Introduction
The time it takes for someone to get better from COVID varies from person to person. Long COVID is when your symptoms continue for over four weeks after you have had COVID and may have new health issues as a result. If you have long COVID, one new issue you may be experiencing is pain that you did not have before.
This booklet is designed to help you better understand the symptoms of pain in relation to long COVID.
How can the long COVID clinic help me?
Your long COVID clinician will assess your pain and decide the best course of advice and treatment. This may involve treatment in the long COVID clinic or a referral to an alternative department such as a specialist musculoskeletal service, to make sure your condition is being treated by the most appropriate clinician.
The cause and nature of your pain can influence the advice and exercises your clinician is likely to prescribe.
Myalgia is the medical term for aches and pains in the body and the Centre for Disease Control and Prevention has advised that it is one of the most common lasting symptoms after having COVID. Myalgia can seem like aching or pain in joints, muscles, and bones.
Types of pain in long COVID
Joint stiffness
When people living with Long COVID move and exercise less, the body soon becomes deconditioned, the muscles can become weak, and joints can also become stiff. The most common areas affected by this are the neck, shoulders, back and knees. These problems are not serious and will get better, but sometimes you might need medicine or treatment.
Activities which may aggravate the pain could include:
- standing up (especially when you have been sat or lying for prolonged periods)
- climbing stairs
- gripping objects with your hands
- lifting your arms above your head
- getting into and out of the bath
You might have already had joint and muscle problems before you got COVID.
These problems can come back or get worse after COVID as you are not using your joints and muscles as much as before.
Neurological pain
Research shows the many neurological symptoms of COVID-19 are likely a result of the body’s widespread immune response to infection rather than the virus directly infecting the brain or nervous system.
Researchers are following some known acute effects of the virus to determine their relationship to long COVID. These effects of long COVID usually include fatigue in combination with a series of other symptoms. These may include trouble with concentration and memory, sleep disorders, fluctuating heart rate, alternating sense of feeling hot or cold, and a cough. You may also experience symptoms such as shortness of breath, problems with sleep, inability to exercise to previous normal levels, feeling sick for a day or two after exercising (post-exertional malaise), and pain in muscle, joints, and chest. It is not yet known how the infection leads to these persistent symptoms and why in some individuals and not others.
Migraines
Migraines are headaches that can:
- be more painful than a normal headache
- make it hard to cope in bright light, you might find dark rooms easier to deal with than more intense bright lights
- make you feel like you need to be sick
- make you vomit
- make you lose your appetite
- give you an upset stomach
- if you already get migraines, having COVID can make them worse and last longer
COVID can cause new long-term headaches that were not present prior to infection. These headaches may last for some time afterwards and can be felt on a daily basis. Often, most aches and pains can be managed with simple lifestyle changes and will not usually require further investigation.
Medications
Painkillers and creams you can buy at your local pharmacy can help, but you should always ask the pharmacist for advice on what you should use. Before you take any new medicine, you should check with the pharmacist or your GP. If your joints suddenly get hot, red, and swell up, you should go to Accident and Emergency (A&E) on the same day because you might have an infection that needs urgent treatment.
Activity and exercise
Being active and taking exercise is a good prescription for managing pain. Knowing where to start can be daunting for some people with chronic pain as they often find it hard to do things on some days more than others. Don’t be put off by the word “exercise”, any type of movement is exercise.
To begin with your muscles might hurt so it’s important that you choose a level of exercise that suits you. Learning how to pace your activity and exercise can help. Most of all it should be enjoyable.
Walking
This might start off with a walk up and down your path or a walk to the end of the street and back. A local park is also a good option, especially if it has benches for you to rest on along the way.
Dancing or moving to music
Dancing or moving to music, either sitting down or standing up (or a mixture of both), is a great way to exercise.
Exercising in the pool
You don’t need to know how to swim to be able to exercise in a swimming pool. The buoyancy of the water makes us feel lighter. This can make movement and exercise easier than on dry land.
Spend 10 to 15 minutes in the water to begin with. Slow movements are best. If you don’t swim take someone with you and stay close to the side.
Yoga
Light Yoga is a form of stretching, breathing control and relaxation that has been found to be beneficial during your recovery from COVID-19.
Yoga and meditation are known to help in alleviating mental stress and anxiety, having a positive effect on psychological wellbeing. So, yoga may have an important role in the recovery of COVID-19 patients who have been socially isolated. Stress, anxiety, and depression may be associated with increased susceptibility to viral upper respiratory infections.
Tai Chi
Tai Chi is a multicomponent rehabilitation approach comprising correct breathing technique, balance, and muscle training as well as stress and emotional management. In addition, practicing Tai Chi elicits the relaxation response and balances the autonomic nervous system thus regulating respiration, heart rate, blood pressure and vitality in general. Hence, we recommend Tai Chi as a suitable rehabilitation tool for people with long COVID.
Relaxation
Finding a way to relax can help to reduce pain. Anything which makes you feel good, you enjoy or gives you pleasure is a form of relaxation. Hobbies and activities may have taken a backseat due to your pain, but it’s worth thinking about how to get back to doing things you enjoy. Anything that helps you to focus on things other than your pain is a good form of self-management.
Mental health
Effective pain management tackles all aspects of your life affected by chronic pain, including your mental wellbeing.
The outbreak of COVID-19 has been stressful for many people. People respond to stress in different ways, and it is normal to experience a range of emotions, including fear, anxiety, and grief. Being isolated from others during the lockdowns and period of infections, the real risk of death, and the stress of hospitalisation and critical care can trigger post-traumatic stress disorder. In addition, given the contagious nature of COVID-19, you may not be the only affected person in the family or circle of friends, some of whom may even have died. Some people may develop a mood or anxiety disorder. The long COVID clinic can assess for this and complete a referral to the NHS Talking Therapies service if appropriate.
Fatigue
Self-help plan
- Plan the things you need to do each day to help you keep on top of your pain.
- Pace yourself, if your pain is stopping you completing a task you can try again later.
- Try to relax, this can be hard, but finding something which relaxes you will reduce the stress of pain.
- Take regular enjoyable exercise, even a small amount if you can, like going for a walk, will make you feel better and help keep your muscles and joints moving.
- Talk to others, such as family and friends, about pain you’re experiencing and why you may need to do things differently at the moment.
- Do things you enjoy, this makes you feel good and can reduce pain.
- Speak to your community pharmacist for advice about pain management.
- Take prescribed medicine if advised by a healthcare professional.
Symptom diary
It may be useful to complete the symptom diary so that you can see patterns emerging with your symptoms. Pain symptoms can often be exacerbated by fatigue.
Write the day and time that the symptoms occurred.
- Activity, what were you doing when the pain occurred?
- Symptoms, describe the pain, where was it? how long did it last? what made it better or worse? what were you feeling or thinking at the time?
- Treatment, did you take medication? use heat or ice?
- Scale, rate your symptoms on a 0 to 10 scale, be realistic, score any level of fatigue you may be feeling.
To request a symptom diary to be sent to you, please contact the Long COVID team via:
- Email: rdash.long-covid@nhs.net
Document control
- Document reference: DP8801/01.24.
- Date reviewed: February 2023.
Page last reviewed: June 28, 2024
Next review due: June 28, 2025
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