Long COVID: Neuropathic Pain

Neuropathic Pain

Pain is one of many symptoms of long COVID. Pain syndromes, or groups of symptoms, are also common. Some examples are headaches; joint pain, and neuropathic, i.e. nerve-related pain. The focus here is on neuropathic pain.

Neuropathic pain is associated with your somatosensory nervous system, one part of the peripheral nervous system (the nervous system outside of the brain and spinal cord).

The somatosensory nervous system includes a pathway that originates in the somatosensory nerve fibers, mostly located in the skin, but also in the muscles, joints, and coverings of organs (fasciae). It then sends signals to the spinal cord and eventually to nerve cells (neurons) in the brain.

The nerve fibers detect the sensations of:

  • Pain, including itching and tickling sensations

  • Temperature

  • Touch, including pressure and vibration

  • Head and body movement and position

With neuropathic pain, there is a problem with sensation (in the nerve fibers of the skin, muscles, etc.), signaling (from the nerves to the spinal cord to the brain), or perception (in the neurons in the brain).

What are the Symptoms of Neuropathic Pain?

You may feel many different painful sensations including warmth or burning; coldness; numbness, tingling, prickling or “pins and needles;” itching; sudden stabbing or “electric shocks”; discomfort from light touch; etc.

It may come and go and change over time. The pain may be mild, moderate, severe, and even disabling. You may have other long COVID symptoms with neuropathic pain.

Why Does Neuropathic Pain Occur in Long COVID? 

Doctors are continuing the research on COVID-19 and long COVID, with new information revealed every day. 

Neuropathic pain may be related to: 

  • Actual tissue damage from SARS-CoV-2, the virus causing COVID-19;

  • The body’s response to the virus; 

  • Intensive care unit (ICU) stays for severe COVID-19 infection 

Damage from/the Body’s Response to SARS-CoV-2

The SARS-CoV-2 virus may damage the nervous system, resulting in neuropathic pain and other long COVID neurologic symptoms. It may be due to:

It is interesting to note

  • The location of the olfactory epithelium is the reason for nasal swab COVID-19 testing

  • The nerve cells in the nose are involved in the sense of smell. This is the connection to the loss of the ability to smell in so many people with COVID-19

  • Damage to, or overreaction to the virus by, the immune system - the body’s defense system. Studies of people with long COVID have found an association between immune system reactions and neurological (nervous system) conditions.

    • Immune system dysfunction may be associated with widespread damage to the somatosensory nerve fibers, known as immune-mediated small-fiber neuropathy (SFN). SFN can result in neuropathic pain. SFN can also be an underlying cause of dysautonomia 

      • Dysautonomia means the autonomic nervous system isn’t working properly. The autonomic nervous system controls automatic body functions like heart rate, blood pressure, body temperature, etc. 

      • If you have dysautonomia, you may have orthostatic intolerance with symptoms like lightheadedness, irregular/rapid heart rate (palpitations), fatigue, difficulty breathing, etc. when you stand up

  • Very serious, but rare complications of COVID-19, e.g. stroke, may also result in neuropathic pain

ICU Stays for Severe COVID-19 Infection

There are several reasons for neuropathic pain that are related to severe COVID-19 infection and ICU hospitalization.

  • Severe illness may affect many body systems including the nervous system

  • Nerve injury from certain treatments or procedures, e.g. body positioning to improve oxygen delivery to the lungs

  • Complications of complex procedures, e.g. tracheostomy (surgery to provide airway),  resulting in nerve injury

How Common Is Neuropathic Pain in long COVID?

From an international study of thousands of people with long COVID, over 90% of the people reported at least one of the following symptoms involving sensory and motor (sensorimotor) functioning

  • Tingling or “pins and needles;” numbness or loss of sensation; vibrating sensation; electrical shocks; numbness/weakness on one side of the body; and tremors 

  • Sensitivity to noise; ringing in the ears (tinnitus); feeling warmth or pressure of the brain; and inability to cry or yawn

How is Neuropathic Pain in long COVID Diagnosed and Treated?

Your doctor will complete a neurologic evaluation to determine the cause of your neuropathic pain and the need for additional testing.  

They will check for conditions other than long COVID, that may be the cause of your neuropathic pain (e.g. diabetes, herpes zoster ("shingles") infection, lack of certain nutrients, spinal cord issues, etc). 

Treatment for neuropathic pain related to long COVID is still under study. Two medications, intravenous immune globulin (IVIG) and corticosteroids (“steroids”), have been used to treat immune-mediated small-fiber neuropathy. The medications decrease the immune system’s response - the cause of nerve fiber damage in this situation.  

There are prescription and over-the-counter (OTC) medications that relieve neuropathic pain in some people. Certain antidepressant and anti-seizure medications help lessen neuropathic pain. And, topical anesthetic (pain-relieving) products with lidocaine and capsaicin may also be used. 

Other treatments include several types of nerve stimulation and behavioral therapy, i.e. cognitive behavioral therapy (CBT) and mindfulness practices. CBT helps to lessen neuropathic pain in people with diabetes.

When Should I Contact My Doctor?

Contact your doctor if the following occur:

  • You think your pain may be nerve-related

  • The pain is severe or suddenly gets worse

  • Your pain interferes with your life activities

Talk with your Goodpath coach if you have questions about nerve-related pain and other long COVID symptoms.