Post-COVID pain may involve headaches, muscle pain, joint pain, nerve symptoms, fatigue, brain fog, dysautonomia, or central pain overlap.
Persistent pain after COVID-19 can affect the muscles, joints, nerves, and autonomic nervous system long after the initial infection has resolved. Dr. Siefferman explains how post-COVID pain is evaluated, the underlying mechanisms that may contribute to ongoing symptoms, and the personalized treatment strategies available to support recovery.
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Hi, I’m Dr. Jason Siefferman, medical director, Manhattan Pain Medicine. We frequently see a lot of complicated cases. One of these situations is post-COVID pain. COVID for a lot of people or even the vaccine for COVID unlocked an immune response which had multiple effects throughout the body.
It may have triggered POTS, mast cell activation syndrome, small fiber neuropathy. It may have lit up or unmasked a previously undiagnosed autoimmune condition. We’ve seen a number of cases which began after COVID but now actually do resemble other medical conditions. Understanding how this came to happen is unclear. Having a clear reversal treatment is not something that’s available. So we really look to understand what might have been a predisposing factor for that patient and we look to control the symptoms. So we really start at the beginning.
We want to understand all of the complaints. We want to understand how they line up. We want to see if there may have been some pre-existing condition like hypermobility spectrum disorder or Ehlers-Danlos, Sjögren’s, or seronegative RA that just hadn’t declared itself, like some other primary immunodeficiency. There’s a number of conditions that we often find pre-existed and then COVID was just the tipping point that allowed it to declare itself a little bit further. At the end of the day, we’re here to treat the patient, help the patient feel better. Part of doing that is understanding everything that’s going on and coming up with a plan to really address all the needs.
Post-COVID pain can occur as part of Long COVID, a complex condition that may involve persistent, recurring, or fluctuating symptoms after COVID infection. Symptoms may include muscle pain, joint pain, headaches, nerve symptoms, fatigue, brain fog, sleep disturbance, dizziness, fast heart rate, GI symptoms, and post-exertional symptom worsening.
Long COVID can include more than 200 symptoms, with fatigue, brain fog, and post-exertional malaise commonly reported. Because these symptoms can overlap with many other conditions, careful evaluation is important before assuming one cause.
At Manhattan Pain Medicine, evaluation begins by understanding the full symptom pattern, COVID timeline, prior testing, pain distribution, headache history, autonomic symptoms, inflammatory signs, neurologic symptoms, and functional impact.
For patients looking for post-COVID pain treatment in Manhattan, MPM helps evaluate whether pain appears headache-related, neuropathic, musculoskeletal, inflammatory, autonomic, centralized, trauma-related, or mixed. MPM does not replace primary care, cardiology, neurology, rheumatology, pulmonology, infectious disease, or dedicated Long COVID care when those are needed. Instead, MPM supports pain, function, and coordinated care planning.
Jason W. Siefferman, MD
Medical Director | Interventional Pain Management | Headache Medicine
Luis Aranguren, MD
Interventional Pain Management
Adam Rosenberg, PA-C
Board-Certified Physician Assistant
Jordan Shankle, PA-C
Board-Certified Physician Assistant
Nino Mikaberidze, MD
Director of Rheumatology & Internal Medicine
Deborah Barbiere, Psy.D., L.Ac.
Pain Psychology
Post-COVID pain can be difficult because symptoms may involve multiple systems at once. A patient may have headaches, body aches, joint pain, tingling, numbness, dizziness, palpitations, brain fog, fatigue, sleep disruption, GI symptoms, or symptoms that flare after activity. Some patients have normal testing but still feel significantly impaired. CDC notes that Long COVID symptoms may be difficult to recognize because they can overlap with other health conditions.
MPM’s diagnosis-first approach helps organize these symptoms. The goal is not to assume every symptom is caused by COVID, but to identify whether pain may be driven by headache pathways, peripheral nerves, musculoskeletal strain, autoimmune or inflammatory disease, dysautonomia, POTS-like symptoms, central sensitization, fibromyalgia overlap, MCAS-like symptoms, medical trauma, or psychological threat physiology.
Post-COVID pain fits across several MPM Zones of Expertise, including Complex Chronic Pain, Autoimmune and Inflammatory, Autonomic Dysfunction, and Headache. This matters because Long COVID may involve headaches, muscle pain, joint pain, nerve symptoms, fatigue, brain fog, dizziness, fast heart rate, GI symptoms, sleep disruption, and symptom flares.
MPM uses the Zones of Expertise framework to evaluate whether pain appears headache-related, neuropathic, inflammatory, musculoskeletal, autonomic, centralized, trauma-related, or mixed. For some patients, the priority is coordination with primary care, cardiology, neurology, rheumatology, or pulmonology. For others, pain and function remain the main barriers and require a focused chronic pain plan.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
ZocDoc
This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
ZocDoc
Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
ZocDoc
Dr. Siefferman is a genius. He is very informed and listens attentively.
ZocDoc
Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
ZocDoc
Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
ZocDoc
Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
ZocDoc
Post-COVID pain refers to persistent or recurring pain after COVID infection. It may appear as muscle pain, joint pain, headaches, nerve pain, burning, tingling, numbness, widespread pain, pelvic pain, or pain that worsens after exertion. It may occur with fatigue, brain fog, dizziness, fast heart rate, sleep disturbance, GI symptoms, or post-exertional malaise. Post-COVID pain is not one single diagnosis. It may involve headache pathways, peripheral nerves, musculoskeletal pain, inflammatory symptoms, autonomic dysfunction, central sensitization, fibromyalgia overlap, or a combination of factors.
Long COVID can include a wide range of symptoms. Pain-related symptoms may include muscle pain, joint pain, headaches, nerve symptoms, tingling, numbness, chest discomfort, abdominal symptoms, and widespread sensitivity. CDC clinical guidance lists recurring headaches, lightheadedness or fast heart rate, bloating, constipation or diarrhea, persistent fatigue, sleep disturbance, and difficulty concentrating among Long COVID symptoms. (CDC) Symptoms may come and go, worsen after exertion, or overlap with other medical conditions, which is why careful evaluation is important.
Some patients develop post-COVID autonomic symptoms, including fast heart rate, dizziness, fatigue, lightheadedness, and exercise intolerance. NIH’s RECOVER-AUTONOMIC trials are evaluating treatments for Long COVID-related autonomic dysfunction, including symptoms such as fast heart rate, dizziness, and fatigue. This does not mean every patient with these symptoms has POTS. Similar symptoms can occur with dehydration, anemia, thyroid disease, cardiac conditions, medication effects, neurologic conditions, anxiety physiology, and other medical issues. Formal evaluation may involve primary care, cardiology, neurology, or autonomic specialists.
Yes. Some patients develop widespread pain, fatigue, poor sleep, brain fog, sensory sensitivity, and post-exertional symptom worsening after COVID. These symptoms may overlap with fibromyalgia, central sensitization, post-viral pain, headache disorders, autonomic dysfunction, or chronic fatigue-related patterns. This does not mean fibromyalgia is the correct diagnosis for every patient. MPM evaluates whether symptoms appear centralized, inflammatory, neurologic, musculoskeletal, autonomic, headache-related, or mixed. The goal is to validate symptoms while also looking carefully for treatable contributors.
Evaluation begins with the symptom timeline, COVID history, prior testing, current diagnoses, medication review, and pain pattern. MPM reviews whether pain is muscular, joint-related, nerve-like, headache-related, pelvic, widespread, activity-triggered, or associated with autonomic symptoms. Additional evaluation may include neurologic review, headache assessment, inflammatory signs, musculoskeletal exam, autonomic symptom review, and coordination with primary care, cardiology, neurology, rheumatology, pulmonology, infectious disease, or Long COVID specialists. Testing depends on symptoms and may be needed to rule out cardiopulmonary, neurologic, autoimmune, endocrine, hematologic, or medication-related causes.
Treatment depends on the pain pattern and suspected drivers. Options may include medication management, pacing strategies, sleep support, pain psychology, biofeedback, acupuncture, Feldenkrais, headache-directed care, and coordination with specialists. Pain psychology and biofeedback support nervous system regulation, coping, pacing, stress physiology, and function. Botulinum toxin injections may be considered for selected headache or muscle-related patterns. Ketamine therapy, lidocaine and ketamine infusions, regenerative medicine, and stellate ganglion blocks are not standard Long COVID treatments, but may be discussed only for selected pain or autonomic-related patterns when clinically appropriate.
Stellate ganglion block is being explored for selected Long COVID-related symptoms, but it should not be presented as a standard treatment for every patient. It does not directly treat viral infection and should not be described as a cure. The decision to consider stellate ganglion block depends on symptoms, diagnosis, medical history, risk factors, prior treatment response, and the broader care plan. MPM evaluates whether symptoms suggest an autonomic-related pain pattern or another condition that may be better addressed through primary care, cardiology, neurology, rehabilitation, pain psychology, or medication management.
Seek urgent medical care for chest pain, severe shortness of breath, fainting, new weakness or numbness, facial droop, speech difficulty, confusion, severe headache, signs of blood clot, severe dehydration, high fever, oxygen problems, or rapidly worsening symptoms. These symptoms may reflect cardiopulmonary disease, blood clots, neurologic disease, infection, inflammatory disease, or other urgent conditions. Post-COVID pain should not be assumed when symptoms are new, severe, or rapidly changing. Emergency, primary care, cardiology, neurology, pulmonology, or other medical evaluation may be needed.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Post-COVID pain can be part of Long COVID, a complex condition that may involve symptoms that persist, recur, or fluctuate after COVID infection. Long COVID can include many symptoms, and fatigue, brain fog, and post-exertional malaise are commonly reported. For many patients, the pain is not isolated. It may occur alongside fatigue, dizziness, fast heart rate, headaches, GI symptoms, sleep disturbance, brain fog, or symptoms that flare after activity.
Post-COVID pain is not one diagnosis. It may involve muscle pain, joint pain, nerve pain, headache pathways, autonomic dysfunction, inflammatory symptoms, central sensitization, fibromyalgia-like symptoms, MCAS-like symptoms, or post-viral nervous system sensitivity. MPM approaches these symptoms with clinical restraint. The goal is to validate the pain while also evaluating other possible causes.
Patients may describe body aches, joint pain, muscle burning, tingling, numbness, headaches, chest wall discomfort, pelvic pain, abdominal symptoms, or widespread sensitivity. Some patients feel pain after activity. Others wake with pain and fatigue that seem disconnected from the previous day. Some have symptoms that come and go without a clear trigger.
Pain may worsen with poor sleep, stress, exertion, infection, heat, upright posture, hormonal changes, or mental effort. This can make daily planning difficult. A patient may tolerate an activity one day but flare the next. This pattern is especially important when post-exertional malaise is present.
Post-exertional malaise, often called PEM, is a worsening of symptoms after physical, cognitive, or emotional effort. PEM may cause symptoms to worsen hours or days after even minor exertion and may last for days or weeks. For patients with PEM, pacing is often more appropriate than aggressive conditioning.
Pacing does not mean stopping life. It means learning the patient’s current energy limits, identifying triggers, spacing activity, protecting recovery, and avoiding repeated boom-and-bust cycles. When pain is part of PEM, MPM evaluates whether symptoms are musculoskeletal, neuropathic, autonomic, headache-related, centralized, or mixed.
Some patients with Long COVID experience symptoms that suggest autonomic dysfunction, including fast heart rate, dizziness, fatigue, lightheadedness, GI changes, and exercise intolerance. Autonomic symptoms may overlap with POTS, headaches, abdominal pain, nausea, constipation, pelvic floor dysfunction, and chronic pain.
These symptoms should be evaluated carefully because dizziness, tachycardia, and fatigue can also reflect anemia, thyroid disease, cardiac disease, dehydration, medication effects, endocrine problems, or neurologic conditions.
COVID may be followed by new headaches, worsening migraine, nerve-like pain, numbness, tingling, or widespread sensitivity in some patients. These symptoms may involve peripheral nerve irritation, headache pathways, central pain syndromes, or central sensitization. Central sensitization refers to increased nervous system sensitivity, where pain may feel stronger, spread more widely, or persist after tissues have healed.
This does not mean symptoms are psychological. It means the nervous system may be amplifying signals. At the same time, MPM evaluates whether there is a specific pain generator that needs targeted care, such as migraine, peripheral neuropathy, inflammatory joint pain, musculoskeletal strain, pelvic pain, or autoimmune-related symptoms.
MPM begins by reviewing the COVID timeline, symptom onset, prior testing, pain location, pain quality, flares, sleep, activity tolerance, medications, headaches, neurologic symptoms, autonomic symptoms, inflammatory signs, and functional impact. The evaluation considers whether symptoms appear headache-related, neuropathic, inflammatory, musculoskeletal, autonomic, centralized, trauma-related, or mixed.
Coordination may be needed with primary care, cardiology, neurology, rheumatology, pulmonology, infectious disease, rehabilitation, or dedicated Long COVID clinics. MPM’s role is to support pain and function, not to replace medical evaluation for systemic, cardiopulmonary, neurologic, or inflammatory causes.
Treatment depends on the clinical pattern. Medication management may target headaches, neuropathic pain, sleep, inflammation, muscle pain, or flare burden when appropriate. Pain psychology and biofeedback may support nervous system regulation, coping, pacing, sleep, fear, trauma response, and function. Acupuncture and Feldenkrais may be considered as supportive tools for selected patients. Botulinum toxin injections may be relevant for selected headache or muscle-related patterns.
Stellate ganglion blocks, ketamine therapy, lidocaine and ketamine infusions, and regenerative medicine should not be presented as standard Long COVID treatments or cures. They may be considered only when a specific pain or autonomic-related pattern supports discussion. Treatment must be individualized and medically supervised.
Patients should seek urgent care for chest pain, severe shortness of breath, fainting, new weakness or numbness, facial droop, speech difficulty, confusion, severe headache, signs of blood clot, severe dehydration, high fever, oxygen problems, or rapidly worsening symptoms. These symptoms may need emergency, cardiology, neurology, pulmonology, or other medical evaluation.
MPM approaches post-COVID pain through a diagnosis-first, coordinated model. The evaluation considers headache and migraine, peripheral neuropathy, autoimmune-related pain, central pain syndromes, fibromyalgia-like symptoms, MCAS-like symptoms, dysautonomia, post-exertional malaise, sleep disruption, psychological threat physiology, and functional limitation.
For patients looking for post-COVID pain treatment in Manhattan, MPM offers a careful, patient-centered approach to persistent pain after COVID. The goal is to validate the symptom burden, identify treatable contributors, coordinate with the right specialists, and build a care plan that supports function, nervous system regulation, and safer long-term management.
