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.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
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.
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...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
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.
