Long COVID Unmasked: Pearls from the AAPM&R Long COVID Collaborative's Consensus Guidance Statement (Member Resource)-Session Recording

Video Transcription

Video Summary

This comprehensive Long COVID talk focused on practical diagnosis, stigma reduction, safe activity guidance, pharmacologic management, and functional recovery through case-based discussions. Long COVID is defined as a multisystem, relapsing or remitting condition lasting at least three months after SARS-CoV-2 infection, affecting 3-6% of the global population, including cognitive, cardiac, musculoskeletal, and fatigue symptoms.<br /><br />Case one featured a 35-year-old veteran runner with new knee pain and profound fatigue following mild COVID. The patient’s patellofemoral pain syndrome was exacerbated by muscle weakness and post-exertional malaise (PEM). Management emphasized validating symptoms, pacing activities to avoid PEM, addressing modifiable risk factors like nutrition and sleep, and cautious use of NSAIDs and physical therapy tailored for post-viral fatigue.<br /><br />Case two presented a 22-year-old woman with hypermobility, multifocal pain, POTS, and cognitive difficulties. Despite extensive evaluations being normal, symptoms started post-COVID and worsened with exertion. Key management included symptom validation, pacing, energy conservation, careful pharmacology (e.g., beta blockers, low-dose naltrexone), and tailored physical therapy focusing on stabilization, avoiding no-pain-no-gain approaches.<br /><br />Case three involved a 45-year-old woman with cognitive impairment ("brain fog") and fatigue persisting six months after COVID, with prior concussions complicating the presentation. A holistic strategy addressed cognition, mood, sleep, and physical symptoms with cognitive rehabilitation, work accommodations, gradual activity return, and cautious pharmacotherapy including stimulants and low-dose naltrexone.<br /><br />The session emphasized combating stigma by validating patient experiences, integrating multidisciplinary care using updated compendiums with clinical guidance, and coding (ICD U09.9) for better research and resource allocation. Practical advice included cautious supplement use, avoiding premature diagnostic closure by maintaining broad differentials, and individualized pacing guided by symptom feedback. Functional recovery requires patience, humility, and patient empowerment to restore quality of life despite uncertainties in long COVID pathophysiology and treatment.

Keywords

Long COVID

post-viral fatigue

patellofemoral pain syndrome

post-exertional malaise

hypermobility

postural orthostatic tachycardia syndrome (POTS)

cognitive impairment

brain fog

pharmacologic management

symptom validation

multidisciplinary care