Low Back Pain and Covid-19

Low Back Pain and Covid-19

Hi, Min_ga_lar_par to all.

This article is about the Musculo-skeletal pain, Low back pain and the pandemic disease SARS-Cov-2 virus we all known as Covid-19. Nowadays, the strains of Covid-19 mutated and the latest is Omicron which is spreading rapidly. Is there any relation with Low back pain (LBP) and Covid-19 infection? The symptom “Muscle and body aches” is one of the presentations of covid. Furthermore, the Musculo-skeletal pain is one of the long-haul syndromes of covid. In this article, the possible relations of LBP and Covid will be shared among the muscle and joint pains.

What is Low Back Pain?

This type of pain tends to be localized to the lower back, buttocks, and sometimes the top of the legs. This part of body supports the upper body and the muscle of low back also help in the walking process. Moreover, this region are the junction of body and limbs so that the nature of motions, such as the flexion, extension and twisting mostly occur.

Above picture shows a muscular pain in lower back especially in your lumbar (loin) region. The possible causes of LBP are facet joints arthrosis, osteoarthrosis (arthrosis means the degeneration of the joint), spondylolisthesis (one vertebra slip out of the place onto the below of the vertebra and its normal alignment is broken down) and acute trauma.

• Sometimes, the patient may feel the LBP presenting with pain or spasms of the muscles along the lumbar spine (paravertebral muscle) which can be due to neurogenic pain when the herniated vertebral disc put the pressure on the spinal cord and so-called Sciatica pain. In Sciatic pain, in which the patient may suffer more in leg pain starting behind the buttock and along with tingling or numbness of the thigh and leg. The patients can complaint of LBP for sciatica pain. The differentiation of LBP or sciatica pain is difficult in situation and need further research. So, the incidence of LBP may be high in covid period, too.

• Some other causes are malignancy and osteoarthritis (inflammation of joints due to infections or Tuberculosis) which cause LBP and together present with “Red Flag Signs” Those red flag signs are loss of weight, loss of appetite, severe pain, night pain or night cry, underlying history of malignancy and obviously the pain will become worse progressively. In osteoarthritis cause, fever may be present and the lab investigations will show elevated WBC level and other markers.
• Eventually, most of the causes of LBP are over used or osteoarthrosis. About half of the people over 50 years could suffer LBP. The manual/physical workers suffer LBP as a result of their works where they lifting heavy objects which may overuse the spine.
• The causes of LBP in people with sedentary/deskbound life styles may be due to their habits of less activity and prolong sitting in the chair. Increasing weight attributable to sedentary life styles will make the LBP get more pain.

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• Low Back Pain and Covid-19

The presenting symptoms of Covid-19 are fever, cough, sneezing, sore throat and etc. Chronic pain or LBP is also one of the presenting symptoms in Covid-19 patients especially in Omicron era. Covid-19 is known to be attacked the respiratory symptoms but Covid-19 can attack the neural tissue and patient may suffer the symptoms of nervous system such as headache, dizziness etc.

• Covid-19 Pathophysiology

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) commonly attack the receptor angiotensin-converting enzyme 2 (ACE2) of the lungs and cause pneumonia as we all knew. These (ACE2) receptors also present on neural tissue and are seem to play a role in the development of chronic pain and post-acute COVID-19 syndrome. And the SARS-CoV-2 releases the inflammatory mediators, too. (Chen R, et al.2021).

PGE2 (Prostaglandin E₂) is markedly elevated in Covid infection (Melanie R H, et al .2021). The high level of PGE2 is associated with arthritis.

Is there any other proof that the association of LBP with Covid-19 and need further study? The researchers thought that most of the patients presenting with severe symptoms are elderly patients. They might already have underlying spine problems or the symptoms of LBP which is pulled the trigger by Covid-19. Most of the study showed that LBP or other pains are just temporary or transient. If the pain will longer than 12 weeks and become chronic, there is no solution till yet.

The doctors still think that the pains may be due to their previous LBP rather than cause of Covid-19. But the correlation with elderly patients (over 50 years) with LBP and Covid-19 is accepted.

• Does the posture of the patient impact on the cause of LBP?

The postures are related with the severity of the disease. When the patient gets serious illness or the oxygen drops down, the patient has to be lying on his chest (prone position) for a long time to support the breathing work. Thus, the prolong staying in prone position or wrong positions or mal-positions of spine may get the LBP. The patient with severe illness cannot maintain his or her posture, too.

• Another reason of LBP in Covid-19 is the prolong sitting in front of ‌‌a computer. The people need to do work from home according to the threats of pandemic Covid. As a result, when they get Covid and they may complaint of LBP. Additionally, they may live in more sedentary life style while staying at home. So, the lack of activities can be one of the reasons for LBP in Covid.

• Furthermore, the obesity can lead to suffer LBP.

The obese patients may have underlying disease such as Diabetic, Hypertension or heart diseases. The overweight can make more loading pressures on the spine. Moreover, the lack of activity or sport activity because of their weights are accompanying with the LBP. And then, the central obesity can lead to get LBP. So, there is supposed to get LBP or other pains if the obese person suffers from Covid.

The types of jobs and LBP …

• Generally, the manual/physical workers can usually get LBP more than the sedentary workers as the reasons of lifting heavy objects.

• They may lift/carry the objects improperly or with wrong positions (lifting heavy objects by using his back repeatedly in wrong ways). When they get Covid, they cannot do the tough jobs and sometimes they have to stay on the bed. And then, they suffer some muscle pains or old pains will appear as a result of the sudden change in life styles.

Delayed or post pone spine operation during Covid-19 Pendemic period.

Some spine operation had to be postponed due to the current Covid situation. So, the postponing on surgery caused the patients suffer LBP continuously before operations are taken. And it is one of the reasons for not decreasing in number of the patients with LBP in Covid period. When they infected with Covid, they will surely present LBP together with other symptoms.

Another difficultity is that the newly LBP cases are hardly to get proper treatment in Covid period. Tele-consultation is not easy to use for poor patients, or it is not available in some places and situations. The proper consultation, which is face to face between the doctor and patient is still better than tele-consultation up to date now. So, there is also a delay in getting proper treatment for a new LBP patient. And there is incresased in numbers of patient with Covid-19 and LBP.

Psychogenic Musculo-skeletal pain?

This should not be left in consideration of LBP in covid. This type of muscle pain or LBP is not easy to treat. Owing to covid’s anxiety, the body can suffer muscle pain. The chronicity of pain can also lead to psychogenic muscle pain, too.

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Conclusion …

For these correlations, we cannot definitely say that LBP and Covid 19 are associated or not. The scientists have been trying to research more evidences about the relationship between Covid-19 and Chronic pains or LBP.

Thank you for reading the article. Also, I would like to appreciate my senior ortho brother Ko THZ, a ma Gyi Prof: Dr. KKT and a ma Sandakuu TZar for editing this article. This article doesn’t mean a scientific paper and the citation are also left to add. The purpose of this article is to get awareness of LBP and Covid, to avoid the improper treatment, and not to be afraid too much about the LBP while you get covid. Stay according to the Covid-19 rules and let’s fight against this one.

Any comment is appreciated. If the reader whoever gets covid with the LBP can freely share your opinions or ask for some advice in comment.