Coronavirus Concerns for Chronic Pain Patients

COVID-19 has remained a central topic for countries all over the world since it reached pandemic status in early March, yet none have been hit as hard as the United States. To date, roughly 157,000 people have died because of complications surrounding a coronavirus infection, with elderly and immunosuppressed individuals struggling the most. While we have learned much about the virus over the past few months, there is still no medication and no vaccine proven to protect the body against this infectious disease.

There is no consistent case fatality rate as countless factors affect how often people die once infected with COVID-19. Given current statistics, we know that most people who become infected survive. This, in part, has contributed to the virus’ spread, as we now know that even asymptomatic individuals can spread it. While most people seem to recover quickly, a significant portion of people either survive with short-term or long-term deficits or die because of severe complications.

Individuals with weakened immune systems and a history of heart and lung conditions are more at risk. Age has also correlated with adverse effects. Both immunosuppression and advanced age also tend to intersect for chronic pain patients, in part because of the pain-related symptoms of some autoimmune diseases, as well as the immunosuppressive effects of several forms of pain treatment, particularly corticosteroids, biologic drugs, and opioid medication.

Potential Long-Term Health Effects of Coronavirus

One of the biggest concerns regarding COVID-19 is the disease’s potential for long-term adverse effects. Current research on the topic is limited, and doctors don’t know why or how many people are affected by COVID-19 long after they’ve recovered. Among those who do experience long-term issues, documented symptoms have included:

• • Persistent loss of smell and taste
  • Shortness of breath
  • Increased joint pain
  • Fatigue
  • Increased heartbeat
  • Brain fog

Research on the subject has brought mixed results. One study from Italy concludes that about 87 percent of surveyed chronic pain patients were still struggling with symptoms two months after being hospitalized for COVID-19. A study relying on app data from chronic pain patients in the US, UK, and Sweden suggest a more conservative rate of 10-15 percent for lingering long-term complications.

Whether these symptoms are in any way related to a chronic pain patient’s history or prior health conditions, and in what way, isn’t clear. But there may be signs that COVID-19 might trigger the onset of chronic conditions in a significant percentage of survivors. How these overlap with existing chronic pain issues is yet unknown. What we do know about chronic pain and COVID-19 is mostly related to the immune system, and the effects of chronic pain medication.

Chronic Pain Management and the Immune System

Chronic pain is defined as pain lasting longer than three months. Because pain is subjective and difficult to trace, it is sometimes difficult to diagnose chronic pain. Chronic pain conditions:

• • Are numerous and range from joint-related conditions such as osteoarthritis and rheumatoid arthritis, to widespread musculoskeletal pain conditions such as fibromyalgia.
  • Can be neurological in nature, caused by damage to the nerves (neuropathy), or conditions like multiple sclerosis.
  • Are sometimes so widespread and dangerous that they cause chronic pain as result, including various cancers.
  • May also increase a person’s risk of suffering complications from COVID-19, including lung and heart diseases (from cancer to COPD, asthma, and cystic fibrosis).

Because chronic pain has so many causes and potential co-occurring conditions, treatment differs from patient to patient. Some chronic pain patients respond well to simple interventions, and pain management plans that rely on following strict dietary advice and physical therapy. In cases of severe terminal pain, high doses of opioid medication may be the only effective form of relief. In between the two, chronic pain may be treated via interventions to the nervous system by surgery or injection, or non-opioid medication such as over-the-counter painkillers.

Aside from corticosteroids and nonsteroidal anti-inflammatories, certain disease-modifying drugs called biologics may help provide pain relief for conditions such as ankylosing spondylitis and other forms of spinal inflammation. These are medications derived from human and animal cells, and work by interfering with how your immune system is handling the situation, thereby reducing inflammation, and bringing your immune function back to normal.

However, all these treatments affect how the body is prepared to handle COVID-19, as well as other infectious diseases. Chronic pain is often caused or involves some form of damage to the body and nerves as a result of, or in combination with excessive inflammation. Bringing that inflammation down often requires immunosuppression on some level, from steroidal injections to chronic use of NSAIDs, to opioid medication. It is not generally recommended to stop or slow down the treatment of chronic pain in response to COVID-19.

Chronic pain patients require their medication to function, and some medication may be dangerous to stop without a slow taper, especially opioid medication. However, if you or someone you love is currently undergoing some form of pain management and there is a chance that they may have been in contact with anyone who could have been carrying the novel coronavirus, it is important to discuss options and considerations with their physician and pain management specialist.

Recommendations and Important Measures for Chronic Pain Patients

Chronic pain patients with a history of ongoing pain management treatment may be considered at-risk for complications from COVID-19, based on the severity of their condition. Chronic pain conditions often co-occur with other diseases that may affect outcomes, including diabetes and heart disease. These conditions weaken the immune system as the body is continuously fighting off systemic inflammation, thereby diminishing the body’s resources to deal with a potential coronavirus infection.

As such, if you or a loved one is suffering from chronic pain and currently treating it, you will want to take extra precautions to avoid an infection. Currently, we know that that will involve:

• • Minimizing contact with others, particularly from outside the household.
  • Frequent and thorough handwashing.
  • Wearing a mask outside the home.
  • Maintaining a safe distance from others (at least six feet).
  • Disinfecting devices and surfaces that are commonly used, especially:
    • Handles
    • Keyboards
    • Computer mice
    • Phones
    • Toilets
    • Sinks
    • Faucets
    • Desks
    • Light switches
    • Doorknobs
    • Countertops

Strengthening the body’s immune response can help stave off a potential infection. The most effective ways to boost your immune system remain the simplest:

• • Eat a balanced and healthy diet, consisting of enough (but not too many) calories, and plenty of foods with high nutrient values (meaning lots of vitamins, minerals, and healthy fatty acids).
  • Maintain some level of frequent physical activity, preferably at home. That means avoiding the crowded jogging path and the gym and opting for home exercises to keep fit.
  • Sleep is critically underrated, and its role in boosting the immune system is immense. Don’t be bedridden but try to be well-rested every day.
  • Try to stay in contact with friends and keep your mood up. Plan virtual social occasions and group workouts. Watch more comedies. Play video games together. Start up a new hobby, like cultivating succulents or learning to crochet. It isn’t yet clear how emotions and immune function converge, but there may be a link. It is clear, however, that low mood exacerbates chronic pain, so managing your emotions is an important part of ongoing pain management during the pandemic.

COVID-19 remains an ongoing issue, and we all have our own adjustments to make in a time of great uncertainty. It’s important not to underestimate this issue because of its (thankfully) diminishing death toll, or to be under the illusion that things have slowed down dramatically. While healthcare systems are learning how to adapt to a “new normal”, we must still do our part to minimize the spread of the virus, particularly for those who are at far greater risk of deadly complications.