Neuropathic Pain and COVID-19: Current Understanding and Future Directions

A small team of French researchers suggests some patients with COVID-19 develop neuropathic pain within weeks or months following infection and that patients with neuropathic pain and COVID-19 sometimes present with deterioration of neurologic complications and/or pain exacerbation. The researchers presented these findings in the publication Pain Reports.

Viral infections can impact the peripheral or central nervous system and ultimately lead to neurologic complications. In particular, documented neurologic complications of COVID-19 include Guillain-Barre ́ syndrome, myelitis, and stroke.

The researchers have routinely followed 50 patients who were exposed to the novel coronavirus responsible for COVID-19 and who also have chronic neuropathic pain caused by either peripheral or central lesions. All patients who have survived have reported a deterioration of their neuropathic pain for several weeks or longer. The researchers suggest that the neurotoxic consequences of the virus, due to the high tropism of COVID-19 on the nervous system, may be enhanced in patients who have a pre-existing neurologic injury.

The investigators state that neuropathic pain may either indirectly result from COVID-19 following intensive care, such as from prone positioning or traumatic procedures, or may be directly caused by the impact of SARS-CoV-2 on the nervous system.

Although the risk of stroke following SARS-CoV-2 infection appears low, some evidence shows acute ischemic stroke can occur in some hospitalized patients with COVID-19. Subsequently, these patients may experience long-term neuropathic pain.

According to the small team of researchers, clinicians should remain diligent to first distinguish other causes of COVID-induced pain from neuropathic pain prior to starting treatment.

While the use of nonsteroidal anti-inflammatory agents may be appropriate in some patients with COVID-19, some groups have voiced concerns about the use of these therapies in this population. Mainstays of neuropathic pain management include gabapentinoids, antidepressants, tramadol, and topical agents. Strong opioids may be used in some patients with refractory pain and nonpharmacologic treatments such as invasive or noninvasive neurostimulation techniques can be considered.

The researchers concluded that in the near future, it “will be of interest to prospectively follow patients with chronic pain affected with COVID-19 and determine whether the risk of pain exacerbation is distinct in neuropathic compared with” patients without neuropathic pain.

Reference

Attal N, Martinez V, Bouhassira D. Potential for increased prevalence of neuropathic pain after the COVID-19 pandemic. Pain Rep. 2021;6(1):e884. doi:10.1097/PR9.0000000000000884