COVID-19 vaccine: will it exacerbate my pain?

COVID-19 vaccination

Will COVID vaccine make my pain worse? Vaccination of any kind including the flu vaccine and COVID-19 vaccine can lead to a transient increase in systemic inflammation as the body mounts an immune response. This increase in inflammation lasts for days to weeks and can result increase in pain. There might also be a skin reaction around the site of injection as well as tenderness in the muscle. However, the benefits of getting the vaccine still outweigh the risks from the vaccine especially in patients with chronic pain conditions. This is because becoming infected with COVID-19 while not being vaccinated greatly increases the risks of developing chronic pain, or of chronic pain becoming more severe.

ICU admission for COVID-19 predisposes to chronic pain

About 10 percent of patients who are infected with COVID-19 will require care in the Intensive Care Unit (ICU), depending on their age and pre-existing medical conditions. Up to 77% of such patients will develop chronic pain. Pain and mental and emotional distress usually receives a lower priority in a sick patient, particularly if there is a shortage of manpower and multi-organ failure. Interventions in the ICU like insertion of lines, turning, tracheal tube suctioning, urinary catheterisation, blood sampling can be painful. When repeated over the course of days to weeks to months in the ICU, the experience can be maddening. Many studies show that acute pain in the ICU can become chronic pain if poorly managed.

COVID-19 survivors who have been through the ICU usually emerge with ICU acquired weakness of their muscles. Risk factors for this include using muscle relaxants and steroids and using mechanical ventilation. ICU acquired weakness leads to deconditioning, pain over multiple joints and contractures. Shoulder pain is a particular problem.

Having to turn patients prone for better ventilatory support can result in brachial plexus injuries, joint subluxation and soft tissue damage. These cause neuropathic and musculoskeletal pain. Symptoms of neuropathic pain include numbness, paraesthesia and pain affecting the large and small nerves.

Will COVID vaccine make my pain worse? COVID-19 vaccine decreases severe illness and reduces the risk of chronic pain. Risk of chronic pain after COVID increases because of the risk of ICU admission, acute pain, Neuroimmune response including Gillian barre, and increase in ptsd anxiety and depression.

COVID-19 can result in neurological symptoms even if you do not require ICU. These are preventable with the COVID-19 vaccine

Neurological symptoms of headache, dizziness and confusion are also common after COVID-19 infection even in those who do not get admitted to the ICU. The angiotensin-converting enzyme 2 (ACE2) receptor, a target in treatment of hypertension, has been implicated. The virus has also been shown to directly injure nerves. Rarely, SARS-CoV-2 aka COVID-19 can cause life-threatening disease such a Gullain-Barré syndrome and polyneuritis. This results because of alterations in the immune system which leads the body to attack its own nervous system.

Infected patients are more prone to low oxygen levels and low blood pressure and their clot tends to clot more easily, resulting in a higher risk of stroke and heart attack. The kidneys are also dysfunctional. Medications used to treat COVID-19 such as hydroxychloroquine, lopinavir and ritonavir are still under investigation and can possibly have neuropathic pain as a side effect.

Patients who are infected with COVID-19 sometimes require opioids like oxycodone, fentanyl patches or tramadol for managing pain. This predisposes them to developing dependence on narcotics and side-effects. Ironically, they can experience even more severe pain in a phenomenon known as opioid-induced hyperalgesia.

Being infected with COVID-19 also increases the psychological burden of patients. Post-traumatic stress disorder (PTSD) can result, as well as anxiety and depression. The relationship goes both ways with chronic pain more likely to lead to psychological illness after COVID-19 infection and vice versa. This is exacerbated by breakdown of the usual social support due to social distancing measures. Wearing masks and other protective equipment further leads to a dehumanising landscape.

Take your COVID-19 vaccine if you are a chronic pain patient

COVID-19 vaccines are important in preventing ICU admission, death and mortality. Side-effects like transient flares in pain can occur lasting days to weeks, but it prevents severe COVID-19 symptoms. Severe COVID-19 symptoms are life-threatening and may necessitate ICU care. That will put you at a much higher risk of chronic pain and permanent physical and psychological disability.

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