Post-COVID sequelae: Back pain and shoulder pain

Article by Master, Doctor Nguyen Minh Son - Interventional Cardiologist - Department of Examination & Internal Medicine - Vinmec Nha Trang International General Hospital

Is back pain COVID? In fact, back pain, shoulder pain can be experienced both during and after COVID-19 treatment. This condition not only affects health but also seriously affects quality of life. In case the use of home remedies does not improve the symptoms, the patient should soon go to specialized medical facilities for examination and treatment.

Low back pain is a very common condition, with about 90% of people experiencing it at some point in their lives. In many countries, low back pain is the most common cause of chronic pain in middle age. Low back pain is an important health problem, not only because of its high prevalence, but also because of its consequences, important to interfere with personal life, and costly for medical services. , reduce working capacity.
Most cases of back pain during the COVID season occur in people of working age, often seen in office workers, using many computers. The pain occurs in the lower back, can be unilateral or diffuse to both sides. The pain is dull, sometimes there is a sharp pain when changing positions. Pain decreases with rest, increases with movement, and can even affect sleep.
Low back pain during the COVID season is often caused by posture when we have to work from home with an environment that is not suitable in many ways compared to a normal work environment. Tables and chairs used to work at home are often not standard for office work, you even work in bad positions such as lying on your stomach, sitting on the ground.
Next is the state of sedentary, less walking, unable to exercise, we often sit or lie down a lot. Not to mention the state of weight gain, psychological inhibition at home. All of these factors combined can cause back pain. In other cases, patients develop back pain after strenuous exercise, such as cleaning the house or lifting heavy objects.

The first thing is not to panic, worry. During the period of social distancing, you should limit going to the hospital as much as possible. Not only is the cause of the increase in Covid-19 infections, but the overload of patients will put enormous pressure on the medical team who are carrying out epidemic prevention work.
Acute back pain responds most well to simple home remedies. Accordingly, you should spend more time resting and should limit sitting for a long time. Arranging reasonable working and resting time. If you have to sit and work continuously, you should have a break, get up and exercise after 1-2 hours. You can use a belt if you have one at home. Besides, you should lie down instead of massage, because improper massage can make the pain worse. Exercises for the back area should only be done after the pain has been controlled and relieved, and should be done daily. According to health experts, a balanced diet, exercise at home will help you maintain a stable weight.
Remember that weight gain is a risk factor for many diseases, not just back pain. If your back pain is not relieved, you can use common pain relievers to control pain such as paracetamol, ibuprofen with remote consultation of doctors. If you have applied the above measures but do not control the pain or the nature of the pain changes to a more serious direction, you should go to the hospital for examination.

COVID-19 also has a seasonal flu-like nature (a viral disease) with similar symptoms, many cases of pneumonia leaving lasting sequelae of back pain.
Long-lasting back pain can occur in any patient with pneumonia caused by viral or bacterial strains. According to Western studies, back pain is seen in 63% of patients with pneumonia due to Delta variant, but Omicron variant only 42%, while seasonal flu accounts for more than 70% of cases.
The three main areas of the body that suffer from pain are: The head and shoulders; lumbar region; area around the knee.

The most important reason for pain is when the body is infected with viruses, both the flu virus as well as the SARS-CoV-2 virus that causes COVID. These viruses stimulate the release of cytokines, including a variety of chemical mediators of inflammation. Cytokines lead to the formation of Pyrogens and Prostaglandin E2. Pyrogens is a product of cellular failure, it helps fight flu/COVID-19 by causing fever, but Pyrogens also attach to nerves that cause pain. Prostaglandin E2 is a specific agent that activates pain pathways.
Pyrogens and Prostaglandin E2 are concentrated in the head and neck muscles, the lumbar muscles, the muscles around the knees. Usually, these substances are present in high concentrations for 4-5 days. Therefore, most cases only have muscle pain for a few days, then stabilize, the pain goes away on its own without leaving any sequelae.
After recovering from the disease, if the body continues to be sensitive to increase the secretion of Pyrogens Prostaglandin E2, the pain will continue to last, it may take 6-9 months to stop the pain.

Pain in the head and shoulders, low back pain: Easily confused with spondylolisthesis, vertebral discitis, bulging or herniated disc. After X-ray, CT or magnetic resonance imaging, treatment according to these diagnostic directions is not effective.
Body aches are a common symptom of COVID-19 or seasonal flu, painful sequelae can last 6-9 months in people with pneumonia. Pain around the knee is similar, the patient complains of discomfort, fatigue, feeling like ants biting and maggots crawling in the bone, unable to sleep at night because of the pain. But the most persistent is still back pain and shoulder pain. Because back pain and shoulder pain have another mechanism, it's damage to the lungs. This is why patients with post-pneumonia due to COVID or influenza have a relatively high rate of pain.

The back is a very important lung protective barrier: To avoid lung damage, you need to avoid and not let your back get cold, that is, keep your back warm. When young children sleep at night, their back sweats, parents need to take a towel to dry, otherwise the child will be very susceptible to pneumonia. Likewise, with COVID patients, especially the Omicron variant, they often sweat on their backs at night, so you need to remember to dry them immediately to keep your lungs warm.

In summary, shoulder pain, back pain, pain around the knee are common sequelae in patients with pneumonia caused by influenza, COVID, or any other cause of bacterial or viral pneumonia. The Omicron variant has the lowest pain rate among all causes. The mechanism of pain may be due to excessive secretion of chemical mediators of the group of Pyrogens and Prostaglandin E2, but persistent pain is mainly due to lung damage.
Pain may be transient or sometimes persist for 6–9 months. In addition to using pain relievers, rehabilitation exercises, massage, acupressure massage, acupuncture are measures that can overcome the pain situation. Deep breathing exercises and meditation, including yoga, qigong, and oriental medicine, also help improve this condition.
In case the application of the above measures does not bring positive results, you need to go to specialized medical facilities for examination and advice on effective treatment.
Post-COVID-19 complications vary from person to person but can last for weeks or months, severely affecting the physical and mental health of the patient. Patients with early examination can promptly detect and treat sequelae caused by SARS-CoV-2, quickly return to a normal, healthy life.
Currently, Vinmec has post-Covid-19 examination packages:
✅ Evaluation of respiratory system function after Covid-19 infection: For patients with persistent shortness of breath, cough, chest tightness; The patient has limited physical activity and is short of breath.
✅ In-depth assessment of respiratory system function after Covid-19 infection: For patients who have been diagnosed with lung injury in the acute phase: opacified lung damage, pneumonia, pulmonary fibrosis
✅ Screening Post-Covid-19 neuropsychiatric disorders: For patients with prolonged symptoms: insomnia, fatigue, muscle pain, headache; Neurological disorders plant; cognitive impairment (brain fog); appearance of mental disorders: paranoia, trauma, depression, anxiety
✅ Assessment of disorders related to the inflammatory response of the system after Covid immunity: For patients with persistent fever (> 2 weeks), unexplained fatigue; skin rash: urticaria, erythema, purpura; damage to many known organs: increased liver enzymes, kidney damage, digestion; disorders of inflammatory markers; Hematological disorders: anemia, hemolysis, leukopenia, thrombocytopenia.
Checkup package for customers over 18 years old The package of intensive assessment of respiratory system function after Covid-19 infection is only available at Vinmec Times City Special offer from March 15 to March 31, 2022
10% discount for The first 100 customers to register and buy a package in March 2022 Discount up to 20% Food for post-Covid-19 health care >>Register now HERE