Long COVID for Patients with Chronic Pain?

[drusso]

Where should these patients be seen and by whom? Pain, ID, PM&R, ID, Neuro, or Psych?

Stanford Medicine opens clinic for patients struggling with long COVID

With research showing up to 30% of COVID-19 patients experiencing lingering symptoms, Stanford Health Care treats such “long haulers” with multidisciplinary teams.

med.stanford.edu

“As the pandemic progressed, we started seeing patients with all kinds of lingering symptoms after their initial COVID infection, including fatigue, dizziness, cognitive dysfunction, mood symptoms, chest pain, shortness of breath, insomnia, loss of taste and smell, hair loss and sleep disturbance,” said Linda Geng, MD, PhD, clinical assistant professor of medicine, who co-directs the clinic at Stanford. “It was clear this was a huge problem, and we needed to serve these patients.”

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[lobelsteve]

Drusso center for laser long covid excellence.

 

[drusso]

Drusso center for laser long covid excellence.

Wait...I have a feeling lasers could help...

Laser treatment shows promise in treating COVID-19 symptoms

A small study finds laser treatment may hold promise for COVID-19 symptoms.

www.wcvb.com

A small study finds laser treatment may hold promise for COVID-19 symptoms. "Of course, we had no idea if this was going to work. I mean, it was a scary time," said Dr. Scott Sigman, an orthopedic surgeon we joined back in 2019 as he demonstrated the cold laser therapy he uses at his Chelmsford clinic to treat chronic pain. Pain that can often be caused by inflammation.

 

[bedrock]

Where should these patients be seen and by whom? Pain, ID, PM&R, ID, Neuro, or Psych?

Stanford Medicine opens clinic for patients struggling with long COVID

With research showing up to 30% of COVID-19 patients experiencing lingering symptoms, Stanford Health Care treats such “long haulers” with multidisciplinary teams.

med.stanford.edu

“As the pandemic progressed, we started seeing patients with all kinds of lingering symptoms after their initial COVID infection, including fatigue, dizziness, cognitive dysfunction, mood symptoms, chest pain, shortness of breath, insomnia, loss of taste and smell, hair loss and sleep disturbance,” said Linda Geng, MD, PhD, clinical assistant professor of medicine, who co-directs the clinic at Stanford. “It was clear this was a huge problem, and we needed to serve these patients.”

Anyone but me.

 

[Agast]

They will be seen by “Long COVID-Literate” nurse practitioners who will put them on oxycodone 30mg q4h

 

[RoloTomassi]

Drusso center for laser long covid excellence.

Drusso center for laser long covid excellence and for patients who want other stuff laser'd good too

 

[painfree23]

Stim em

 

[hyperalgesia]

"Long covid" is the new Lyme disease.

 

[Agast]

"Long covid" is the new Lyme disease.

I doubt it. Males seem more susceptible to COVID than females so I suspect more Long COVID patients will be men. Which means it will actually be taken seriously.

 

[painfree23]

I doubt it. Males seem more susceptible to COVID than females so I suspect more Long COVID patients will be men. Which means it will actually be taken seriously.

Is this a dig on us needing to take the fibro more seriously?

 

[hyperalgesia]

I doubt it. Males seem more susceptible to COVID than females so I suspect more Long COVID patients will be men. Which means it will actually be taken seriously.

I'll take that bet. More females will have "long covid" than men. What then?

 

[Agast]

I'll take that bet. More females will have "long covid" than men. What then?

Then it’ll become a joke and you guys will roll your eyes and sigh when they walk through your door

 

[painfree23]

Then it’ll become a joke and you guys will roll your eyes and sigh when they walk through your door

Reposting this - this a dig on us needing to take the fibro more seriously?

 

[Agast]

Reposting this - this a dig on us needing to take the fibro more seriously?

No, and I’m not sure why you would jump to that conclusion.

Womens' pain not taken as seriously as mens' pain

Researchers found that when male and female patients expressed the same amount of pain, observers viewed female patients' pain as less intense and more likely to benefit from psychotherapy versus medication as compared to men's pain, exposing a significant patient gender bias that could lead to...

www.sciencedaily.com

Women are often written off when they express pain. For example I had a lady referred to me by her PCP for fibromyalgia. I found bilateral rotator cuff tears and cervical radiculitis. Another lady was requiring steadily escalating hydrocodone for thoracic back pain out of proportion to her MRI. I called her PCP to express my concern about her chest CT findings. He told me that “she’s done this before and she got better” and the CT scan was stable but maybe he’d consider consulting a pulmonologist about the tuberculosis appearance. Now she’s getting her pain meds from her oncologist. There was a med mal case where a woman came in with excruciating abdominal pain and vomiting/peeing herself, she was sent home with some antacids and died a few hours from her bowel perforation.

 

[callmeanesthesia]

No, and I’m not sure why you would jump to that conclusion.

Womens' pain not taken as seriously as mens' pain

Researchers found that when male and female patients expressed the same amount of pain, observers viewed female patients' pain as less intense and more likely to benefit from psychotherapy versus medication as compared to men's pain, exposing a significant patient gender bias that could lead to...

www.sciencedaily.com

Women are often written off when they express pain. For example I had a lady referred to me by her PCP for fibromyalgia. I found bilateral rotator cuff tears and cervical radiculitis. Another lady was requiring steadily escalating hydrocodone for thoracic back pain out of proportion to her MRI. I called her PCP to express my concern about her chest CT findings. He told me that “she’s done this before and she got better” and the CT scan was stable but maybe he’d consider consulting a pulmonologist about the tuberculosis appearance. Now she’s getting her pain meds from her oncologist. There was a med mal case where a woman came in with excruciating abdominal pain and vomiting/peeing herself, she was sent home with some antacids and died a few hours from her bowel perforation.

5 months from onset of symptoms. In a wheelchair by the time she made it to me. Golf ball sized tumor in her cerebellum. Surgery the next day
Another, at least 6 months of progressive pain and loss of function of her arm after being mugged. One of the MAs told me she had a reputation for being a drug seeker, from when she had seen my Ortho partner about it. Turned out the swelling she kept telling her PCP about was lymphadenopathy from lung mets and a large mass invading her brachial plexus.

 

[hyperalgesia]

Then it’ll become a joke and you guys will roll your eyes and sigh when they walk through your door

I will roll my eyes if the dx of "long covid" is not substantiated. In that case, IIRC, if it's a male presenting, I think most people will be more inclined to think there is a secondary gain issue. If it's a female, most docs will be more inclined to think there is a psychosomatic issue.

 

[drusso]

They will be seen by “Long COVID-Literate” nurse practitioners who will put them on oxycodone 30mg q4h

New evidence has doctors worried about long-term damage from COVID 'brain fog'

Studies have found many who recovered from COVID experience cognitive decline.

abcnews.go.com

 

[cowboydoc]

New evidence has doctors worried about long-term damage from COVID 'brain fog'

Studies have found many who recovered from COVID experience cognitive decline.

abcnews.go.com

30mg of oxy q4 will clear that right up.

 

[Agast]

Saw my first post-COVID pain patient today:

Middle-aged previously healthy/normal BMI male, works in IT. COVID in December with residual fatigue. Significant all-over-body itching, he is forcing himself not to keep scratching. Full body pain worse with sitting to standing, ROM type movements of hips and shoulders. Thinks he's still having problems with shingles after lesions erupted on the left shoulder, but the other "shingles lesions" were single blisters in different extremities at the same time. At night his legs will randomly jerk with a vigorous kick. When he stood up he immediately had severe pain in his sides, in a region that is also very itchy. Otherwise nothing really came out on his exam. Gabapentin has some calming effect but causes drowsiness.

Working diagnosis: small fiber neuropathy post-COVID. Started low dose naltrexone for pain, nortriptyline and atarax for the itching. Referred to peripheral neuropathy neurologist.

 

[drusso]

Saw my first post-COVID pain patient today:

Middle-aged previously healthy/normal BMI male, works in IT. COVID in December with residual fatigue. Significant all-over-body itching, he is forcing himself not to keep scratching. Full body pain worse with sitting to standing, ROM type movements of hips and shoulders. Thinks he's still having problems with shingles after lesions erupted on the left shoulder, but the other "shingles lesions" were single blisters in different extremities at the same time. At night his legs will randomly jerk with a vigorous kick. When he stood up he immediately had severe pain in his sides, in a region that is also very itchy. Otherwise nothing really came out on his exam. Gabapentin has some calming effect but causes drowsiness.

Working diagnosis: small fiber neuropathy post-COVID. Started low dose naltrexone for pain, nortriptyline and atarax for the itching. Referred to peripheral neuropathy neurologist.

Is this an HF-10 candidate?

I took heat several months ago for talking about Post-COVID neuropathy, but pain clinics are going to drowning in these patients.

 

[Agast]

I would like the neurologist to comment first, but I'm not seeing anything appropriate for procedures on exam.

 

[lobelsteve]

Call it Fibro, treat it like Fibro.
Call it SFN, treat it like Fibro.

No shots or procedures, just fairly useless meds.

 

[painfree23]

Saw my first post-COVID pain patient today:

Middle-aged previously healthy/normal BMI male, works in IT. COVID in December with residual fatigue. Significant all-over-body itching, he is forcing himself not to keep scratching. Full body pain worse with sitting to standing, ROM type movements of hips and shoulders. Thinks he's still having problems with shingles after lesions erupted on the left shoulder, but the other "shingles lesions" were single blisters in different extremities at the same time. At night his legs will randomly jerk with a vigorous kick. When he stood up he immediately had severe pain in his sides, in a region that is also very itchy. Otherwise nothing really came out on his exam. Gabapentin has some calming effect but causes drowsiness.

Working diagnosis: small fiber neuropathy post-COVID. Started low dose naltrexone for pain, nortriptyline and atarax for the itching. Referred to peripheral neuropathy neurologist.

Wats the peripheral neuropathy neurologist gonna do?

 

[Agast]

Wats the peripheral neuropathy neurologist gonna do?

Peripheral neuropathy is his jam. He does the EMG himself and sends for muscle/nerve biopsies and has an IVIG infusion clinic. One of my patients has CIDP and he went from frequent falling with his walker to standing and walking on his own.

 

[painfree23]

Peripheral neuropathy is his jam. He does the EMG himself and sends for muscle/nerve biopsies and has an IVIG infusion clinic. One of my patients has CIDP and he went from frequent falling with his walker to standing and walking on his own.

Oo ok, So if the biopsy is normal , wats the usual next step? Just trying to learn!

 

[Agast]

Oo ok, So if the biopsy is normal , wats the usual next step? Just trying to learn!

I thought the sensation of full body pruritus was very interesting. I would probably consult dermatology, this neurologist usually orders a rheumatology panel himself. The atarax and nortriptyline should cover psychogenic itch. And I would send for ketamine infusions.

 

[Dr. Ice]

I thought the sensation of full body pruritus was very interesting. I would probably consult dermatology, this neurologist usually orders a rheumatology panel himself. The atarax and nortriptyline should cover psychogenic itch. And I would send for ketamine infusions.

After this circle jerk of referrals goes nowhere the patient will wind up back in your office because you are the only one who “cared enough” to not see them for 2 minutes and dismiss them, all the while with your back to them charting on emr, like every other specialist. Happens to me All.The.Time.

 

[Nodolor]

Agreed Neurologist are the worst....

 

[Tboned]

After this circle jerk of referrals goes nowhere the patient will wind up back in your office because you are the only one who “cared enough” to not see them for 2 minutes and dismiss them, all the while with your back to them charting on emr, like every other specialist. Happens to me All.The.Time.

Have you you ever seen Neurology notes? Soooo long. I bet they never stop documenting. Bless their souls, they are great but jeez.
I really love how their assessment/plan restates the entire HPI and physical exam with in it. Trying to dig out their actual A/P makes my eyes bleed sometimes

 

[Gauss]

Saw my first post-COVID pain patient today:

Middle-aged previously healthy/normal BMI male, works in IT. COVID in December with residual fatigue. Significant all-over-body itching, he is forcing himself not to keep scratching. Full body pain worse with sitting to standing, ROM type movements of hips and shoulders. Thinks he's still having problems with shingles after lesions erupted on the left shoulder, but the other "shingles lesions" were single blisters in different extremities at the same time. At night his legs will randomly jerk with a vigorous kick. When he stood up he immediately had severe pain in his sides, in a region that is also very itchy. Otherwise nothing really came out on his exam. Gabapentin has some calming effect but causes drowsiness.

Working diagnosis: small fiber neuropathy post-COVID. Started low dose naltrexone for pain, nortriptyline and atarax for the itching. Referred to peripheral neuropathy neurologist.

Calvin and Hobbes by Bill Watterson for November 18, 1990 | GoComics.com

Calvin as a doctor: For this patient, I'm going to need more tongue depressors. All right, what's wrong with you? Like I care. Susie as patient: My foot hurts doctor. Calvin: Your foot hurts? What kind of stupid problem is that??! Susie: You're the doctor! You're supposed to find out...

www.gocomics.com

 

[lobelsteve]

Calvin and Hobbes by Bill Watterson for November 18, 1990 | GoComics.com

Calvin as a doctor: For this patient, I'm going to need more tongue depressors. All right, what's wrong with you? Like I care. Susie as patient: My foot hurts doctor. Calvin: Your foot hurts? What kind of stupid problem is that??! Susie: You're the doctor! You're supposed to find out...

www.gocomics.com

Too good to have to click a link, here is the cartoon:

 

[Agast]

Ok, next time I see the patient I’ll kick him in the junk and whisper “SDN sends their regards” in his ear