Persistent COVID-19 and chronic pain. Are we prepared?: Presentation of three clinical cases and review of the literature

ABSTRACT

Long COVID is a term that describes a group of multiorganic symptoms that affect patients who have suffered from COVID-19 and who remain symptomatic for a sustained period of time after the acute phase of the disease. Amongst those symptoms, pain is one of the most frequently reported, shaping into different specific syndromes such as persistent thoracic pain, generalized pain, arthralgia, myalgia and cephalalgia. Multiple mechanisms can explain the onset and perpetuation of chronic pain in these patients. It is known that SARS-CoV-2 is a neurotropic virus that can alter the somatosensory nervous system and which can also cause an intense autoimmune response with effects on multiple organs and systems. We present three clinical cases of long COVID where pain was the main symptom altogether with anxiety, depression, insomnia, catastrophic thoughts related to pain, cognitive impairment and post-traumatic stress disorder. These all show the existing complexity in the management of this new-found entity. Given the extensive number of SARS-CoV-2 infections reported globally, chronic pain in relation to long COVID can become a public health issue. Therefore, it is necessary to make it visible and to establish strategies to prevent it and confront it.