The Mystery of Long COVID

"Long COVID" is a name being given to a variety of physical, emotional, and cognitive symptoms that develop after a COVID viral infection. We have undoubtedly been conditioned to experience a great deal of fear and stress related to the pandemic. We can think of chronic pain as chronic anxiety—i.e., a nervous system that has become hyper-sensitized to emotions, particularly fear and anger. Decades of research show that stressful life events can cause debilitating physical symptoms/conditions including inflammation in the body.

Many long COVID patients are being told that their symptoms are "all in their head" or simply due to anxiety, as tests and scans are often not revealing any structural dysfunction. Yet their chronic pain, fatigue, and neurological symptoms are real and persisting, leading to an immensely decreased quality of life and resulting in disability for many.

Many chronic pain problems can be understood as a brain coding problem related to the brain turning on the pain signal and misinterpreting sensory signals. Pain and fear are hardwired biological mechanisms that have allowed us to survive when confronted with danger. In chronic pain, it has been discovered that activation of sensory areas of the brain is transferred to areas that are thought to process emotions. Thus, negative emotions can trigger pain. Anxiety can thus be understood as the release of stress neurochemicals from the brain into the body.

The complex interplay of our emotions and resulting somatic symptoms aside, it is key to rule out structural, biological causes of physical symptoms when addressing chronic pain. Often, it can be difficult to tease apart causes due to the powerful mind-body connection.

Some innovative approaches have recently been developed to further test if long COVID symptoms are due to structural or neurocircuit issues, or a combination of both. Once structural problems have been ruled out, psychological techniques to reduce fear and anxiety, as well as instill hope, can be effective in restoring quality of life and symptom abatement.

Pain is actually a danger signal. In non-structural chronic pain, the danger signal has become incorrectly encoded in the brain. As one of the participants in my recent training suggested, the danger encoding is akin to a computer virus malware that infects the brain.

Unfortunately, mainstream Western medicine typically neglects the role of emotions in illness and disease, opting for a purely biomechanical model. Yet numerous studies have shown, for example, that emotional factors are more predictive of spine surgery outcomes than anatomical pathology.

Fortunately, there are a growing number of medical and mental health professionals researching and publishing mind-body perspectives on illness and disease. (The suggested readings and resources below will provide an overview of the clinical and empirical work being done in this area that is yielding promising results; long COVID sufferers and their providers could particularly benefit from Sarah Rainwater's work that covers many excellent resources.)

The pressing issue of how to help heal long COVID sufferers begs that we no longer ignore the connection between our minds and our bodies. Despite the challenges of embracing a mind-body approach and forging increasing links between medical and mental health professionals, the best healing can happen when all modalities are utilized with integrative approaches that treat the whole person.