The Covid-19 pandemic will forever be remembered as a historical marker for the spread of a viral infection in such a short time leading to a pandemic worldwide reulting in many deaths. It has left a lasting impact on our global society in unprecedented ways. It can present in many ways:
1. Asymptomatic
2. Flu like illness
3. Pneumonia and respiratory failure (can lead to long term breathing issues)
4. Death from organ failure
5. Post Covid-19 chronic fatigue syndrome in 50 percent of patients (Long haulers of Covid-19)
It has been demonstrated that clinical outcomes of Covid-19 are significantly worse in persons with old age and those with ‘traditional’ medical comorbidities such as, cardiovascular disease, pulmonary disease, diabetes, malignancy, and immunosuppression.
But there is an ever-increasing group of people in our society, especially in the West many of who do not have ‘traditional’ medical co morbidities like those mentioned above who suffer chronically from pain, and fatigue following the Covid-19 infection. These are the patients who suffer from fibromyalgia (FB) and chronic fatigue syndrome (CFS).
Even though these are two medically distinct pain conditions they share a common pathophysiological aetiology which is central sensitisation of pain. This is due to chemical changes in the brain and spinal cord which alters the pain sensitivity mechanism increasing the sensitivity to pain hence the term central sensitisation.
Fibromyalgia
Fibromyalgia is a chronic centralised pain sensitivity disorder characterised by diffuse pain, fatigue, sleep disturbance, mood changes and many other somatic complaints. The illness is characterised by pain, anxiety and depression. At present, the prevalence of FM in USA is two to eight percent of the US population. No data is available in Sri Lanka and this is under diagnosed. Statistically, approximately 1 in every 10-12 people in the west has Fibromyalgia.
Stresses such as physical, mental, financial and work related can increase central sensitisation of pain and aggravate fibromyalgia. Therefore, Covid-19 related stresses can increase the severity of fibromyalgia in the existing group of patients.
Symptoms of Fibromyalgia
Fatigue
Sleep disturbance
Morning stiffness
Sensory issues such as feeling cold
Poor memory
Headaches
Dizziness
Anxiety
Depression
Fibromyalgia and depression are like the chicken and the egg. We do not know whether depression has led to fibromyalgia or vice versa. But the illness can be debilitating with day to day activities becoming increasingly difficult, leading to work related issues and unemployment. In Sri Lanka I don’t expect fibromyalgia to be a common problem like in the west. I have seen patients being wrongly diagnosed with fibromyalgia in Sri Lanka. According to my opinion, our lifestyle and the good weather reduces the incidents. Most patients in England tell me that the hot weather conditions reduce the pain.
Diagnosis
It is mainly a clinical diagnosis.
Treatment
Cognitive behavioural therapy
Lifestyle adjustments
Exercise regimes
Swimming
Drug therapy
Cannabis – Not yet legalised in the U.K for use in fibromyalgia But patients have benefitted from cannabis.
Interventions – Trigger point injections, etc
Chronic Fatigue Syndrome (Myalgic Encephalomyelitis)
Chronic fatigue syndrome is also known as myalgic encephalomyelitis (ME) a condition characterised by chronic fatigue, lasting at least three months to years. It impairs one’s ability to perform daily activities. It demonstrates malaise, poor sleep and pain.
Patients with fibromyalgia and chronic fatigue syndrome can be extremely vulnerable to Covid-19 infections. At least 50 percent of patients might suffer from chronic fatigue syndrome following Covid-19 infection. Chronic fatigue syndrome usually follows a viral infection.
I have seen many patients with this condition in the U.K in my clinics, following the seasonal flus. But I am yet to see post Covid-19 patients in Sri Lanka. I hope this article will bring awareness to Sri Lankans.
FB and CFS are pain conditions that affect day to day life including work which can be debilitating.
FB and CFS can be pre existing conditions among the Covid-19 sufferers leading to increase in symptoms and disability. Chronic fatigue syndrome can also occur in healthy individuals who suffer from Covid-19 lasting up to six months or less. With time we will have more data and studies conducted in relation to chronic fatigue syndrome.
Diagnosis
Clinical diagnosis with a history of Covid-19 or any other viral infection. This is not specific to Covid-19 but the incidence is higher among the sufferers of Covid-19.
Treatment
Similar to Fibromyalgia
If you suffer similar symptoms please visit a suitable doctor and seek medical advice.
Dr Senasinghe MBBS, Dip in Pain Med, FFARCS, FFPMCA, CCST (U.K)is a Consultant in pain medicine at the London Pain Management Centre, No 31, Horton Place, Colombo 7, Sri Lanka. The hotline to the centre is 0767155716. He has worked as a Consultant in pain medicine for 17 years at the East Kent University NHS trust and the Brighton and Sussex university NHS trust and in the private sector in U.K.