020 7730 8508Post Covid Syndrome with pain and hypermobility
Introduction
Post-Covid Syndrome — often called Long Covid or the post-acute sequelae of SARS-CoV-2 infection (PASC) — describes a cluster of symptoms that persist beyond 12 weeks after acute infection and cannot be explained by an alternative diagnosis. In the UK, clinical care is guided by the NICE NG188 rapid guideline, which recognises three phases: acute Covid-19 (0-4 weeks), ongoing symptomatic Covid-19 (4-12 weeks) and Post-Covid Syndrome (12 weeks+) NICE.
Although population estimates vary, studies suggest millions worldwide experience long-term fatigue, pain, breathlessness or “brain-fog”. Dr Stephanie Barrett’s unique background in rheumatology, autonomic dysfunction and non-invasive brain stimulation (rTMS) places her at the forefront of personalised care for these complex, multisystem symptoms.
What is Post Covid Syndrome?
Post-Covid Syndrome is a multisystem disorder thought to arise from a combination of:
- Immune dysregulation and persistent inflammation
- Autonomic nervous system imbalance (similar to dysautonomia seen in hypermobile Ehlers-Danlos Syndrome, another of Dr Barrett’s specialities)
- Central sensitisation and altered pain processing, overlapping mechanistically with fibromyalgia
- Microvascular and mitochondrial dysfunction affecting energy production and tissue oxygenation
- Risk appears higher in those who had severe acute infection, required hospitalisation, or have pre-existing autoimmune or connective-tissue disorders, yet it can affect anyone, including those with mild initial illness.
Symptoms of Long Covid Syndrome:
Long-Covid symptoms can be wide-ranging and fluctuate day to day. The most common include:
Musculoskeletal pain: Generalised or localised pain, myalgia, joint stiffness, weakness.
Neurological / Cognitive symptoms: Brain-fog, memory lapses, headaches, sleep disturbance.
Autonomic symptoms: Palpitations, dizziness or fainting on standing (POTS-like), temperature dysregulation.
Respiratory problems: Breathlessness, persistent cough, chest tightness.
Systemic issues: Profound fatigue, post-exertional symptom exacerbation (PESE)
Others: Altered taste/smell, gastrointestinal upset, mood change, skin rashes
WE DEAL SPECIFICALLY WITH PAIN LINKED TO FATIGUE IN LONG COVID
Fibromyalgia, dysautonomia and Mast Cell Activation Syndrome are all found within the symptoms and signs of Long Covid. The beauty of our Rheumatology Clinic with the unique applications of RTMS and PMS means we can treat the major debilitating components of Long Covid. Dr Stephanie Barrett has spent the past five years researching and treating these conditions within a rheumatology clinic setting. We know, therefore, that we can assess and screen accurately in order to use the best protocols for treatment. We also have an extensive network of allied specialist colleagues in gastroenterology, cardiovascular medicine and autonomic nervous systems.
There is currently no single “cure”; management focuses on tailored, multi-disciplinary rehabilitation and symptom modulation.
Dr Barrett follows the step-wise approach set out by NICE NG188
Detailed history & symptom timeline – documenting triggers, fluctuations and any PESE.
Comprehensive physical examination – especially musculoskeletal.
Baseline investigations to exclude alternative or additional pathology (blood counts, inflammatory markers, blood sets to exclude auto-immune diseases and blood tests which help with the diagnosis of MCAS, musculoskeletal imaging when indicated.
Functional/autonomic testing – tilt-table or active stand for POTS, heart-rate variability analysis (within our network of specialist colleagues).
Validated questionnaires – We ask patients fill in questionnaires prior to their appointment to assess for dysautonomia, hypermobility, fibromyalgia impact score, body mapping for pain areas.
Repetitive Transcranial Magnetic Stimulation (rTMS)
Following research (RCT) of 90 patients with Fibromyalgia in 2020, (Tanwar et al 2020) the research showed that rTMS worked very effectively for Fibromyalgia.
In 2025, we replicated the study (Dr Stephanie Barrett, et al, now published in Frontiers in Pain, this study showed significant improvements in pain, fatigue, fibromyalgia impact score, anxiety and depression. we have had a response rate of 93% with 44% of patients going into remission.
Integrated care for overlapping conditions
Where Dysautonomia, MCAS or Hypermobility are present, Dr Barrett coordinates care with cardiology, allergy/immunology, Gastroenterology and Hypermobilty trained physiotherapy colleagues to address internal and external symptoms which are related and contribute to the continuing poor health of our patients. We treat holistically in the true sense of the word.