In this article we describe the link between covid and back pain and the most effective ways to treat it.
Coronaviruses are a highly diverse group of viruses that have single-stranded RNA. They can affect many systems of the body, including the respiratory system, nervous system, and circulatory system. it has varying severity among humans and animals (1). nCOV is a pathogen that causes COVID-19, and it was first diagnosed in January 2020. The first outbreak of coronavirus occurs in Wuhan. Its mode of transmission is from one human to another. The main route of transmission is from droplets and by coming in close contact with the infected individual. The incubation period is around five days, and most patients appear to have symptoms after 12 days of contact with an infected person, so it requires 14 days of quarantine and medical observation to stop its spread.
According to symptoms severity, patients can be divided into three groups, i.e., mild cases, severe cases, and critical cases. Laboratory diagnosis of coronavirus is more reliable. PCR test is used to detect viruses from nasal secretions. PCR test has been widely used all over the world for its detection. Treatment of covid-19 is usually done symptomatically. Many antivirals have been used, like oseltamivir, ribavirin, lopinavir, etc., to reduce viruses and respiratory complications. Ventilation (noninvasive or mechanical) is given to patients with low oxygen levels, which are called hypoxia, and in patients with worsened shortness of breath. Furthermore, preventive measures should be taken to avoid its widespread. Authorities should warn people to socialize in a controlled way in order to avoid further outbreaks.
The upshots of widespread coronavirus are multifaceted. It has enormously affected masses both physically and mentally with its broad spectrum of spread physical and mental health (2). Symptoms of covid-19 can appear before its severe onset, and it can affect almost all parts of the body. There are people who do not present any covid-related symptoms. Everybody experiences covid-19 infection in a different way. Most people present typical common symptoms such as
- body aches, including muscle pain, i.e., myalgia (3)
- stuffy nose
- loss of taste and loss of smell
- fatigue and muscle spasm
- SOB( shortness of breath)
- headaches and fever
- sore throat
The onset of Covid and back pain
Many people develop covid symptoms which persist for a longer period of time, like weeks or even months, which are referred to as long haul symptoms. Either young or elderly may develop long-term symptoms, which may be due to tissue damage or long-term inflammation. Chronic fatigue, like muscle aches or lower back pain is also reported by many patients to their health professionals. Joint and musculoskeletal pain can occur in any body part, but it typically results in chronic back pain.
Joint pain and backaches can become worse if you are inactive during your illness and exacerbate the situation. The balance between rest and work schedule can relieve low back pain, but if the pain persists for a longer period of time and keeps getting worse, and worse one should seek healthcare professional attention. Physical therapy can contribute to lowering muscle pains and joint stiffness in patients with long-haul symptoms.
Covid-19 Pandemic and societal stress:
The pandemic has created a global emergency among the masses resulting in individual and societal anxiety and stress. This anxiety and stress have physical and mental health clinical implications. Covid-19 keeps spreading globally with its lethal effects on public health (4). With a lack of proper treatment and endpoint of the corona pandemic, it has severely affected individuals psychologically, resulting in anxiety and stress disorders. Healthcare professionals are more prone to psychiatric issues as they are always in close contact with viral infections. They have a fear of exposing others to viruses. Taking difficult decisions ethically, such as isolation, can create immense pressure on them along with social media coverage of issues.
Other Complications Associated with Covid-19
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2):
It is usually an asymptomatic or very mild infection among children. Its pathogenesis is not clear yet, but it has some overlapping features with Kawasaki disease and autoimmune etiology (5). It is important to recognize typical and atypical symptoms among covid-19 patients in the pediatric category to identify the risk of morbidity among children (6). Although the multisystem inflammatory syndrome is a rare occurrence, it requires aggressive medical intervention and treatment in order to prevent morbidity.
Long Covid and back pain:
Long covid or post covid is a condition that may affect people who survived through covid-19. It was first recognized by social groups, followed by scientific and medical groups. Although this term is poorly defined, its symptoms include fatigue and shortness of breath even after months of recovering from covid-19. Studies show that patients with a history of anxiety and who were using antidepressants were more likely to develop long covid symptoms. Females are more likely to develop post covid symptoms, but it requires more clinical clarification. Rehabilitation is very important for the management of long covid symptoms like light aerobic exercises. Psychological help may also improve mental health.
Many symptoms are expected with the occurrence of covid-19, like fever, cold, and flu but back pain is least expected. Backache is the main symptoms of omicron related coronavirus. People with omicron often complain about a sore throat, a cough along with severe back pain, which may resemble periods of pain or kidney stone pain. Back pain wasn’t a common symptom of covid until the omicron variant appeared. The cause of backache is still unclear, but now it is considered one of the main symptoms. However, it is important to note that back pain doesn’t always mean that it is because of covid, even when it appears in conjunction with sore throat or flu-like symptoms. It can only be confirmed by an antibody test. Pain is the main symptom of long covid, which has made people quit their jobs. Workout and stretching exercises can be helpful in relieving muscle or joint pain (7).
Among all the variants of coronavirus, omicron is the highly mutated version with a total of 50 mutations in its genome (8). An increased number of mutations increases infectivity and prevent the effective immune response from the immune system. The infectivity of the omicron virus is ten folds higher than the original virus. SAR COV-2 not only affects the respiratory system but can also affect other body parts as well compared to its original strain. Clinical studies show that variants (alpha, beta, and delta) are more lethal than the original strain, and they usually have more risk of hospital admission, ICU transfers, and death rate. Data suggests that omicron escapes the immune system and has more risk of reinfection than the other variants. The Omicron variant is the most transmittable variant among other VOCs, and it has become an epidemic among countries globally.
Management of Covid Back Pain
As already mentioned, patients of Covid-19 experience intense body pains, most of which are related to the muscles. The muscles of the back are one of the most vulnerable muscles. These can be affected by both the viral attack that weakens the immune response and also by the stress that is induced by this fatal pandemic disease. The management of Covid back pain, especially in patients who suffer from the long covid, is intensely challenging (9). Here are a few tips and medical recommendations that have proven to be beneficial for the treatment of back pain:
Initially, there was a weird curiosity in the air about the use of pain medications in Covid-19. Even ibuprofen use was suspected for safety during the first peak prevalence of covid-19. However, no research ever suggested the unsafe role of NSAIDs. Ibuprofen has a complete safety profile. Any pain medication taken during this viral disease will definitely not cure the disease but will help cope with pain. The list of NSAIDs that can be used safely includes naproxen, ibuprofen, and aspirin.
Paracetamol or acetaminophen still remains the safest option among the available pain medications. This medicine poses the least drug interactions and gives effective pain relief at the same time. Also, the medicine will effectively work against any fever which is resulting in body pain. The use of corticosteroids like dexamethasone and prednisolone is very common in patients who present to the hospital with a severe case of Covid-19. Although the main indication of this medicine is inflammation, it is also used as adjunctive therapy with other painkillers.
The impact of covid-19 has affected the economic and psychosocial life of the public. The buying capacity of the people has fallen down to a great extent, and not everyone is ready to spend money on the back pain only. This includes the use of pressure, elevation, cold therapy, heat therapy, compression, and rest.
Physical Therapy for Covid back pain
Sometimes the patient’s body presents new symptoms and uncommon back pains that become unmanageable through medications only. There are further steps that need to be taken for effective and quick recovery. The CDC and NHS have recommended taking pain medications as the first line of pain treatment, but there are other ways to manage pain too. Physical therapists and chiropractors offer a very fair option for improving physical activity and regaining muscle strength in sick patients.
Many structures in the back have a poor blood supply, which is why they can struggle to heal on their own. It is the oxygen and nutrients in our blood supply that help to heal these structures.
Prolotherapy involves the injection of a regenerative solution into these structures to provide a direct supply of what is needed to heal them and provide pain relief.
As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix.
Frequently asked questions
- What organs are most affected by Covid-19?
The virus settles in the lungs of the patient and destroys the structure of the lungs. Therefore, the lungs are the most affected organs during Covid-19.
- How long should a patient exercise during quarantine?
According to WHO, the patients are recommended to do some physical activity for 70 to 150 minutes at least during the period of quarantine.
- What age group is more vulnerable to Covid-19?
People in old age are more vulnerable as compared to the rest of the population because they have weakened immunity and lesser strength and usually are already suffering from some chronic illnesses, like diabetes and other cardiovascular diseases.
- He, Feng, et al. “Coronavirus Disease 2019 (COVID-19): What We Know?” Journal of Medical Virology, vol. 92, no. 7, 14 Mar. 2020, pp. 719–725, www.ncbi.nlm.nih.gov/pubmed/32170865, 10.1002/jmv.25766.
- Tsamakis, Konstantinos, et al. “COVID‑19 Related Stress Exacerbates Common Physical and Mental Pathologies and Affects Treatment (Review).” Experimental and Therapeutic Medicine, 22 Apr. 2020, 10.3892/etm.2020.8671.
- Kucuk, Adem, et al. “Can COVID-19 Cause Myalgia with a Completely Different Mechanism? A Hypothesis.” Clinical Rheumatology, vol. 39, no. 7, 26 May 2020, pp. 2103–2104, 10.1007/s10067-020-05178-1.
- Serrano‐Ibáñez, Elena R., et al. “Chronic Pain in the Time of COVID‐19: Stress Aftermath and Central Sensitization.” British Journal of Health Psychology, vol. 26, no. 2, 25 Oct. 2020, pp. 544–552, 10.1111/bjhp.12483.
- Consiglio, C. R., Cotugno, N., Sardh, F., Pou, C., Amodio, D., Rodriguez, L., Tan, Z., Zicari, S., Ruggiero, A., Pascucci, G. R., Santilli, V., Campbell, T., Bryceson, Y., Eriksson, D., Wang, J., Marchesi, A., Lakshmikanth, T., Campana, A., Villani, A., & Rossi, P. (2020). The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19. Cell, 183(4), 968-981.e7. https://doi.org/10.1016/j.cell.2020.09.016
- Toraih, E. A., Hussein, M. H., Elshazli, R. M., Kline, A., Munshi, R., Sultana, N., Taghavi, S., Killackey, M., Duchesne, J., Fawzy, M. S., & Kandil, E. (2021). Multisystem inflammatory syndrome in pediatric COVID-19 patients: a meta-analysis. World Journal of Pediatrics, 17(2), 141–151. https://doi.org/10.1007/s12519-021-00419-y
- Tsamakis, K., Triantafyllis, A., Tsiptsios, D., Spartalis, E., Mueller, C., Tsamakis, C., Chaidou, S., Spandidos, D., Fotis, L., Economou, M., & Rizos, E. (2020). COVID-19-related stress exacerbates common physical and mental pathologies and affects treatment (Review). Experimental and Therapeutic Medicine. https://doi.org/10.3892/etm.2020.8671
- Iqbal, Fahad M., et al. “Characteristics and Predictors of Acute and Chronic Post-COVID Syndrome: A Systematic Review and Meta-Analysis.” EClinicalMedicine, vol. 36, June 2021, p. 100899, 10.1016/j.eclinm.2021.100899.
- Tian, Dandan, et al. “The Emergence and Epidemic Characteristics of the Highly Mutated SARS‐CoV‐2 Omicron Variant.” Journal of Medical Virology, 3 Feb. 2022, 10.1002/jmv.27643.
- Drożdżal, Sylwester, et al. “COVID-19: Pain Management in Patients with SARS-CoV-2 Infection—Molecular Mechanisms, Challenges, and Perspectives.” Brain Sciences, vol. 10, no. 7, 20 July 2020, p. 465, 10.3390/brainsci10070465. Accessed 21 Dec. 2020.