From the Guidelines
Post-COVID myalgia (muscle pain) can be managed with a combination of rest, gentle exercise, and pain medications, prioritizing acetaminophen over NSAIDs due to its preferred use in COVID-19 patients as stated in the guidelines 1. For pain relief, start with acetaminophen (Tylenol) 500-1000mg every 6 hours as needed (not exceeding 4000mg daily) or NSAIDs like ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours with food (maximum 3200mg daily), considering the recommendations for NSAIDs use in patients with COVID-19 1. Apply heat therapy for 15-20 minutes several times daily to sore muscles. Begin gentle stretching and gradually increase physical activity as tolerated, aiming for 5-10 minutes initially and slowly building up. Stay hydrated by drinking 8-10 glasses of water daily and maintain proper nutrition with anti-inflammatory foods. Most post-COVID myalgia resolves within 2-4 weeks, but if pain persists beyond 4-6 weeks, worsens significantly, or is accompanied by severe weakness, breathing difficulties, or chest pain, seek medical attention. The muscle pain occurs because viral infections like COVID-19 trigger inflammatory responses and immune system activation that can damage muscle tissue and nerve endings, while deconditioning during illness can contribute to ongoing discomfort. It is essential to follow the principles for using NSAIDs and steroids as recommended by the international expert panel 1, ensuring continuity of care and pain medications, especially opioids, and utilizing telemedicine for patient management. Given the potential risks and benefits, the use of steroids should be carefully evaluated, considering the increased risk of viral infection and adrenal insufficiency 1. In the context of the COVID-19 pandemic, it is crucial to prioritize telemedicine and biopsychosocial management of pain, as recommended by the consensus guidelines 1. By following these recommendations and guidelines, healthcare professionals can provide optimal care for patients with post-COVID myalgia, minimizing the risk of morbidity and mortality while improving quality of life.
From the Research
Causes of Post-COVID-19 Myalgia
- The exact pathophysiological mechanisms of musculoskeletal post-COVID pain are not completely understood, but studies have reported the complexity of post-COVID pain including immune, biological, and psychological factors 2
- The hypothesis of angiotensin-converting enzyme 2, inflammation, hypoxia, and muscle catabolism is supported by valuable data 3
- Medications used for the treatment of COVID-19, such as corticosteroids, can also have musculoskeletal adverse effects, such as myopathy and osteoporosis 3
- Clinical predictors for post/long COVID-19 syndrome include female sex, obesity, elderly patients, hospitalization, prolonged immobility, having mechanical ventilation, not having vaccination, and comorbid disorders 3
Treatment Options for Post-COVID-19 Myalgia
- Analgesics, such as acetaminophen and ibuprofen, are commonly used to manage painful symptoms during and after COVID-19 4
- A personalized, tailored approach to treating patients with chronic post-COVID pain, known as "precision pain medicine", is suggested 5
- Management of post-COVID pain should include multimodal pharmacological and non-pharmacological modalities targeting emotional/cognitive aspects, central sensitization-associated mechanisms, exercise programmes, and lifestyle interventions 5
- Multidisciplinary and multimodal treatment approaches are considered relevant for managing musculoskeletal post-COVID pain, but no specific guideline has been proposed 2
- Rehabilitation strategies for COVID-19 patients should consider the combination of physical fatigue, muscle weakness, and myalgia 6