Lyme Disease Pain Management and Chronic Pain
Pain may affect multiple body systems
Lyme disease pain can involve joints, nerves, and central pathways
Treatment often requires more than pain medication alone
Lyme disease pain management is challenging because pain can arise from inflammation, neuropathy, autonomic dysfunction, central sensitization, or persistent symptoms after treatment.
Patients describe headaches, eye pain, neck pain, chest pain, abdominal pain, bladder pain, joint pain, neuropathy, burning sensations, and widespread body pain. Some improve with antimicrobial treatment while others require symptom-based approaches.
See also: Chronic Lyme Disease Pain
Reported pain associated with Lyme disease may involve multiple systems simultaneously. Pain medication alone may not always be effective because inflammation, neurologic dysfunction, autonomic changes, and central sensitization may contribute.1,6,8
Central Sensitization and Chronic Lyme Pain
Chronic pain, debilitating fatigue, and heightened sensory disturbances are common in Lyme disease patients.
In the article Post-Treatment Lyme Syndrome and Central Sensitization, Batheja and colleagues proposed that some persistent symptoms may reflect central sensitization syndrome (CSS).1
Central sensitization syndrome involves changes within the central nervous system involving altered neurotransmission and heightened pain processing.1
“Notably, in relation to Lyme disease, infections, in general, are known to activate central sensitization in some patients, possibly through the release of inflammatory cytokines,” Batheja explained.1
See also: Central Sensitization Syndrome and Lyme Disease
Abdominal Pain as a Lyme Disease Presentation
At age 8, a boy was hospitalized for severe abdominal pain and underwent extensive testing that was initially unrevealing.2
One year later, he developed cognitive symptoms, irritability, speech difficulties, and gait abnormalities.2
He was diagnosed with abdominal neuroradiculopathy associated with late Lyme disease and treated with oral and intravenous antibiotics.2
His gait and school performance eventually resolved after treatment.2
See also: Lyme Disease Manifesting as Abdominal Pain
Persistent Pain After Lyme Disease Treatment
Persistent pain following treatment remains a challenge for some patients.
One study found that approximately 31% of patients reported significant pain months after treatment for erythema migrans.3
Researchers also described a 31-year-old woman with PTLDS whose pain remained refractory despite radiofrequency ablation, opioid treatment, vitamin infusions, and multiple medications.4
Her symptoms included diffuse body pain, fatigue, headache, and brain fog.4
Ketamine reduced pain severity substantially in this case.4
See also: Ketamine for PTLDS Pain
Nerve Pain and Neuropathy in Lyme Disease
Nerve pain is frequently described by Lyme disease patients.
A 36-year-old man with PTLDS reported severe neuropathic foot pain despite methadone, gabapentin, duloxetine, narcotics, and multiple interventions.5
Two surgical procedures eventually improved symptoms.5
Author’s note: I might have reconsidered retreatment with antibiotics in this setting.
See also: Pain Due to Lyme Disease
Can Central Sensitization Affect Fatigue and Brain Fog?
Fatigue and cognitive impairments frequently accompany chronic pain syndromes.
Studies have shown patients with PTLDS may experience impairments involving memory, processing speed, concentration, and verbal fluency.1,6
Central fatigue may overlap with cognitive dysfunction, autonomic symptoms, and sleep disruption.1,6,8
See also: Brain Fog and Lyme Disease
Complex Regional Pain Syndrome and Lyme Disease
Complex regional pain syndrome (CRPS) and reflex sympathetic dystrophy have been described following Lyme disease.9
One patient developed severe pain and swelling involving the foot severe enough to impair walking.9
Even minor skin contact caused severe pain.9
The patient improved after four weeks of intravenous ceftriaxone.9
See also: Autonomic Dysfunction and Pain
Frequently Asked Questions
Can Lyme disease cause chronic pain?
Yes. Some patients experience chronic pain involving joints, nerves, muscles, or central pain pathways.
What helps Lyme disease pain?
Treatment may include antimicrobial therapy when appropriate, rehabilitation, symptom-based medications, sleep management, and addressing autonomic dysfunction.
Can nerve damage from Lyme disease be reversed?
Recovery varies. Some patients improve significantly while others experience prolonged neuropathic symptoms.
Does gabapentin help Lyme disease pain?
Gabapentin may help some patients with neuropathic symptoms but responses vary considerably.
Why does Lyme pain continue after treatment?
Persistent inflammation, neuropathy, autonomic dysfunction, central sensitization, and other mechanisms may contribute.
Clinical Takeaway
Lyme disease pain may arise from multiple mechanisms including inflammation, neuropathy, autonomic dysfunction, and central sensitization.
Understanding the mechanism behind pain may be as important as treating the pain itself.
Related Articles
Post-Treatment Lyme Disease Syndrome
Persistent Lyme Disease Symptoms
Autonomic Dysfunction and Lyme Disease
Lyme Disease Symptoms Guide
References
- Batheja S, Nields JA, Landa A, Fallon BA. Post-treatment Lyme syndrome and central sensitization. J Neuropsychiatry Clin Neurosci. 2013;25(3):176-186.
- Savasta S, Fiorito I, Foiadelli T, Pichiecchio A, Cambieri P, Mariani B, Marone P, Marseglia GL. Abdominal pain as first manifestation of Lyme neuroborreliosis in children: Case report and review of literature. Ital J Pediatr. 2020
- Bechtold KT, Rebman AW, Crowder LA, Johnson-Greene D, Aucott JN. Standardized symptom measurement of individuals with early Lyme disease over time. Arch Clin Neuropsychol. 2017;32(2):129-141.
- Hanna A, et al. Intravenous ketamine for chronic pain in post-treatment Lyme disease syndrome. Case Rep Anesthesiol. 2017.
- Karri J, Bruel BM. Dorsal root ganglion stimulation for post-Lyme disease chronic peripheral neuropathic pain. Neuromodulation. 2021;24(4):794-795.
- Rebman AW, Aucott JN. Post-treatment Lyme disease as a model for persistent symptoms in Lyme disease. Front Med. 2017;4:57.
- Lim M, Kinjo S. Anesthetic management of severe pain after dental surgery in a patient with post-treatment Lyme disease syndrome. Saudi J Anaesth. 2018;12(4):647-650.
- Carod-Artal, F. J. (2018). Infectious diseases causing autonomic dysfunction. Clinical Autonomic Research, 28(1), 67–81
- Sibanc R, Lesnicar G. Complex regional pain syndrome associated with Lyme borreliosis. Eur J Neurol. 2002.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
