COVID-19 and chronic pain in children and teens

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Children and teens with chronic pain may find their pain symptoms are getting worse during the COVID-19 pandemic. This may be due to increased amounts of stress and the decreased levels of physical activity.

Key points

  • For children and teens with chronic pain, the increase in stress and a decrease in physical activity, due to the COVID-19 pandemic, can cause their pain symptoms to be worse.
  • For children and teens with COVID-19 and chronic pain, treatment should involve treating the symptoms of both the infection and the chronic pain.
  • Strategies to manage pain include mind-body strategies, physical strategies and medications.
  • There are different types of pain (nociceptive, neuropathic and nociplastic) and they are treated with different types of medications.

COVID-19 is an infection caused by the coronavirus named SARS-CoV-2. It is a respiratory virus which spreads mainly through close contact with an infected person.

Symptoms of COVID-19 may include fever, cough, fatigue, body aches, headache, nausea, vomiting, diarrhea as well as loss of taste or smell. Children and teens with chronic pain who have COVID-19 may find their pain symptoms get worse.

Treatment for COVID-19 should involve treating the symptoms of the infection and the chronic pain.

Chronic pain, stress and COVID-19

Stress can change how your child or teen experiences painful sensations. COVID-19 can be stressful due to things such as being separated from family and friends, being out of a regular routine and worrying about oneself or loved ones. Many children and teens are feeling stressed or worried about COVID-19. This can increase their sensitivity to pain experiences, especially for those with chronic pain. Children and teens are also getting less physical activity during the COVID-19 pandemic and this can increase their sensitivity to pain experiences. Although it may be challenging to reduce the amount of stress and worry, while at the same time increasing levels of physical activity, it is more important than ever to do this. Your child or teen can use various strategies for managing pain, such as:

  • mind-body strategies
  • physical strategies
  • medications

Mind-body strategies

Mind-body strategies are often called coping skills or strategies. Coping involves using skills or strategies to manage stressful experiences. Ways of coping come in all shapes and sizes. Some examples of coping skills and strategies include distraction, self-soothing strategies, and mindfulness.

Children and teens living with chronic pain may find it harder to use coping skills and strategies for managing pain during the COVID-19 pandemic. For example, many children and teens may feel isolated from their peers. This can increase their feelings of stress and decrease their motivation to use coping skills. It can be helpful to develop creative coping skills and strategies to increase your child’s or teen’s motivation for using these strategies.

Distraction involves keeping your thoughts and attention focused on something pleasant or enjoyable when experiencing pain or when feeling stressed. Distraction strategies will be different for everyone. Some people like reading a book and some like spending time outdoors. Be creative and give one of these a try!

  • Make a play list of your favourite songs.
  • Think of funny stories or memories.
  • Write a story where you are the main character and ask someone else to make up an ending to the story.
  • Text, call or have a video chat with a friend or family member.
  • Write down your thoughts and feelings in a journal.
  • Use a search-and-find book.
  • Read a favourite book.
  • Watch your favourite TV show or movie.
  • Spend time drawing, painting or completing a craft activity.

Self-soothing involves using strategies to calm yourself. Think of what brings you comfort and try to use it when you are feeling stressed or upset. If you need some ideas, give one of these a try!

  • Relax your body from your head to your toes.
  • Try belly or four-square breathing.
  • Use positive self-statements. For example, I am strong and I can do this!
  • Take a mental vacation. For example, imagine your favourite place and who would be there with you.
  • Create pictures in your mind. Think of your favourite animal, sports game or family holiday, and imagine these things in your mind. Think of all the details, imagine the smells and the sounds.

Mindfulness involves directing your attention to the present moment. There are many different types of mindfulness activities that you can try. Practice mindful walking, eating or listening.

Physical strategies

For children and teens living with chronic pain, regular physical activity is extremely important. Although it may be harder to engage in physical activity during the COVID-19 pandemic, there are many creative ways to stay physically active!

Check out the ParticipACTION website for creative ideas when exercising at home!


Medications are one of the strategies that may be used when treating chronic pain. Medications are rarely used alone for managing chronic pain. They are most effective when used in combination with mind-body and physical strategies.

Pain medications are used to help with:

  • Improving your child’s or teen’s level of functioning.
  • Improving quality of life for your child or teen, and the entire family.
  • Managing pain when used in combination with both mind-body and physical strategies.

COVID-19 and medications

Health Canada recommends the use of either acetaminophen or ibuprofen to reduce fever for children over 6 months of age who are infected with COVID-19.

At the beginning of the pandemic, there were recommendations for those diagnosed with COVID-19 to avoid the use of non-steroid anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. However, the current recommendations are that it is safe to use NSAIDs for those diagnosed with COVID-19 with fever.

If your child to teen is taking any of these medications to manage chronic pain, do not stop taking them before consulting your health-care provider.

Read this article to find more information about medications for chronic pain, or consult your pharmacist or clinic nurse.

Types of pain and medications used to treat it

Nociceptive pain

This type of pain often results from activation of pain receptors in the body. Injury or inflammation in different areas of the body can result in this type of pain. For example, sprains, broken bones, muscle strains from exercise can all cause nociceptive pain.

Examples of over the counter medications for nociceptive pain include:

  • Acetaminophen
  • Non-steroidal anti-inflammatory medications such as ibuprofen and naproxen
  • Topical medications such as topical diclofenac

Neuropathic pain

This rare type of pain occurs when there is damage to the nerves (the pain signalling pathways of the body). For example, medications for certain cancer treatments, nerve injuries at birth and complex regional pain syndrome (CRPS) can all cause neuropathic pain. Neuropathic pain can cause painful sensations such as tingling, burning, electrical or pins and needles.

Examples of medications prescribed for neuropathic pain:

  • Gabapentin
  • Amitriptyline
  • Nortriptyline
  • Duloxetine

Nociplastic pain

This type of pain occurs when the nervous system becomes very sensitive and it is often referred to as primary pain. It is sometimes seen in children with irritable bowel syndrome or after they experience a minor injury or infection.

This kind of pain is sometimes treated with one of more of the types of medications listed above, depending on the specific symptoms and circumstances.


Opioids are a group of medications (morphine, hydromorphone, and oxycodone) that are rarely used for treating chronic pain. If you are taking an opioid and have an infection causing fever, cough, diarrhea or vomiting, let your doctor know you are taking this medication. If you are not sure how to monitor and recognize the side effects of taking an opioid such as sedation, constipation, nausea and dizziness, then talk to your doctor or clinic nurse.

When to seek medical attention

If you are concerned about your child’s or teen’s health, contact your child’s primary health-care provider or Health811 (811 | TTY: 1-866-797-0007). In case of an emergency seek immediate medical attention.

Last updated: May 26th 2020