors, kidney disease, liver disease, connective tissue disorders, alcoholism, medications, and nerve pressure or trauma. Having one or more of these risk factors likely increases your risk of developing paresthesia as a symptom of PASC.
Seeing a Doctor for Tingling Sensations
If paresthesia becomes consistently painful, it may be time to seek professional help. Your primary care physician may be helpful in determining whether your paresthesia is normal or may need specialist attention. Your primary care provider may refer you to a neurologist, a specialist who can assess and treat your paresthesia.
Diagnostic tests may include a neurological exam, blood tests, imaging, nerve function tests, nerve biopsy, and skin biopsy. Treatment may include medication, such as pain relievers, anti-seizure drugs, topical treatments, or antidepressants. Your doctor may also recommend a therapeutic or procedural option, for example, transcutaneous electrical nerve stimulation, plasma exchange and intravenous immune globulin, or physical therapy. Your doctor will provide you with guidance in determining which treatment, or combination of treatments, is right for you based on your symptoms and the diagnostic tests they perform.