Critical patients with Covid-19 may have a high risk of developing chronic pain. However, the exact nature and mechanisms of Covid-19-related chronic pain are still unknown. 

 A report describes clinical features, treatments, and outcomes of herpes zoster and postherpetic neuralgia in a 70-year-old woman with critical Covid-19. The patient reported a history of type 2 diabetes and myasthenia gravis and developed herpes zoster in the right 10 to 12 lumbar dermatomes in the recovery period of Covid-19.

She received Intravenous (250 mg 3 times a day) and then oral (400 mg 5 times a day) acyclovir as antiviral therapy, and Pregabalin (75 mg orally twice a day) and ibuprofen for analgesia. She showed resolution of her skin lesions 21 days after the onset of the rash. However, she continued to experience persistent pain in the same dermatomal distribution. 

Thus, her pregabalin dosage was increased to 150 mg orally twice a day, which partially relieved her pain. During the telephone follow-up four months after herpes zoster eruption, she still reported intermittent pain in the right 10 to 12 lumbar dermatomes. 

This case draws attention to postherpetic neuralgia in Covid-19 patients. Such patients must receive antiviral treatment as early as possible and use it longer than a typical course. Analgesics should be given based on the dermatome involved, the severity of the pain, and the comorbidities. This report indicates that future studies must monitor longer-term pain management outcomes in Covid-19 patients.

J Pain Res. 2020 Sep 22;13:2361-2365. doi: 10.2147/JPR.S274199. PMID: 33061551; PMCID: PMC7519825.