What are the Pain Manifestations in Covid-19 Patients?

Synopsis

We are going through the Covid-19 pandemic caused by novel coronavirus originated in Wuhan province, China. The numbers of cases are on the rise since 31^st December 2019. It has been observed that Covid-19 patients often complain of muscular pain along with stomach pain, joint pain, and testicular pain. In a few rare cases, neuropathic pain has been reported. Pain manifestations in Covid-19 patients are estimated to be caused by occurrence and distribution of angiotensin-converting enzyme 2 (ACE-2). Patients who experience pain especially neuropathic pain do not respond effectively to therapies which further leads to development of depression that affects quality of life. Pain management in Covid-19 patients can be done with the help of painkillers, biopsychosocial management approach, usage of telemedicine, and modifying therapies in order to lower down the risks of Covid-19 complications. This needs to be done while continuing with the treatment.

Introduction

Coronavirus disease 2019 (COVID-19) has been posing as a threat to global health since it has originated in Wuhan, China. Till date, this disease has affected millions of people across the globe and claimed lives too. With each passing day, the coronavirus is getting stronger and more destructive in nature with new strains coming into the picture.

The World Health Organization (WHO) announced that the disease is caused by severe acute respiratory syndrome coronavirus. It can be spread from person to person and this explains its aggressiveness. COVID-19 transmits through the droplets expelled through coughing and sneezing by the affected person. The incubation period of virus ranges from 1 to 14 days and the commonly occurring symptoms are fever, dry cough, cold, fatigue. Alongside, patients also complain of having stomach pain, nasal congestion, sore throat, headache, myalgia, and arthralgia.

Pain experienced by Covid-19 patients includes headache, myalgia or muscle pain, arthralgia, stomach pain. Muscle pain is quite a common type of pain seen in patients while neuropathic pain is experienced by a very few people. Some patients also show signs of depression while they battle the virus.

The purpose of this article is to shed light on other clinical manifestations of Covid-19. Most often, these symptoms stay for longer even after the recovery and the patient has tested negative for coronavirus. Therefore, one has to follow the post-recovery protocols quite seriously. Taking enough rest and maintaining nutritious diet help in fighting off fatigue post recovery.

Musculoskeletal pain in covid-19 patients

It is one of the most common symptoms occur in Covid-19 patients. As per a meta-analysis study involving patients 59,254 from 11 countries concluded that 36% of the patients complain of muscle pain. Two studies carried out in Wuhan where the first patient of Covid-19 was found have concluded that muscle pain is common amongst patients.

Arthralgia or joint pain also occurs in Covid-19 patients with a pervasiveness of 10-15%. It is also recognized as one of the potential early symptoms of the disease. Studies carried out in different countries have confirmed that joint pain occurs in majority of people infected by the coronavirus.

Adult patients of Covid-19 are more likely to experience pain symptoms than paediatric patients. One study has categorized muscle pain or joint pain as a skeletal injury which is defined as a condition in which patients suffer from musculoskeletal pain and their serum creatinine kinase levels go up than 200 U/L. Along with it, these patients also show higher neutrophil count, lower lymphocyte counts, elevated levels of C-reactive protein, and D-dimers. Additionally, these patients were found to have multiple organ injuries, liver and kidney problems.

Stomach pain and testicular pain

Stomach pain is one of the commonly occurring symptoms in Covid-19 patients. ACE2 receptors found in the intestines are often responsible for diarrhoea in patients. Studies have found presence of SARS-CoV RNA in stool examination. Patients especially those who do not experience fever of muscle pain showed stomach pain, back pain, and testicular pain. This pain if often describe as throbbing sharp pain that starts in the groin region and spread through stomach, pelvis, chest, and back. These patients who show stomach pain often denies having sore throat or nasal congestion.

Stomach pain often arises in Covid-19 patients is due to two-way communication between the gut microorganisms and the brain especially the endocrine, the immune system, and nerves. The immune system has huge role in causing pain in Covid-19 patients. The coronavirus target ACE2 which is found in the intestines. This explains why patiemts often suffer from stomach pain.

Neuropathic pain in Covid-19 patients

Neuropathic pain is notified by pain that occurs due to a lesion or disease of the somato-sensory system. It can also develop due to underlying health conditions such as peripheral neuropathy, multiple sclerosis, stroke, spinal cord injuries or disorders, and infections. These underlying conditions often non-treatable and they also require chronic treatment options to eradicate the symptoms. Neuropathic pain patients often show not so impressive response to therapies and often diagnosed with psychological disorders such as depression and others which leads to decreased quality of life.

There have been several reports which explain the neuropathic symptoms found in Covid-19 patients. These are categorized into central nervous system manifestations such as headache, convulsions, acute cerebrovascular disease, loss of consciousness. The peripheral nervous system manifestations include loss of taste, loss of smell vision disorders, nerve pain etc.

Pain management in COVID-19 patients

The common symptoms are dry cough, fever, and other flu-like symptoms which can be taken care with the help of medications and enough rest in alignment with the protocols. Your doctor keeps you on painkillers depending on the severity of the pain and the affected body parts. A constant monitoring is required to check if the pain has spread from its original spot to other body parts so that changes in the treatment can be done.