Management of Chronic Pain associated with Small Fiber Neuropathy Secondary to SARS-CoV-2

 

Introduction

65 million people worldwide have been identified as

having long COVID symptoms. "Long COVID-19” is a

term commonly used to describe the myriad of

symptoms patients continue to experience following

an acute COVID-19 infection. Neuropathic pain is one

of these 200 long COVID symptoms. It has been

suggested that more than one in three patients with

long COVID will develop neuropathic pain. Recent

post-COVID-19 chronic pain studies have identified

an association of acute SARS-COV-2 infection and

resultant small fiber neuropathy (SFN). SFN is a

peripheral neuropathy that commonly presents with

chronic, diffuse, and often burning pain. Case studies

have shown patients, who have recovered from

COVID-19, presenting with sensory and/or autonomic

dysfunction indicative of SFN.

 

Case Description

A 51-year-old female developed small fiber

neuropathy after COVID-19 infection and vaccination

four years prior. As a result, her previous myofascial

and chronic pain and cervical radiculopathy

worsened. Further skin biopsies confirmed loss of

cutaneous nerve innervation consistent with SFN.

Initial management, including conversative trials of

NSAIDs and physical therapy, proved unsuccessful.

She has since been managed on pregabalin,

duloxetine, topiramate, and alpha-lipoic acid along

with regular exercise and weight loss. Previously

significant widespread pain has improved on this

current treatment regimen.