The experience of deep, systemic discomfort felt during COVID-19 often leads people to ask if the virus causes bone pain. While the pain may feel as though it originates in the bones, medical professionals typically classify this widespread suffering as musculoskeletal pain. This generalized body ache, known as myalgia, is a frequent and often early symptom of infection with SARS-CoV-2, the virus that causes COVID-19.
Understanding Musculoskeletal Pain in Viral Infections
The subjective experience of “bone pain” during a viral infection like COVID-19 is usually a manifestation of severe muscle aches (myalgia) and joint pain (arthralgia). The sensation of pain is deep-seated and widespread, often affecting the back, shoulders, neck, and limbs. Unlike an actual bone fracture or infection, the pain is rooted in the soft tissues surrounding the skeleton, not the bones themselves.
Generalized body aches are common across many systemic viral illnesses, including influenza, but the severity reported with COVID-19 is often intense. The pain can be severe enough to interfere with daily activities, making movement difficult and limiting mobility. Studies have identified that myalgia and arthralgia are a significant part of the disease presentation in COVID-19 patients.
The Biological Drivers of COVID-Related Body Aches
The underlying reason for this widespread discomfort is the body’s immune response, not the direct attack of the virus on bone tissue. When the immune system detects SARS-CoV-2, it releases signaling proteins called cytokines to coordinate the defense. These cytokines are inflammatory mediators, including interleukin-6 (IL-6), interleukin-1 (IL-1), and tumor necrosis factor-alpha (TNF-α), which trigger systemic inflammation.
This inflammatory state causes the surrounding tissues to become sensitized, leading to the pain felt in muscles and joints. The inflammatory molecules irritate nerve endings throughout the body, resulting in the dull, aching sensation that can be mistaken for pain deep within the bone. While the immune response is the primary driver, some research suggests the virus may also directly damage muscle tissue by binding to muscle cells, contributing to the myalgia.
Timeline of Discomfort: Acute Phase and Long COVID Persistence
The musculoskeletal pain typically begins early in the infection, often within the first two days of symptom onset, and can even precede the more recognized respiratory symptoms. During the acute phase of COVID-19, myalgia and arthralgia are highly prevalent, sometimes affecting over 80% of patients. For most individuals, these body aches resolve as the immune system clears the virus and the systemic inflammation subsides.
However, for some, the pain persists or develops weeks or months after the initial infection, becoming a feature of Post-Acute Sequelae of SARS-CoV-2 infection (PASC), commonly known as Long COVID. Musculoskeletal symptoms, including joint and muscle pain, are among the most common persistent complaints in Long COVID patients. This persistent pain may be linked to ongoing dysregulated inflammation or, in some cases, a lack of blood flow to the muscle tissues, a condition known as ischemic myalgia.
Strategies for Managing Pain and Discomfort
Managing COVID-related body aches focuses on reducing inflammation and supporting recovery. Rest and adequate hydration are essential for recovery. Applying heat, such as through a warm bath or a heating pad, can help relax sore muscles and provide relief from the aching sensation.
Over-the-counter medications are commonly used to address pain and fever. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, work by reducing the generalized inflammation that drives the pain. Acetaminophen is also effective for pain relief and fever reduction, though it lacks the anti-inflammatory properties of NSAIDs. Consult a physician regarding the appropriate use and dosage of any pain relievers, especially if you have underlying health conditions.