Upper Back and Rib Pain After COVID-19: Causes and Solutions

Q: Upper Back and Rib Pain After COVID-19: Causes and Solutions

Hello： It is suspected that there may be a thoracolumbar compression fracture or other conditions. It is recommended to consult a spine specialist surgeon. An MRI evaluation is advised. Wishing you a speedy recovery. By Dr. Lai Chao-Kang, Department of Spine S

Pain in the upper back and rib area?

Hello, my mother is 66 years old.
She was first diagnosed with COVID-19 on December 9, 2022, and tested negative on December 19.
During her infection, she experienced severe throat pain and loss of smell, which have not yet recovered.
She has never received a COVID-19 vaccine.
Prior to her diagnosis, she felt a pulling sensation in her back after lifting her arms, which was followed by back pain.
However, during her COVID-19 infection, she did not experience back pain, possibly due to the anti-inflammatory and pain relief medications she took.
After testing negative, she began to suffer from severe pain in her back and ribcage.
She found a position to sleep in that alleviated the pain, but she struggles to turn over or get up, as these movements are extremely painful (as described by her: moving feels like muscle pulling, and the pain is unbearable), which has affected her quality of life.

Due to her osteoporosis, she has already visited an orthopedic clinic for X-rays, which showed no fractures.
However, her spine is relatively flat with no curvature, and there is mild slippage at the L4 and L5 vertebrae, with one vertebra being somewhat narrowed.
She has taken anti-inflammatory medications, received pain relief injections, and B12 supplements, but none have alleviated her pain.

I would like to ask if there are cases of neurological issues resulting from post-COVID syndrome, or if her symptoms are more likely related to spinal problems or myofascial issues.
I am unsure which specialty to consult next or how to find the right treatment direction.
Additionally, under what symptoms is nerve block therapy appropriate? Thank you.

Ms. Hu, 40~49 year old female. Ask Date: 2023/12/24

Dr. Lai Zhaokang reply Neurosurgery

Hello: It is suspected that there may be a thoracolumbar compression fracture or other conditions.
It is recommended to consult a spine specialist surgeon.
An MRI evaluation is advised.
Wishing you a speedy recovery.
By Dr.
Lai Chao-Kang, Department of Spine Surgery, Changhua Hospital.

Reply Date: 2023/12/24

More Info

Understanding upper back and rib pain after COVID-19 can be complex, especially in older adults with pre-existing conditions such as osteoporosis. Your mother’s situation, involving severe pain and discomfort following a COVID-19 infection, raises several important considerations regarding potential causes and treatment options.

Potential Causes of Pain
1. Post-COVID Syndrome (Long COVID): After recovering from COVID-19, many individuals experience lingering symptoms, commonly referred to as Long COVID. These can include fatigue, muscle pain, joint pain, and neurological issues. In your mother’s case, the persistent pain in her back and ribs could be a manifestation of this syndrome. Research indicates that muscle and joint pain can occur in patients who have recovered from COVID-19, potentially due to inflammation or immune response triggered by the virus.

2. Musculoskeletal Issues: Given your mother’s history of osteoporosis and the findings from her X-ray, it’s possible that her back pain is related to musculoskeletal issues. Osteoporosis can lead to weakened bones, making them more susceptible to fractures or stress injuries, even without visible fractures on X-ray. The slight slippage of the vertebrae (spondylolisthesis) and the narrowing of the spinal canal (spinal stenosis) can also contribute to pain and discomfort, particularly if they are pressing on nerves.

3. Muscle Strain or Myofascial Pain: The description of her pain as feeling like muscle pulling could indicate a strain or myofascial pain syndrome. This condition involves pain in the muscles and surrounding tissues, which can be exacerbated by inactivity or poor posture, especially during recovery from an illness.

4. Nerve Involvement: If there is any compression of the spinal nerves due to the structural changes in her spine, this could lead to radiating pain or discomfort in the upper back and ribs. This is particularly relevant if she experiences any tingling or numbness along with the pain.

Treatment Options
1. Consultation with Specialists: Given the complexity of her symptoms, it would be beneficial for your mother to consult with a rheumatologist or a pain management specialist. They can provide a comprehensive evaluation of her symptoms and may recommend imaging studies, such as an MRI, to assess for any nerve compression or other underlying issues.

2. Physical Therapy: Although there may be concerns regarding osteoporosis, a physical therapist can develop a tailored exercise program that focuses on strengthening the muscles around the spine, improving flexibility, and promoting better posture. Gentle exercises may help alleviate pain and improve mobility without putting her at risk for fractures.

3. Pain Management: If over-the-counter anti-inflammatory medications are not effective, a pain management specialist may consider other options, such as nerve blocks or corticosteroid injections, to reduce inflammation and pain. These interventions can provide temporary relief and allow for more active rehabilitation.

4. Alternative Therapies: Techniques such as acupuncture, massage therapy, or chiropractic care may also provide relief for musculoskeletal pain. However, it’s essential to ensure that any practitioner is aware of her osteoporosis and other medical conditions.

5. Monitoring and Support: Regular follow-ups with her healthcare provider are crucial to monitor her condition and adjust treatment as necessary. Keeping a pain diary can also help identify triggers and effective strategies for managing her pain.

Conclusion
In summary, your mother’s upper back and rib pain following COVID-19 could stem from a combination of post-viral syndrome, musculoskeletal issues, and potential nerve involvement. A multidisciplinary approach involving specialists, physical therapy, and appropriate pain management strategies will be essential in addressing her symptoms and improving her quality of life. It’s important to remain proactive in seeking care and exploring various treatment options to find what works best for her.

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