COVID-19, Long COVID and Fibromyalgia

Since its emergence in late 2019, COVID-19 has reshaped global health in both immediate and lasting ways. While the acute symptoms of the virus have been widely discussed, a growing body of research is turning attention to its long-term effects—particularly a condition known as Long COVID.

Characterized by persistent fatigue, muscle pain, cognitive difficulties, and sleep disturbances, Long COVID bears a striking resemblance to fibromyalgia, a chronic pain disorder already affecting millions worldwide. This overlap has raised important questions among clinicians and researchers: Could COVID-19 be triggering fibromyalgia in some patients? Are those with fibromyalgia more vulnerable to prolonged post-viral symptoms? 

In this article, we explore the potential connection between COVID-19, Long COVID and fibromyalgia by examining the shared symptoms, underlying pathophysiology, and evolving clinical insights.

COVID-19 and Long COVID

COVID-19, caused by the SARS-CoV-2 virus, is primarily a respiratory illness that can also affect multiple organ systems. While many people recover fully within a few weeks, a significant number experience lingering symptoms well beyond the acute phase of the infection. This condition is known as Long COVID or post-acute sequelae of SARS-CoV-2 infection (PASC).

Long COVID encompasses a wide range of symptoms, including fatigue, muscle pain, brain fog, and sleep disturbances. These symptoms can persist for months and vary in intensity, similar to other chronic pain conditions such as fibromyalgia.

Estimates suggest that over 10% of people who contract COVID-19 go on to develop Long COVID symptoms; a 2023 review published in Nature Reviews Microbiology reported that approximately 65 million people worldwide may be affected.¹ It also found that Long COVID is more prevalent in women and in individuals with pre-existing health conditions, including autoimmune and chronic pain disorders like fibromyalgia.

Long COVID and Fibromyalgia

Fibromyalgia is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, cognitive issues, and sleep problems. Since Long COVID and fibromyalgia share a significant symptom overlap, researchers have begun to investigate whether there is a connection between developing COVID-19, Long COVID and fibromyalgia—or whether people with fibromyalgia are more susceptible to developing Long COVID after exposure. 

Central Sensitization: A Link Between Long COVID and Fibromyalgia

Recent studies suggest that COVID-19 may lead to the development or worsening of fibromyalgia symptoms through a process called central sensitization. This is a condition in which the central nervous system becomes hypersensitive to stimuli, leading to increased pain perception.

Central sensitization is a key feature in fibromyalgia and other nociplastic chronic pain disorders. It occurs when repeated stress or injury to the nervous system, due to either physical or emotional pain, results in heightened sensitivity to pain and sensory input, even when no painful stimulus is present. 

COVID-19 may contribute to the development of central sensitization in several ways:

• Chronic inflammation: Systemic inflammation during and after a COVID-19 infection can alter the way the brain and spinal cord process pain.² This inflammatory response has  been linked to alterations in central nervous system functioning, supporting the central sensitization hypothesis.
  
• Neurochemical Imbalances: Infections like COVID-19 can disrupt neurotransmitters involved in pain regulation, such as serotonin and norepinephrine.³
  
• Stress and trauma: Physical and psychological stressors from illness, isolation, and uncertainty may exacerbate the development of sensitization.⁴

A 2023 study published in Frontiers in Neurology also highlighted that individuals with pre-existing central sensitivity syndromes, like fibromyalgia, are more vulnerable to developing Long COVID symptoms. 

Other Potential Causes of Long COVID 

The exact mechanisms behind Long COVID are still under investigation, and while central sensitization is a leading theory, several other contributing factors have been proposed:

• Immune System Dysregulation: Prolonged immune activation and inflammation may damage tissues and disrupt normal cellular processes.⁵
• Viral Persistence: In some cases, viral fragments or reservoirs may remain in the body, triggering a chronic inflammatory response.⁶
• Autonomic Nervous System Dysfunction: Some individuals experience dysautonomia, which affects heart rate, blood pressure, and other involuntary functions.⁷

Symptom Overlap and Diagnostic Challenges

Fibromyalgia has several hallmark symptoms, including widespread pain, fatigue, and cognitive difficulties like challenges with memory and concentration. Since Long COVID shares many of these, this symptom overlap can make diagnosis challenging. 

Patients with fibromyalgia may not recognize that their worsening symptoms are due to Long COVID; likewise, those recovering from COVID-19 may be newly experiencing what appears to be fibromyalgia. This diagnostic ambiguity can delay treatment and increase patient distress.

A study in PLOS ONE found that, 5 months after being discharged from the hospital for COVID-19, 15% of patients met the diagnostic criteria for fibromyalgia, and 87% had at least one fibromyalgia-related symptom.⁸

These findings reinforce the need for clinicians to consider both conditions when evaluating patients with lingering symptoms after COVID-19.

Fibromyalgia During COVID-19

For individuals already diagnosed with fibromyalgia, contracting COVID-19 can complicate symptoms more than in other groups. The physical stress and inflammation caused by COVID-19 can intensify fibromyalgia symptoms, while the emotional burden of illness including isolation and uncertainty, can worsen stress and increase fibro flares. 

If you live with fibromyalgia and contract COVID-19, there are steps you can take to manage symptoms and protect your health:

1. Monitor Symptoms: Keep track of new or worsening symptoms, and report them to your healthcare provider.
2. Prioritize Rest and Recovery: Give your body time to heal and avoid overexertion, which can lead to symptom flares. Support your immune system and energy levels with a balanced diet and adequate hydration.
3. Gradually Resume Activity Resumption: Slowly return to daily activities, and consider a pacing plan to help manage flares.
4. Find Strategies to Manage Stress: Use techniques like deep breathing, meditation, or gentle movement to reduce stress and promote relaxation as much as possible.
5. Actively Communicate with Your Care Team: Ensure your providers understand your baseline fibromyalgia symptoms so they can distinguish them from Long COVID. They may also be able to recommend new or modified treatment for your care plan.

Summary

The connection between COVID-19, Long COVID and fibromyalgia underscores the importance of understanding central sensitization and the long-term effects of viral infections. Early intervention, self-care, and medical guidance can help reduce the impact of overlapping symptoms and improve quality of life.

Medically reviewed by Dr. Andrea Chadwick, MD, MSc, FASA

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