Postacute Sequelae of SARS-CoV-2: Musculoskeletal Conditions and Pain

Abstract

Musculoskeletal and pain sequelae of COVID-19 are common in both the acute infection and in patients experiencing longer term symptoms associated with recovery, known as Post-Acute Sequelae of COVID-19 (PASC). Patients with PASC may experience multiple manifestations of pain and other concurrent symptoms that complicate their experience of pain. In this review, we explore what is currently known about PASC-related pain and its pathophysiology as well as strategies for diagnosis and management. 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 autoantibodies, autonomic dysregulation, mitochondrial dysfunction and/or clotting abnormalities. 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 focused on 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.