Since December 2019, the world is dealing with the novel coronavirus disease 2019 (COVID-19) pandemic, and now, nearly 20 months since, as the COVID-19 pandemic continues, we continue to learn about the new and long-term manifestations and complications of this disease. There has been a surge of invasive fungal co-infection in patients with COVID-19, many cases being reported worldwide.^{1, 2} One characteristic presentation in these patients is severe facial pain and numbness on the affected side, mostly involving V1 and V2 distribution of the trigeminal nerve, and often associated with a hemi-cranial headache. As per the International Classification of Headache Disorders (ICHD-3), this entity falls under the classification of “Painful trigeminal neuropathy attributed to other disorder.”³

Neural damage can induce pain originating in a peripheral nerve, in a ganglion, in a dorsal root, or from the central nervous system. Trigeminal neuropathies are a group of clinical disorders that involve injury to the primary first order neurons within the trigeminal nerve.⁴ The focus here is on pain resulting from injury to the peripheral branches of the trigeminal neuron, the injury caused by the rapidly progressive and destructive fungal infection.

The primary management of the disease includes urgent imaging followed by surgical debridement and early antifungal therapy, and that remains the most important intervention for reducing the pain.⁵ These patients often require around the clock analgesia. Early use of standard antineuropathic medication is helpful in managing pain in these individuals. Injectable paracetamol and weaker opioids, like tramadol, play an important role in reducing the pain. The involvement of inflammation in a clinical painful neuropathy is a clear indication for anti-inflammatory therapy to minimize inflammation due to disease as well as due to surgery. However, simultaneous use of antifungal drugs, like Amphotericin B, have nephrotoxic potential and close monitoring of renal function tests may be necessary. Being an infectious pathology, steroids hold a limited role.

While we continue to deal with this deadly disease and invest all resources toward minimizing mortality, this is an attempt to address the need of efficient pain management in this subgroup of patients. Early diagnosis and treatment are essential, because once chronic pain is established the condition is hard to treat.

自 2019 年 12 月以来，世界正在应对 2019 年新型冠状病毒病 (COVID-19) 大流行，而现在，近 20 个月以来，随着 COVID-19 大流行的继续，我们继续了解新的和长期的表现和这种疾病的并发症。COVID-19 患者的侵袭性真菌合并感染激增，世界范围内报告了许多病例。^{1, 2}这些患者的一个特征性表现是患侧严重的面部疼痛和麻木，主要涉及三叉神经的 V1 和 V2 分布，并且通常与偏颅性头痛有关。根据国际头痛疾病分类 (ICHD-3)，该实体属于“归因于其他疾病的疼痛性三叉神经病变”的分类。³

神经损伤可诱发起源于周围神经、神经节、背根或中枢神经系统的疼痛。三叉神经病是一组涉及三叉神经内初级一级神经元损伤的临床疾病。⁴这里的重点是三叉神经元外周分支损伤引起的疼痛，这种损伤是由快速进行性和破坏性的真菌感染引起的。

该疾病的主要治疗包括紧急成像，然后是手术清创和早期抗真菌治疗，这仍然是减轻疼痛的最重要干预措施。⁵这些患者通常需要全天候镇痛。早期使用标准抗神经病药物有助于控制这些人的疼痛。可注射的扑热息痛和较弱的阿片类药物，如曲马多，在减轻疼痛方面发挥重要作用。炎症在临床疼痛性神经病中的参与是抗炎治疗的明确指示，以尽量减少由于疾病和手术引起的炎症。然而，同时使用抗真菌药物，如两性霉素 B，具有肾毒性潜力，可能需要密切监测肾功能检查。作为一种传染性病理学，类固醇的作用有限。

虽然我们继续处理这种致命疾病并投入所有资源以尽量减少死亡率，但这是为了解决这一亚组患者对有效疼痛管理的需求。早期诊断和治疗至关重要，因为一旦确定慢性疼痛，病情就很难治疗。