Clinical Cases

A Case of Painful Post Covid Sequelae

Dr. Maurizio Paolella shares a case of post-Covid sequelae involving intense neuralgic pain. Amelioration from warmth and movement suggested Rhus tox but another remedy proved to be the simillimum.           

This case has been taken in supervision on Oct. 7th 2023. The patient was not vaccinated for Covid 19.

The lady (69 years old) tested positive for Covid infection on Sept. 16th. Her main symptoms were dry cough, described as superficial, and weakness, lacrimation and burning pain in the eyes.  Without any treatment on Oct .20th she felt much better, tested negative for Covid, but noticed the beginning of pain in left leg.

Very intense neuralgic pain. This pain was very much worse at night and was

aggravated lying down. She MUST move for some relief. The day after her homeopath prescribed her constitutional remedy (unknown to me), but this did not help.

As this pain in her left leg was very severe, she decided to go to an Emergency Aid to check it out but nothing wrong was found on arteries and veins. Was prescribed lots of Novalgin and even after 4g. of this painkiller, which is common dosage, there was no relief.

After 10 days of this excruciating pain, I was asked for help and I took all symptoms as carefully as possible.


Sciatica type of pain, leftsided. It is in the back side of her left foot and the outer side of the left leg.  It was as if there were two neurological areas involved with this pain, one along the sciatic nerve of the left side and mostly on back of the feet and also the left thigh.  Desire to move all night for some minimal relief.

Looking at her pics I thought for a moment of an unusual form of herpes zoster –

She complained of having being bitten by insects, and there were around 20 visible spots but obviously this was considered related to a neuropathic vasculitis post Covid infection

She was given Rhus tox 30C by a collegue every 8 hrs, and she was able to sleep 4 hrs. afterwards.  However, the next day the pain returned and it became extreme the day after, even worse than previous days.

She was given Arsenicum C30, by the same collegue, but there was no relief after 4 doses.  Then Rhus tox C200 was tried but to no avail.

She was sent to Emergency Aid again, and they said the picture was not clear. Blood tests were still negative.  She was given Pregabalin 50mg 2 times/daily (neuropathic painkiller).

Back to Analysis of the Present Symptoms:

 The pain is of a changing nature.  Now the pain is stitching in the groin and also also the thigh, with more burning, left side only.  Slight touch <<<, as if from skin / nerve involvement at the same time, only in the groin area. No rash in that area and the rash is only on the leg.

She reported another pain as cramping plus tension on the back of her feet and later also halfway up the lower limb, always on the left side. All pains come in waves and she MUST move, cannot lie down. Has to move all the time when lying because of pain, so cannot sleep at night. Sitting is better than lying.

Occupation (working) ameliorated .  Pain is described always as very strong, typical for neuralgic pains. She likes HOT on her legs and feels better from that (Rhus tox).

Also HOT showers >. She likes to eat sour cold grapes, raspberries and blueberries.

Just before the Corona infection she started working in a new place and her main stress was feeling of not being able to perform enough

The prior diagnosis of neuropathic vasculitis is definitively confirmed.

She suffers overall from depressed mood and is quite often depressed. She lost her house where she had lived for 20 years, felt mortified when she had to leave it.

This was my first repertorization using ADONIS (Radar):

Decided (with a few doubts) for Phosphorus Lm3 (only potency available at home)***  (*** lower case letters near some symptoms stand for combined symptoms)

Why Phosphorus?

To me at this stage the case is clear only from the pathology side, not yet clear from the homeopathic point of view, although presenting many collectable symptoms.

Ars. and Rhus tox. still seemed the best options but were tried without effect.

Too many generals were not covered for remedies like China and Bell, and the same for Lycopodium. Sepia was interesting but in my experience not so related to Covid 19.  It was worthwhile to ponder as Sepia is 3 degree for “occupation amel.”

Phoshorus was worth a try, as it is complementary to Ars. and very much a Covid remedy. Also a sensitive, burning remedy (skin, nerves) and very much left sided.

After Phosphorus LM3 she felt more quiet inside. An old symptom came back, pain in the head, leftsided only.  Phosphorus LM5 was administered.  Still taking Pregabalin , now 50+50mg (!), pain still very strong.

The next day the patient woke up with occipital pain, only left side, described as tensive.

Occupation amel +++ very clear and strong

Stitching pain groin – leftsided; everythings is LEFT SIDED

Extreme skin sensitivity still present

She feels not well enough to work and is brooding over this.

Warm tea, desires

Still very wants warm baths, sometimes even HOT

I repertorized again with ADONIS, trying to focus more on the essential symptoms.

MEZEREUM, bingo!

Occupation amel is from Kent, so VERY reliable, although only a 1°degree

Hot bath amel very important here (Ars-Rhus-t.), from Phatak

Pain in waves, from Boger/Boenninghausen, liked to see that too

And finally….Sleeplessness from pain in legs, from Hering/Knerr…

Also the similarity of her state to a sort of zoster-like pain, skin papulae plus neuralgic extreme pain! (classic for Mez.)

I want to mention to all collegues the incredible amount of clinical additions by Dr. Farok Master in the section GENERALS of Adonis Rep. The extensive experience of Dr. Master is recognised by our community worldwide.

I chose HYPERSENSITIVE VASCULITIS because it matched my diagnostic criteria. These rubrics are never considered by me for choosing remedies, but at the end, for confirmation, they could be gems!

Mezereum C 200 in water, just one sip and wait 12hrs

The next day: She had a good night, no headache.  Still pain and burning in leg, but less.

No repetition of remedy.  The next day strong pain again at night, and she took  another dose, one sip. Didn’t sleep until morning. Next day she said she had a good night, although woke up often by pain, but soon fell back to sleep!

Overall good energy, she said she could do many things. The next day: another good day, almost no pain in leg

MEZEREUM C200, another sip

Next day: much, much better

C200 one sip at bedtime

Cure was complete after 4 doses of C200

PS: If I do not know the person, and there is a prolonged suffering, when pain comes and goes, even during an amelioration, my tendency is to repeat the dose of the remedy, because often it means the energy is quite unstable, so this kind of nighttime booster I noticed very effective, obviously as little as possible….  And stop as the improvement is consolidated.


Family: Thymelaceae

About the author

Maurizio Paolella

Dr. Maurizio Paolella is an M.D. practicing Classical Homeopathy in Rome since 1986. He trained with A.Geukens, M.Mangialavori and Jeremy Sherr (Dynamis Course 200/2002) among others. He also studied at the Clinic of Dr. Dario Spinedi from 2008 until 2014, mostly for Oncology followed by Classical Homeopathy. Dr. Paolella worked for 9 months in 2014 as Assistant Doctor at Clinica Santa Croce (Orselina, Switzerland) directed by Dr.Dario Spinedi. He is available for medical homeopathic consultation in person in Rome and also via Skype (dr.pao) Visit Dr. Paolella at his website

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