Long COVID-19 is linked to chronic pain conditions

Therapies for pain conditions like fibromyalgia provide clues for helping those with long COVID

5:00 AM

Author | Kelly Malcom

Woman sleeping on a couch holds her stomach, as if in pain
Credit: Getty Images

Many patients continue to struggle in the wake of the pandemic as they grapple with ongoing symptoms triggered by COVID-19 infection, a condition commonly known as long COVID. However, the onset of symptoms such as brain fog, fatigue, headache, and other types of pain is not unique to COVID infection, according to  a new U-M study.

What’s more, these patients may be helped by capitalizing on the body of research around chronic overlapping pain conditions (COPCs), such as fibromyalgia, migraine, low back pain and others.

The work, led by Rachel Bergmans, Ph.D., of the Department of Anesthesiology and a team from the Chronic Pain & Fatigue Research Center at Michigan Medicine, sought to identify whether long COVID was distinct from other pain syndromes and whether chronic pain conditions increased the risk of features of long COVID. 

“We hypothesized we’d see an increase in pain and fatigue because it’s something we’ve seen in the past with other infectious diseases, like the SARS outbreak in 2002,” said Bergmans.

To test this, they identified health records of three subsets of patients from throughout the U.S.: people with COVID, people with influenza, and people without an infection. They then compared the likelihood of receiving a long COVID diagnosis in people with COPCs vs. those without pain conditions. 

We hypothesized we’d see an increase in pain and fatigue because it’s something we’ve seen in the past with other infectious diseases, like the SARS outbreak in 2002,” 

--Rachel Bergmans, Ph.D.

They discovered that having a COPC increased the risk for long COVID features in each group and had a similar effect size as sex or being hospitalized for COVID, known risk factors for long COVID. Interestingly, those with influenza were even more likely than those with COVID infection to have features of long COVID. Furthermore, long COVID features were found in a little over 24% of people with COPCs even in the absence of infection.

What could be going on? Bergmans noted that a relatively recently defined type of pain known as nociplastic pain — pain due to heightened sensitization in the central nervous system -- might help explain some of the findings. 

“A big predictor of future pain is having had pain in the past,” she said. “With nociplastic pain, some people have what you might call a pain setting turned up in their central nervous system. There’s evidence showing that infections, trauma, and stress can be a trigger for nociplastic pain features and related symptoms.” 

Nociplastic pain often co-occurs with cognitive dysfunction and other symptoms related to long COVID, she added. The good news is the existing body of evidence around the treatment of chronic pain could offer patients with long COVID a basis for management as more research into the condition continues. For example, Michigan Medicine developed a resource for patients with post-acute sequelae of COVID-19, providing advice for navigating this often-misunderstood condition.

“The pandemic brought awareness to how disabling these symptoms can be and the burden they have on people’s lives,” said Bergmans.

Additional authors: Daniel J. Clauw; Candace Flint; Herb Harris; Seth Lederman; Andrew Schrepf

Funding: Bergmans and Clauw report consulting fees from Tonix Pharmaceuticals Inc. Harris and Lederman and Flint report employment by Tonix Pharmaceuticals Inc.

Citation: “Chronic overlapping pain conditions increase the risk of long COVID features, regardless of acute COVID status.” PAIN, DOI: 10.1097/j.pain.0000000000003110

Live your healthiest life: Get tips from top experts weekly. Subscribe to the Michigan Health blog newsletter

Headlines from the frontlines: The power of scientific discovery harnessed and delivered to your inbox every week. Subscribe to the Michigan Health Lab blog newsletter

Like Podcasts? Add the Michigan Medicine News Break on SpotifyApple Podcasts or anywhere you listen to podcasts.


More Articles About: Demographics infectious disease Flu Covid-19 Mental Health Pain management Rheumatology Fibromyalgia Sleep Disorders Wellness and Prevention
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


woman holding back in pain sitting on couch
Health Lab
What to do when pain lingers
Experts at Michigan Medicine are focusing on helping people with chronic pain, which is defined as pain that lasts more than three months.
Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories Moving illustration of family at the dinner table eating healthy diet
Health Lab
Playing short order cook, forcing clean plates may sabotage healthy eating habits in kids
While most parents of preschool and elementary aged children strive to give their children a balanced, nutritional diet, some of their strategies to promote healthy eating may backfire.
Pill capsule pushing through a paper with amoxicillin printed on it.
Health Lab
Rise seen in use of antibiotics for conditions they can’t treat – including COVID-19
Overuse of antibiotics can lead bacteria to evolve antimicrobial resistance, but Americans are still receiving the drugs for many conditions that they can’t treat.
marijuana leaf drawing blue lab note yellow badge upper left corner
Health Lab
Data shows medical marijuana use decreased in states where recreational use became legal 
Data on medical cannabis use found that enrollment in medical cannabis programs increased overall between 2016 and 2022, but enrollment in states where nonmedical use of cannabis became legal saw a decrease in enrollment
Illustration of a microscope
Health Lab
Helpful enzymes vanish in many patients with antiphospholipid syndrome
Researchers recently revealed a new mechanism behind antiphospholipid syndrome that the investigators hope will eventually allow treatments to be targeted closer to the source of the problem.
Mothers Babies Postpartum
Health Lab
Rapid rise seen in mental health diagnosis and care during and after pregnancy
Perinatal mental health research shows more pregnant people and those who have recently given birth are getting diagnosed and treated for depression, anxiety and PTSD, but disparities remain.
Speculum illustration including a gloved hand holding a swab in front of microscopic cells
Health Lab
U.S. could cut cervical cancer cases, deaths by up to 20% if more patients followed up after screening, study suggests
Many women don’t get cervical cancer screening such as Pap tests, or don’t go for follow up diagnostic tests; a new study shows what could happen if all of them did.