Post-Acute Sequelae of SARS-CoV-2 (PASC): Musculoskeletal Conditions and Pain, 2023, Michelle Copley et al

Clinical Care Points

• Painful musculoskeletal conditions are common in patients with PASC.
  Many patients with PASC experience multiple concomitant pain symptoms.
• Pathophysiology of pain in PASC is still unproven but a variety of immune system changes including inflammation, the presence of autoantibodies, mitochondrial dysfunction, autonomic dysregulation and changes in clotting, have been hypothesized.
• Treatment strategies should be holistic and take into consideration other concurrent PASC symptoms and a biopsychosocial treatment approach.

Summary
Pain is common in people who are recovering from COVID-19 and patients may experience a wide range of painful conditions including musculoskeletal-related and neuropathic pain. Patients may experience multiple different painful conditions and other concurrent symptoms that complicate their experience of pain. Although the pathophysiology of pain in PASC is still largely unproven, it likely relates to a variety of immune system changes including inflammation, the presence of auto-antibodies, autonomic dysregulation and changes in clotting.

A thorough history and diagnostic evaluation is important given the myriad symptoms, concurrent conditions and exacerbating factors that can impact recovery from pain. Despite the limited availability of clinical trials of specific treatment strategies for PASC-related pain, there are many rehabilitation strategies that can be employed to address COVID-related pain and a number of emerging and promising treatments that are under evaluation.

https://www.pmr.theclinics.com/article/S1047-9651(23)00031-1/fulltext