Chronic Pain Affects COVID-19 Symptoms

Those experiencing chronic pain, may not only be more susceptible to the COVID-19 virus, but if infected, may face additional consequences and higher morbidity risks than others.

That’s because there is a complicated relationship between the brain, the immune system, and chronic pain, explains Leanne O’Neil, owner of INDY Neurofeedback. This relationship is heightened, we are just now seeing, when a COVID client has been taking long-term pain therapies.

Generally speaking, chronic pain clients can be considered immune-compromised. Many are elderly and have multiple and inter-related health issues. Some are also on long-term opioid therapies and steroids, which are known to interact with the immune system, often times, suppressing it. That makes pain management during COVID-19 treatment, especially with seniors, particularly tricky.

The COVID team at the Western Reserve Hospital in Cuyahoga Falls, Ohio, has discovered a complicated relationship between opioids and COVID-19:

“Patients who use opioids to manage pain need to be especially careful during COVID-19,” Dr. Rhayed Narouze, MD, PhD, of Western Reserve Hospital noted. “As doctors, we should be mindful that the more and longer opioids have been taken, the more patients lose respiratory reserves, and may not be able to fight this particular infection.”

“As with many virus-related diseases, COVID-19 can present with extensive muscle aches and pains,” weighs in Jeffrey Fudin, PharmD, of the Stratton VA Medical Center in Albany, New York. “This can aggravate various pain syndromes, particularly those involving muscle and bone, such as chronic back or neck pain.”

Since COVID-19 affects respiration, excessive coughing will likely worsen experienced pain. As the person becomes sicker – especially if they are elderly – there will be at an elevated risk of requiring sedation, leading to opioid-induced respiratory depression, which increases mortality.

For persons on one or more sedating drugs or opioids, the risk seems to be even higher. These drugs included in this initial observational study include:

  • antidepressants
  • skeletal muscle relaxants — especially cyclobenzaprine (Flexeril and others)
  • carisoprodol (Soma), and

Chronic pain clients may be on oral steroids or may have received a recent steroid intervention, and thus may have an altered immune response. Steroids, for example, have been associated with a higher risk of influenza (and COVID).

So what can those with chronic pain do during the COVID pandemic to maintain health and wellness?

“We need to encourage continued movement and adaptive exercise options,” said Beth Darnall, PhD, of Stanford University in Palo Alto, California. Although they may not be able to attend regular physical therapy sessions (due to pandemic restrictions) to help manage pain, the good news is that there are a number of online tools available to demonstrate how to perform physical therapy exercises at home.

Here is a resource link from The American Chronic Pain Association to help patients stay active during the pandemic.

Clinical video can also promote client health and wellness, says Leanne O’Neil. This holds for medical, psychology, neurofeedback, and social work consultations, too. “Ideally,” O’Neil says, “clients need access to all three. This support can help those with chronic pain remain connected at a time when they may be feeling more isolated.”

Importantly, our clients with pain need to know how to get help if they need it. Let us know if you or a loved one need help managing chronic pain over and above prescription pain relief. That’s why we’re here.

Breathing, Your Brain, and the Coronavirus

Over the past 20 years, we’ve begun to understand how intensely breathing patters affect brain health and contribute to illness. Researchers working together with biofeedback techniques have

developed coaching strategies to optimize breathing patterns, improve health and wellbeing, and mental performance.

A prime example of how learning to self-optimize breathing patterns to help control health has to do with asthma. In a 2003 study, people with asthma were taught to reduce their reactivity to cigarette smoke and other airborne irritants.

  • Participants were first taught how to slow diaphragmatic breathing.
  • Next, they were taught to hold their breath but relax their bodies the moment they became aware of an airborne irritant such as cigarette smoke.
  • They then moved away from the polluted air while exhaling very slowly through their nose, waiting until the air was clearer to inhale and continue diaphragmatic breathing.

Using this research, people may well be able to reduce their exposure to the coronavirus by changing their breathing patterns.

Naturally, the first step to preventing catching the illness is by prevention by following the recommended public health guidelines, including social distancing, frequent thorough hand washing, surface disinfecting, and keeping hands away from one’s face. Recently, wearing a mask to protect one’s face has been added to this list.

So, how can one reduce their exposure to the virus when near other people by changing their breathing pattern? 

Normally when startled or surprised, we tend to gasp and inhale air rapidly. We also do this when someone sneezes, coughs or exhales near you – which causes a potential intake of germs from the contaminated person. Instead, change your breathing pattern.

Here’s how:

When a person is getting too close

  • Hold your breath with your mouth closed and relax your shoulders (just pause your breathing) as you move away.
  • Gently exhale through your nose (without inhaling), no matter how little air you have in your lungs.
  • When far enough away, gently inhale through your nose.
  • Remember to relax and feel your shoulders drop when holding your breath – which should last for only a few seconds as you move away from the person.
  • Exhale before inhaling through your nose.

When a person coughs or sneezes

  • Hold your breath and rotate you head away from the person while moving away from them and exhaling though your nose.
  • If you think the droplets of the sneeze or cough have landed on you or your clothing, go home, disrobe outside your house, and put your clothing into the washing machine. Take a shower and wash yourself with soap.

When passing a person who is approaching you

  • Inhale before they are six feet from you, and exhale through your nose as you pass them.
  • When you are more than six feet away, gently inhale through your nose.

When talking to people outside

  • Stand so that the breeze or wind hits both people from the same side. This way, any exhaled droplets are blown down wind from both of you.

“Although these breathing skills are simple,” suggests Leanne O’Neil of INDY Neurofeedback, “they will take practice and mindfulness to before they become habitual – and genuinely helpful – especially if you or someone in your family has asthma. Remember, this breathing pattern should not be forced. In fact with practice, it will occur effortlessly.”

There are so many, many interesting ways INDY Neurofeedback can help you and your family members use techniques to retrain your brain. If you have a physical, emotional or health issue holding you back, we welcome your call. Your first consultation is always free.