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Aug 12, 2021


Why Long Covid Patients Suffer Chronic Pain

Patients around the globe who have recovered from acute Covid-19 are discovering their suffering isn’t over. Many turn to their doctors for relief from chronic pain, including muscle and joint pain, severe headaches, and fibromyalgia. Studies at the University of New South Wales’s Kirby Institute are looking into the numerous ways the Coronavirus has affected these patients and why they now suffer from chronic, sometimes debilitating, pain.

Professor Gregory Dore noted that most patients who now experience chronic pain had mild to moderate cases of Covid-19, which surprised some researchers. Many test subjects who suffered from severe and lasting pain were healthy and active before becoming sick and first presented with chronic pain four to eight months after recovering from the initial infection.

“We are seeing many patients with headaches so severe they require an MRI,” Professor Dore noted. “Headache can be part of the acute illness, but it is also persisting in many patients months after they recovered from the initial infection. It’s much more prevalent than in the general population.”

Possible Culprits

 Early indicators point to possible nervous system inflammation as the culprit, but according to Dr. Daniel Carr, a pain specialist at Tufts University School of Medicine, there are three paths to chronic pain that can contribute to post-Covid pain:

  • A viral attack on tissues in the spinal cord, brain, and nerves.
  • Hyperactive inflammatory responses were attacking organs and tissues, creating a chain reaction in the body.
  • Blood clotting or thromboembolisms that can lead to complications such as tissue damage and gangrene.

Other doctors note that patients who spend extended periods in intensive care lying on their stomachs (to aid in breathing) may sustain permanent damage to the nerves and joints in elbows and shoulders.

The study confirms that more research is needed to determine ways to counteract the chronic pain suffered by many Long Covid patients.

Pain Mapping May Help Personalize Treatment of Chronic Pain

Mapping the location or locations of chronic pain may be vital to treating patients with a more personalized, effective approach, according to researchers at the University of Pittsburgh. Benedict Alter, the lead researcher, published the results of the study in the journal PLOS ONE.

The article indicates that patients with chronic pain syndromes that have been perceived as distinct conditions may share relevant characteristics, including the impact that pain distribution in the body has on successful treatment. The data accumulated from patients in the study determined nine distinct pain distribution patterns, with variations across each in pain intensity and impact. The lowest impact was seen in patients in the Neck and Shoulder Pain group, while the effect on those in the Neck, Shoulder, and Lower Back Pain group was higher. The greatest pain intensity was in patients with widespread pain throughout the body.

According to the article’s authors, “Using an algorithmic approach, we found that how a patient reports the bodily distribution of their chronic pain affects nearly all aspects of the pain experience, including what happens three months later. This emphasizes that chronic pain is a disease process and suggests that this facet of the chronic pain phenotype will be important for future developments in diagnosis and personalized pain management.”

The Demographics of Opioid Treatment for Chronic Pain

The long-running debate about the over-prescribing of opioids has once again come to the forefront as the CDC has released statistics on who is most often prescribed opioids for chronic pain and who isn’t. A new study at the Centers for Disease Control indicates that only 22 percent of individuals suffering from chronic pain used opiates in the three months prior. That leaves three-quarters of patients without access to the most effective form of pain relief.

The study explored the demographics of patients who did and didn’t receive opioid prescriptions and found distinct trends in prescribing patterns. The most likely recipients of opioids are females between 45-65 years of age, who lived in rural areas, and were unemployed. Non-veterans, Black people, and those living below the poverty level were also more likely to be prescribed opioids.

Those least likely to use prescription opioids included males between 18-30 years of age, military veterans, those with private insurance, and individuals with higher incomes. Hispanics, individuals with a college education, and metropolitan dwellers were also less likely to use opioid medications.

While the study shows an apparent disconnect between the socioeconomic and demographic parameters between those who used opioids and those who don’t, there are limits to the study, which doesn’t consider restrictions placed by insurers and agencies such as the Veterans Administration. However, there does seem to be a correlation between opioid use for chronic pain and unemployment, lack of education, and poverty.

AMA Continues to Criticize CDC Guidelines for Opioid Prescriptions

The battle between the CDC and the American Medical Association over opioid prescribing guidelines, which started three years ago, continues to rage. The AMA’s initial objection called on the CDC to revise the policies, which were being misapplied and misused by some physicians, pharmacists, and insurance companies to establish harsh limits on how much medication patients could be prescribed, in some cases making opioids unavailable altogether. According to the AMA, this left many chronic pain patients in terrible, debilitating pain.

The CDC has acknowledged that the guidelines, established in 2016, have been used to justify unreasonable limits or stop opioid treatment for patients who needed the pain relievers after surgery or when suffering from cancer or chronic pain. However, the new president of the AMA stressed that nothing much has changed.

“Reports we get from patients and physicians suggest that problems remain. Despite CDC acknowledging that its guidelines should not be used as hard thresholds, there has been almost no effort by state legislatures, health insurance companies, pharmacy chains, or PBMs (pharmacy benefit managers) to evaluate the harmful effects of these one-size-fits-all laws,” explained Gerald Harmon, MD. “The AMA continues to receive reports that the laws are used to deny, for example, prescriptions for opioid therapy for patients with cancer or in hospice as well as long-time, stable patients with chronic pain.”

The CDC is currently reviewing the guidelines behind closed doors, relying on a panel of physicians and pain specialists as well as input from the public. Any revisions are expected to be announced some time in 2022.

This Week’s Pain Fact:

There are biological differences in how men and women perceive pain, with women 21.7 percent more likely to experience chronic pain. The culprit? Glial cells, which are the primary regulators in neural function and synaptic transmissions in the brain. Glial cells sense anomalies in neural activity and respond accordingly. Women have nearly twice as many glial cells as men, making them more susceptible to pain.

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