Summary: Long Covid teaches us to manage chronic pain differently. Researchers propose clearer rules for diagnosis, care that starts with a family doctor, clinics with many kinds of specialists, and a whole-person approach. Millions of US adults live with poorly understood conditions like long Covid and chronic pain. These problems do not fit the classic disease model. So doctors struggle to find the cause and give the best care.
Doctors say we can learn a lot from long Covid about managing chronic pain, because the two have much in common. Both are hard to manage because they no longer seem tied to the illness that started them. In both, doctors struggle to find the cause. Often they cannot find any real damage in the body, so they struggle to treat them. Neither fits the classic disease model.
Why can’t doctors find the cause of long COVID?
The pandemic is far from over, but it is slowing down. Covid may have caused close to 7 million deaths, but more than 600 have survived the disease and recovered. Many who fully recovered from Covid now show no signs of the infection. Their lungs and other organs are in good shape, and their lab tests are normal.
Yet many of them still suffer. Doctors struggle to explain what is causing their problems, like body aches, fatigue, poor focus, sleep problems, and so on. Much as with chronic pain, doctors cannot find the cause of long Covid and struggle to explain the symptoms. So health experts recommend a new model of care for these patients:
- Improve disease diagnostics
- More involvement from family doctors (primary care)
- Use teams of different specialists to manage the condition
- Use whole-person care that looks at body, mind and life together.
How is long COVID diagnosed?
The main symptoms of long Covid may be fatigue, poor focus, and sleep problems. But researchers have found more than 200 symptoms of the condition. It counts as long Covid if someone keeps having these problems for more than three months.
But right now, different definitions of long Covid exist. Doctors are not even sure whether people with organ damage from Covid belong in this group. There are still no agreed-upon rules for diagnosing it. So estimates of long Covid vary widely, from 2% to 50% of people infected with Covid-19.
Put simply, in most cases of long Covid, doctors keep treating symptoms but do not see long Covid as a disease in itself. Likewise, studies suggest doctors see chronic pain as a disease in itself in only about 10-15% of cases. So in most cases, doctors do not treat chronic pain as its own disease.
Who should treat long COVID and chronic pain?
In many countries, family doctors manage long Covid and chronic pain. That is not the case in the US. So millions of people keep living with these conditions. That needs to change. These problems should be treated by family doctors, and only a small number of more severe patients should be sent to specialists or pain clinics.
Are there clinics for long COVID?
To manage long Covid, we need to build large medical clinics. Small, independent clinics must also be better prepared to handle these problems. The US already has about 200 clinics helping manage long Covid. But that is not enough for a country as large as the US.
Is there one treatment that works for long COVID and chronic pain?
Finally, it comes down to whole-person care for long Covid and chronic pain patients. No single treatment will work in every case. Some may benefit from painkillers. Others may benefit from treating sleep problems, depression, anxiety, and so on. Many may benefit from complementary chronic pain treatment methods.
To sum up, it is time to see the huge burden of poorly understood conditions like long Covid and chronic pain. To manage them well, we need to change how we approach them, with better diagnosis and care.
Frequently asked questions
What are the common symptoms of long COVID?
The most common are fatigue, trouble focusing, sleep problems and body aches. Researchers have now listed more than 200 symptoms tied to the condition. What makes long COVID so frustrating is that many people with these symptoms have healthy lungs and organs and normal lab tests. The distress is real even when the usual tests come back clean.
How long do symptoms have to last to be called long COVID?
Symptoms usually count as long COVID once they last more than three months after the infection. There is still no single, agreed-upon definition. Doctors disagree on whether people with organ damage from COVID belong in the same group. That is why estimates of how many infected people get long COVID vary so widely, from 2% to 50%.
How is long COVID like chronic pain?
Both conditions outlast the illness or injury that started them. In both, doctors often find no clear damage in the body to explain the symptoms. Neither fits the classic disease model. So both are usually managed symptom by symptom instead of being treated as a condition in its own right. Studies suggest only about 10-15% of chronic pain cases are seen as a disease in itself.
How are long COVID and chronic pain treated?
No single treatment works for everyone. Some people do better with pain medicine. Others improve once their sleep problems, depression or anxiety are treated. Many benefit from complementary approaches. The model researchers propose starts with family doctors and sends the more severe cases to specialists or pain clinics. It uses a team that looks at the whole person, body and mind together.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
