4 Keys Approach Will Be Vital To Deal With The Upcoming Tidal Wave Of Post COVID – 19 Chronic Pain, Depression and Anxiety

COVID-19 has dominated our lives for nearly a year now and while we may be becoming immune to the subject, there are new articles emerging constantly as we learn more about this epidemic, providing important new insights, which we should not ignore.

A recent paper, referenced below, published by physiotherapist Dr Adriaan Louw, written for the medical community, is well researched and gives strong indications of what our post COVID-19 lives may involve. Sadly, it will not just be a matter of getting through the epidemic. For many, there will be significant long term consequences.

The author forecasts a tidal wave of chronic pain, depression and anxiety heading our way.

Here we will translate the paper burdened with medical terminology into something which can be more easily understood by the general public.


SARS was a coronavirus epidemic and as such, was considered a good place to start to review what happened during and after the epidemic:

  • Up to 65% of survivors developed depression, anxiety disorders, panic disorders, phobias and psychosis.
  • Between 25% and 44% of Hong Kong SARS survivors were diagnosed with posttraumatic stress disorder (PTSD). 15% experienced depression for at least two and a half years.

It became very clear that SARS showed the importance of the need to treat patients with a broad approach, looking at their physical, mental and general health situation.

Inflammation and Immune System

We will all understand that the strength of our immune system is a key resistor to poor health. Perhaps not so well known will be that our own inflammatory responses are closely linked to our immune system. An acute viral illness, for example, can trigger an inflammatory response that will present as myalgia, fatigue and organ specific symptoms.

These responses can also be long lived. Long term chronic pain is well reported post ICU (intensive care unit), with 40% recording chronic pain up to 4 years later. Another study showed that many experienced persistent difficulties for up to 11 years with mobility (52%), pain/discomfort (57%), normal daily activities (52%) and cognition (43%).

With an immune system already under threat, the immune system will be further challenged with depression, poor sleep and opioid use, all of which suppress the immune system.

Social Aspects

Lockdowns and social isolation have psychological and financial implications and inevitably cause stressors such as fear of illness, future uncertainty and concerns of second waves will only exacerbate this.

Early evidence shows that anxiety and depression and sleep disturbances are common reactions to this pandemic.  Sleep deprivation can lead to symptoms virtually indistinguishable from widespread pain, fatigue and diffuse tenderness.  While exercise is known to help sleep, our abilities to get the exercise we need has been restricted by the pandemic.

Restrictions on access to regular medical care further adds to the potential downstream consequences expected after COVID-19.

Physical & Emotional Link

It is well known that physical and emotional pain are closely related. Functional MRI studies have shown that physical and emotional pain mapping in the brain overlap by 88%.  It is thus very important to accept that thoughts, emotions and physical pain should be considered and treated together as one problem.


The evidence suggests that in chronic and complex pain cases, there are likely to also be problems with fear, mood and personality. The indicators are that there will be both an increase in the rate of chronic pain cases and the severity of its impact will have widespread social implications.

It is considered evident that the physiotherapists approach to treating chronic pain must include consideration of social and environmental aspects, including mental aspects, emotional wellbeing, nutritional advice, mindfulness, lifestyle and preventative care.


4 Keys To Health

Many of you will know that our clinic has long promoted an approach to treatment which embraces both physical and social aspects. Nicky Snazell has written five books on this subject and has been invited to speak on over 30 radio stations right across the USA, to promote and educate an alternative to excessive opioid use, long before the COVID-19 pandemic started. The advice is equally important and valid to treating the forecast tidal wave of chronic pain coming.

Nicky’s first book, The 4 Keys To Health, available from Amazon, described an approach which looked at every aspect considered important in this paper:

  • Mindset
  • Nutrition
  • Lifestyle
  • Fitness & exercise

A simple traffic light system was included to score patients and provide a preventative road map and pathway to better health. Wellness, or prevention, was naturally incorporated into the service we offered.

Thus, the direction of Nicky Snazell’s Wellness and Physiotherapy Clinic has been solidly towards providing a capability which exactly matches the need as proposed as a vital need by Adriaan Louw.


Dr Adriaan Louw has provided insightful and well researched evidence to suggest that a tidal wave of chronic pain, depression and anxiety is coming post COVID-19. Treatment, to be effective, will require consideration of physical, social and environmental aspects.

While none of us will have control of the potential size of the tidal wave coming, we do have the opportunity to be properly prepared. At Nicky Snazell’s Clinic, we have already long embraced, taught and learnt the proposed skills that are suggested as vital to win the battle.

If you want to get ahead of the curve and start thinking about prevention as better than cure, then now is the time to talk to us. We can help.

Our clinic has an enviable reputation for treating pain, with patients travelling from far and wide. We have treatment skills at the highest level, combined with a thorough understanding of the importance of treating the whole person.

Call now on 01889 881488. Erica and Jean will be happy to help.


For those who wish to read the full paper, this is the reference:


Letter to the editor: chronic pain tidal wave after COVID-19: are you ready? Adriaan Louw, PT, PhD.  PHYSIOTHERAPY THEORY AND PRACTICE, 2020, Vol 36, No 12, 1275 -1278. https//doi.org/10.1080/09593985.2020.1840717