Wyva
Senior Member (Voting Rights)
Practical Pain Management: COVID Long Haulers and the New Chronic Pain Profile
Most of the article is general info on long covid (and the possible connection with ME/CFS, fibromyalgia, POTS) but here is what some of the doctors said:
Most of the article is general info on long covid (and the possible connection with ME/CFS, fibromyalgia, POTS) but here is what some of the doctors said:
Dr. Morlion weighed in on his perspective based on his experience with PASC in his pain clinics: “We have started screening them with a CSI questionnaire and notice elevated to high scores, indicative for central sensitization. These are very preliminary findings but in line with some larger observations made by the colleagues at the free University of Brussels.” He added, “My personal gut feeling tells me that we will look at some common pathway of central sensitization of the nociceptive/pain networks with major emotional distress, probably based on mechanisms of peripheral and central neuroinflammation by the infection.”
Dr. Chung described the theories regarding underlying pathophysiology of POTS in relationship to patients with PASC who present with similar signs and symptoms. “Basically, this appears to be a vasomotor dysfunction. In many cases, we have evidence from cutaneous nerve biopsy and other autonomic tests that the parasympathetic nerve fibers that regulate blood volume and flow are undergoing denervation. Therefore, patients will have trouble regulating their blood flow. Paradoxically, exaggerated central sympathetic tone through baroreflex may be seen to compensate for vasomotor dysfunction, resulting in another set of symptoms, such as palpitation, anxiety, and insomnia.”
If blood flow is not regulated appropriately, people may experience symptoms such as exertional intolerance and fatigue. In addition, brain fog may result, as blood flow may not increase enough to help people concentrate and take on mental activities. Muscle soreness and pain may also be related to this change, again due to affects on circulation, he explained. Further, compensatory sympathetic activity may lead to tachycardia, difficulty sleeping, GI symptoms include decreased appetite, constipation alternating with diarrhea, nausea, and vomiting.
Dr. Chung does see some promise in seeing these phenomena in patients with PASC. He notes the plausible autoimmune basis underlying POTS in patients with or without prior COVID infection. “We are now maybe seeing a rise of an autoimmune condition right after a specific infection. We may be able to find a biomarker for autoimmunity, and, hopefully in the near future, prove a causal relationship between an autoimmune condition and a viral infection.”
(...)
“Immediate treatment is needed to control pain and reduce its chronic impact on patients,” adds Dr. Abd-Elsayed.
Last but not least, stated Dr. Morlion, “Until better data is available, we need to treat these patients with interdisciplinary, multimodal, and biopsychosocial-oriented strategies.”
Dr. Chung described the theories regarding underlying pathophysiology of POTS in relationship to patients with PASC who present with similar signs and symptoms. “Basically, this appears to be a vasomotor dysfunction. In many cases, we have evidence from cutaneous nerve biopsy and other autonomic tests that the parasympathetic nerve fibers that regulate blood volume and flow are undergoing denervation. Therefore, patients will have trouble regulating their blood flow. Paradoxically, exaggerated central sympathetic tone through baroreflex may be seen to compensate for vasomotor dysfunction, resulting in another set of symptoms, such as palpitation, anxiety, and insomnia.”
If blood flow is not regulated appropriately, people may experience symptoms such as exertional intolerance and fatigue. In addition, brain fog may result, as blood flow may not increase enough to help people concentrate and take on mental activities. Muscle soreness and pain may also be related to this change, again due to affects on circulation, he explained. Further, compensatory sympathetic activity may lead to tachycardia, difficulty sleeping, GI symptoms include decreased appetite, constipation alternating with diarrhea, nausea, and vomiting.
Dr. Chung does see some promise in seeing these phenomena in patients with PASC. He notes the plausible autoimmune basis underlying POTS in patients with or without prior COVID infection. “We are now maybe seeing a rise of an autoimmune condition right after a specific infection. We may be able to find a biomarker for autoimmunity, and, hopefully in the near future, prove a causal relationship between an autoimmune condition and a viral infection.”
(...)
“Immediate treatment is needed to control pain and reduce its chronic impact on patients,” adds Dr. Abd-Elsayed.
Last but not least, stated Dr. Morlion, “Until better data is available, we need to treat these patients with interdisciplinary, multimodal, and biopsychosocial-oriented strategies.”