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eConsult Clinical Question

I have a 37-year-old patient who developed a pulmonary embolus after a COVID infection and has had significant pleuritic chest pain afterwards. He has tried a number of options - NSAIDS, Tylenol, topicals, Flexeril, and was started on opiates, to which he has developed some dependence. We started him on duloxetine for any potential neurogenic component of the pain. What options you might recommend for prolonged pleuritic pain after COVID and a pulmonary embolus?

eConsult Response

I agree with what you have tried to date for pain including Cymbalta. I have referred patients to the pain clinic for trial of alternate agents if that doesn't work. We have seen neuropathic pain as part of COVID. His pulmonary embolus was earlier, and I would expect that his pain should be improving. You could consider repeat CT scan to evaluate for alternate etiology.

These real-life examples have some limitations. Given the evolving recommendations and guidance on COVID-19 care, these cases should not be considered complete or definitive and may not reflect the most up-to-date guidance.