New pain epidemic linked to Covid-19 and lifestyles

Dr. C.M de Villiers (Spinal Orthopaedical Surgeon/Pain Interventionist) – Cases of Long Covid-19 involving from headaches to joint pain, is rapidly rising worldwide. These cases are mostly seen in patients who were admitted to ICU for more than 6 weeks. Long Covid-19 patients are treated for amongst others headaches from viral encephalitis, myositis (painful muscles or pleuritis), chronic bone and joint pain (arthritic bone pain in large joints like knee or hip
joints.
The best approach to these chronic cases is a multi-disciplinary team approach with an interacting pain platform to coordinate and collaborate the multi-disciplinary team approach focussing
on the same combined outcome.
Lazy lifestyles have also weakened our muscle, tendon and reflex responses which predisposes us to back injuries. In reference, America has two million people addicted to morphine pain killers, while 80 000 patients die from accidental morphine (opioid) overdose in the country. The chronic pain epidemic in which pain lasts more than four months, affects more than 100
million Americans costing US$635 billion per year on treatment alone. The cost to the Top 500 Fortune Companies for back pain, neck pain and headaches exceeds mental illness and cancer combined.
In West Virginia, USA, US$ 8 billion was awarded to patients against the manufacturer Purdue for opioid medication prescribed and used for non-cancer pain such as joint pain and arthritis.
Long or chronic Covid-19 is also giving rise to myositis i.e., muscle pain, chest pain (pleurisy-like pain) and joint pains in patients admitted to hospital for more than four weeks for Covid-19.
It is important to understand the difference between acute pain and subacute pain.
Acute pain is pain lasting less than 4 weeks and is a warning of tissue damage or the overuse of an injury. Subacute pain is pain lasting more than 4 weeks but less than 3 months and could be ongoing tissue damage which is misdiagnosed. It could also refer to trauma that is repetitive like no adequate rest for a tennis elbow.
lf acute and subacute pain (lasting from 6 to 18 weeks) is not adequately diagnosed and treated, it will become chronic pain (unresolved pain lasting more than 3 months. Only 8% of pain cases results in 90% of the expenses in pain management due to misdiagnosis, multiple specialist visits and high-tech expensive MRI and CT scans.
How to stop the pain epidemic by following a simple approach:
*Exact Location of the severe pain e.g. abdomen.
*lntensitv of the pain (VAS) from 0 - 10 score.

* Radiation of pain e.g. radiates from chest into left arm; left thumb i.e. angina.
*Duration of pain - present for less than 4 weeks (acute pain); 4 weeks to 3 months (subacute pain), lasting more than 3 months, lack of sleep and anxiety (chronic pain).
*24 Hour pain pattern: Compare headache patterns.
The six different pain depending on the organ involved:
• Nerve pain: Due to direct pressure and or crushing of the nerve - sharp shooting pain with pins and needles and numbness in the area supplied by the nerve.
• Vascular Pain: Deep constant dull ache, worse with exercise e.g angina in chest, hamstring injury.
• Bone/joint pain: A deep "boring" ache like a toothache with "burning" in muscles e.g. knee pain.
• Visceral or organ pain: A spasmodic "colicky'' pain that comes and goes with nausea and vomiting.
• Neuropathic pain: Chronic deep but sharp constant pain with numbness i.e. "ghost pain" of amputation or pain of cancer invading the nerve. The patient experiences increased sensitivity and
• "bouts of pain".
• Atypical pain: Group of genetically determined Chronic Pain Syndromes i.e., Multiple Sclerosis, Fibromyalgia and Myalgic Encephalitis (ME).
The most important factors to determine whether to see a doctor urgently:
1. Where (on my body) is the worst pain and which type of pain (1 – 6) is it?
2. How intense is my pain (0/10 – 10/10)?
3. Does the pain radiate e.g. into my arm or leg?
4. What makes my pain worse?
5. How long have I had the pain? (i.e. acute/chronic pain).
6. What is the 24-hour pattern of pain?
See your Allied Health Professional (biokineticist/physio/chiropractor or GP for acute and subacute
pain lasting less than L2 weeks in acute phase. Acute and subacute pain are functional pain patterns, they identify and indicate where the tissue damage is like a slipped disc and pinched nerve or colicky pain with nausea and vomiting due to appendicitis.
The relevant practitioner is to treat acute and subacute pain aggressively with an accurate diagnosis of the type of pain like nerve pain of a slipped disc. The ideal is to then resolve all pain by 12 weeks to prevent chronicity. All chronic pain lasting more than 3 months should be referred to a relevant specialist or pain centre for an accurate diagnosis. The diagnosis is to be confirmed with a nerve block and treated effectively before pain lasts 6 months. - [email protected]