Considering the Potential for an Increase in Chronic Pain After the COVID-19 Pandemic

Daniel J. Clauw; Winfried Häuser; Steven P. Cohen; Mary-Ann Fitzcharles


Pain. 2020;161(8):1694-1697. 

In This Article

Abstract and Introduction


The COVID-19 pandemic has impacted the lives and health of persons worldwide, with potential for further effects in the future. The experience of living within this pandemic has disrupted daily life across all sectors, including those living with chronic pain (CP), those infected with the coronavirus Severe Acute Respiratory Syndrome (SARS)-CoV2, healthcare providers and essential workers, as well as those who remained physically healthy. The toll of this pandemic extends beyond physical illness, with important psychosocial stressors that include prolonged periods of limited interpersonal contact, isolation, fear of illness, future uncertainty, and financial strain. Uncertainty is fuelled by the constant media coverage, often with conflicting information, differing recommendations by public health authorities in different jurisdictions, and the unknown duration and likelihood of resurgence of this pandemic. In this context, we will examine the potential health consequences of COVID-19 germane to CP, which might be nociplastic, neuropathic, or nociceptive. Specific possibilities might include: (1) CP as part of a postviral syndrome or the result of viral-associated organ damage; (2) worsening of CP due to exacerbation of preexisting pain physical or mental complaints; and (3) CP newly triggered in individuals not infected with COVID by exacerbation of risk factors (poor sleep, inactivity, fear, anxiety, and depression).

Chronic pain must be considered in the context of the biopsychosocial model, which views symptoms as the result of a complex and dynamic interaction between biological, psychological, and social factors.[36,39] Underlying predisposing mechanisms include genetic factors, previous pain experience, and traumatic events that could be physical or emotional.[2] Chronic pain conditions can be triggered by psychosocial stressors or organ-specific biological factors, which may preferentially occur in individuals with a fragile stress response system.[8,10,24,40,47] The COVID-19 pandemic has many characteristics that could potentially increase the prevalence of CP, especially with stressors extending over many months.

The worldwide pain community is invited to consider the possible downstream consequences of COVID-19, not only for patients surviving infection, but also for the wider community that has experienced psychological, social, and economic effects. Although we address these issues from the perspective of physicians practicing in developed countries, many of the consequences discussed will be particularly relevant for people in other countries, with a call for colleagues in Asia, Africa, and South America to enter into this dialogue.