A small team of French researchers suggest that some patients with COVID-19 develop neuropathic pain within weeks or months of infection, and that patients with neuropathic pain and COVID-19 sometimes have worsening neurological complications and / or pain exacerbation. The researchers presented these results in the publication Pain Reports.
Viral infections can affect the peripheral or central nervous system and ultimately lead to neurological complications. Documented neurological complications of COVID-19 include, in particular, Guillain-Barre® syndrome, myelitis, and stroke.
The researchers routinely observed 50 patients who have been exposed to the novel coronavirus, which is responsible for COVID-19, and who also have chronic neuropathic pain caused by either peripheral or central lesions. All patients who survived reported worsening of their neuropathic pain over several weeks or more. The researchers suggest that the neurotoxic effects of the virus due to the high tropism of COVID-19 on the nervous system may be aggravated in patients with a pre-existing neurological injury.
The researchers state that neuropathic pain can either be caused indirectly by COVID-19 following intensive care, such as prone position or traumatic surgery, or it can be caused directly by the influence of SARS-CoV-2 on the nervous system.
Although the risk of stroke after SARS-CoV-2 infection appears low, some evidence suggests that acute ischemic stroke may occur in some hospitalized patients with COVID-19. Long-term neuropathic pain may then develop in these patients.
According to the small research team, before starting treatment, clinicians should remain diligent in order to first differentiate between other causes of COVID-induced pain and neuropathic pain.
While the use of nonsteroidal anti-inflammatory agents may be appropriate in some patients with COVID-19, some groups have raised concerns about the use of these therapies in this population. The mainstays of neuropathic pain management include gabapentinoids, antidepressants, tramadol, and topical agents. Strong opioids may be used in some patients with refractory pain, and non-pharmacological treatments such as invasive or non-invasive neurostimulation techniques may be considered.
The researchers concluded that, in the near future, “it will be of interest to prospectively follow patients with chronic pain affected by COVID-19 and determine whether the risk of pain exacerbation in neuropathic patients compared to patients without neuropathic pain is different.
Attal N, Martinez V, Bouhassira D. Potential for increased prevalence of neuropathic pain after the COVID-19 pandemic. Pain Rep. 2021; 6 (1): e884. doi: 10.1097 / PR9.0000000000000884
This article originally appeared on Clinical Pain Advisor