Treatment of Neuropathic Pain Complaints caused by Long COVID at Excellent Care Clinics
Excellent Care Clinics (ECC) provides lidocaine treatments to patients referred for pain complaints resulting from Long COVID. A dedicated department has been established for this patient group, which often presents with severe symptoms. The treatments are based on the well-known anaesthetic and pain management drug lidocaine, which is administered at Excellent Care Clinics (ECC) through multiple routes of administration. The specific application depends on the patient's symptoms and condition. Over time, lidocaine has been administered intravenously (via the bloodstream), subcutaneously (under the skin), and via a spray (under the tongue), including in combination. In 2024, a modified lidocaine treatment was introduced that allows patients to self-administer the treatment at home. Thanks to this modified lidocaine treatment, severely ill patients who are unable to travel to the clinic, or who experience worsening symptoms as a result, can also be treated.
The treatments are aimed at reducing neuropathic pain complaints and other symptoms associated with Long COVID. For daily guidance and monitoring of patients, Excellent Care Clinics uses digital tools, including apps and wearable measurement devices (wearables). These allow patients to track their symptoms, functioning, and recovery in a structured way from home, while clinicians maintain remote insight into the course of treatment.
Research into the effects and results of these treatments has been conducted in collaboration with researchers from Amsterdam UMC and the Vrije Universiteit.
Pain and Long COVID
Long COVID, also referred to as post-COVID or PASC (Post-Acute Sequelae of SARS-CoV-2 infection), is a chronic condition that can be accompanied by a wide range of symptoms. Many patients with severe Long COVID experience, in addition to pronounced fatigue, significant pain complaints, often with characteristics of neuropathic pain. These pain complaints typically arise during the same period as the other Long COVID symptoms and often follow a similar course, where worsening or improvement of pain complaints frequently runs in parallel with changes in other symptoms. In addition to fatigue and pain, symptoms include post-exertional malaise (PEM), severely reduced exercise tolerance, breathlessness, and cognitive impairments such as brain fog, concentration difficulties, and sensory overstimulation. In many patients, these symptoms form a coherent clinical picture, where physical exertion or overload can simultaneously lead to an increase in both pain and other symptoms.
Common long COVID symptoms
1
Severe fatigue
2
Concentration problems and brain fog
3
Sensitivity to sound and light
4
Nerve pain
5
Breathing problems
6
POTS (dysregulation of heart rate and blood pressure upon standing)
7
PEM (post-exertional malaise – severe relapse after exertion)
8
Many more symptoms/complaints
In the Netherlands alone, the number of patients with a severe form of Long COVID is estimated at approximately 100,000, while an estimated 450,000 people are dealing with moderate to moderately severe symptoms. For this very large patient group, there is currently no registered, causal treatment available.
In clinical practice, we observe that many patients with Long COVID suffer from neuropathic pain complaints. General practitioners and medical specialists refer patients with these complaints to our clinic. Treatment with lidocaine leads in many patients not only to relief of pain, but they also report a reduction in other Long COVID-related symptoms, such as fatigue, sensory overstimulation, and cognitive complaints. These potential broader effects of lidocaine are currently being investigated further.
These symptoms can persist for months to years and have an enormous impact on virtually all aspects of life and social functioning for many patients. Many patients become (partially) unable to work, have to discontinue their studies, or see their participation in social and daily activities severely restricted. Spontaneous improvement in patients who have been severely ill for more than a year is relatively rare. Worldwide, it is estimated that approximately 450 million people have been affected by long-term post-COVID symptoms.
Availability and Costs
Current situation
The lidocaine medication is currently compounded by a specialized pharmacy. This pharmacy specializes in sterile hospital preparations. Due to the limited production scale, the labor-intensive preparation process and the expensive raw materials, producing this medication is costly. Unfortunately, this lidocaine preparation is currently not reimbursed by health insurers.
Production still on a limited scale
Medication is not (yet) reimbursed by health insurers
Medication is costly; treatment is only possible with a personal contribution to medication costs
Future perspective
It is important that treatment with the lidocaine preparation becomes available on a larger scale for long COVID patients. A first and necessary step is reimbursement of the medication by health insurers. Additionally, ECC is working on a collaboration with an international compounding pharmacy that can realize large-scale production of the medication. This makes the treatment not only more widely accessible, but also helps to reduce medication costs. Patients can also contribute by letting their health insurer know that they would like to be eligible for this treatment, provided it is reimbursed. ECC's goal is to:
Our wish
For Dutch long COVID patients, we want the treatment to become structurally available and reimbursed through basic health insurance, so that everyone who can benefit has access.
ECC-International
Parallelweg 2
1948 NM Beverwijk