Long COVID can present with any of over 100 symptoms, but new research has found that pain may be the most common.
A study published August 28 in the Journal of the Royal Society of Medicine Open revealed that pain was the symptom most frequently reported by people with long COVID, accounting for about a quarter of all symptoms in those with this condition. Physical pain was even more common than neuropsychological issues, fatigue, and shortness of breath.
According to W. Michael Brode, MD, medical director of the Post-COVID-19 Program at UT Health Austin, these findings reflect what clinicians are seeing nationwide and internationally.
“Pain is very common [in long COVID patients],” he told Health. “People can have chest, abdominal pain, headaches, or migraines, but I think the most common type of pain people experience is muscle ache pain and nerve pain, which feels like numbness, tingling, or burning.”
Though many unanswered questions remain about the link between long COVID and physical pain, here’s a look at what we know so far.
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Due to the relative newness of long COVID, defining the illness is difficult. “Right now, there still is not a universally agreed-upon definition for long COVID,” Brode said.
The Centers for Disease Control and Prevention references the National Academies of Science, Engineering, and Medicine’s definition, stating that “Long COVID is defined as a chronic condition that occurs after SARS-CoV-2 infection and is present for at least three months. Long COVID includes a wide range of symptoms or conditions that may improve, worsen, or be ongoing.” These symptoms can include shortness of breath, fatigue, brain fog, muscle pain, and a slew of others.
To diagnose the condition, doctors may look at medical history or do a physical exam. They may also order diagnostic testing, though no single lab test can conclusively reveal whether someone has long COVID.
To determine the most common symptoms of long COVID, researchers at the University College London collected self-reported data from 1,008 people in England and Wales using an app called Living With COVID Recovery. All participants had experienced long COVID symptoms for at least 12 weeks and were asked to add information about their symptoms and their severity.
After analyzing the data, the researchers found that pain was the most common complaint. Pain accounted for more than 26% of the reported symptoms, and 44% of patients said they experienced some pain.
The type of pain—whether throbbing, aching, or tingling—wasn’t uniform, and the location of pain also varied. People reported discomfort in numerous areas, including the eyes, abdomen, ears, chest, back, and jaw.
“However, a preliminary review of the data reveals a high occurrence of pain reported in the head, chest, and limbs,” study author David Sunkersing, PhD, told Health.
Other common symptoms included neuropsychological issues, fatigue, and shortness of breath, accounting for 18%, 14%, and 7% of all symptoms, respectively.
Variables like age, gender, ethnicity, and education were significantly associated with the intensity of long COVID symptoms, including pain. “Overall, older individuals were found to experience much higher symptom intensity, with those aged 68 to 77 reporting 32.8% more severe symptoms, and those aged 78 to 87 experiencing an 86% increase in symptom intensity compared to the 18 to 27 age group,” Sunkersing said.
Women were more likely to experience more intense pain than men, and people of color experienced more intense pain than white individuals. A higher level of education was also associated with lower severity of pain, and subjects from less economically disadvantaged areas reported less intense symptoms than those from the most deprived regions.
Since COVID-19 typically presents as a respiratory infection, it may seem surprising that pain is its most prevalent long-haul symptom. Sunkersing said researchers are still working to determine the reasons for this. “Currently, there is not enough conclusive evidence to pinpoint exactly why pain was the top reported long COVID symptom in our study,” he said.
However, according to Brode, a few theories are on the table. The first concerns inflammation.
“Big picture, the mechanism of this illness is that the virus triggers inflammation in the body,” he said. “The inflammation causes the immune system to go haywire, and the immune system and inflammation disrupt the functioning of the neurovasculature—the nerves and smallest blood vessels that run alongside them.”
When neurovascular functioning gets disrupted, pain is the outcome, he explained. “Muscles and nerves are not getting good oxygen or generating energy like they should.”
Another potential reason for pain is long COVID’s ability to damage the body’s smallest nerve endings, a condition known as small-fiber neuropathy. “This can cause a lot of the uncomfortable, burning, shooting pain sensations,” Brode said.
It’s also possible that the illness hijacks the nervous system’s pain signaling, leading to amplified sensations of discomfort. “Long COVID really seems to affect the autonomic nervous system, which includes pain and pain responses,” he noted.
Brode said there are four primary treatment options for long COVID.
Initial strategies entail learning to manage your daily lifestyle to minimize pain, employing therapies like physical therapy and cognitive behavior therapy to manage stress, and taking medications such as NSAIDs and nerve pain pharmaceuticals. Then, if these approaches fail to bring relief, a medical professional may recommend more experimental treatments like hyperbaric oxygen therapy or medications used for autoimmune disorders.
Research about long COVID is ongoing, according to Sunkersing, and effective new treatments for the condition may emerge in the months or years to come.
