Objectives
To determine the prevalence and breakdown of pain complaints among COVID-19 patients admitted for non-pain symptoms, and the association between the presence of pain and ICU admission and death.
Patients and Methods
In this multi-center prospective study, data on the intensity and type of pain was collected on 169 patients with active SARS-CoV-2 infection at 2 teaching hospitals in the U.S. and Korea and on 8 patients with acute pain at another large teaching hospital between February 1, 2020 and June 15, 2020.
Results
Sixty-five (38.5%) of 169 patients reported an active pain condition. The most common pain complaints were headache (n=22, 30.1%), chest pain (n=17, 23.6%), spinal pain (n=18, 24.7%), myalgia (n=13, 18.1%), abdominal or pelvic pain (n=13, 17.8%), arthralgia (n=11, 15.3%), and generalized pain (n=9, 12.5%). Those reporting headache as their main complaint were less likely to require intensive care unit (ICU) admission (P = .003). Acetaminophen or NSAIDs were prescribed to 80.8%, opioids to 17.8%, adjuvants to 8.2% and ketamine to 5.5% of pain patients. When age ≥ 65 years and sex were controlled for in multivariable analysis, the absence of pain was associated with ICU admission (OR 2.92; 95% CI 1.42–6.28; P = .004) and death (OR 3.49; 95% CI 1.40–9.76; P = .01).
Conclusions
Acute pain is common during active COVID-19, and may affect multiple organ systems. Reasons why pain may be associated with reduced mortality include that an intense systemic stimulus (e.g. respiratory distress) might inhibit pain signals or that the catecholamine surge associated with severe respiratory distress might attenuate nociceptive signaling.
Background: Because it affords greater accuracy than landmark-based techniques, ultrasound guidance may reduce the volume of local anesthetic required for sympathetic blockade of the upper extremity. We hypothesized that 4 mL would provide a similar clinical effect when compared to larger volumes. Methods: One hundred and two patients with chronic neuropathic pain of the upper extremity or face were randomly assigned to receive an ultrasound-guided (USG) stellate ganglion block (SGB) with either 4 mL (group A), 6 mL (group B) or 8 mL (group C) mL of 1.0% lidocaine. Skin temperatures of the face, hand, and axillary fold were measured bilaterally at baseline, 10, 20, and 30 min after the block. Our primary outcome was the relative increase in hand temperature on the blocked side at 30 min and our non-inferiority margin was −0.6 °C. Secondary outcomes included success rate (as defined by a relative temperature increase of ≥1.5 °C), pain relief, degree of ptosis and side-effects. Results: The 95% confidence intervals for the difference of the means exceeded our non-inferiority margin (A versus B: −0.76 to 0.24; A versus C: −0.89 to 0.11) for temperature changes in the hand; however, success rates were similar (44, 45 and 55% for A, B and C respectively, p = 0.651). No intergroup differences were found in temperature-related outcomes for the other measurement sites (face, axilla). The incidence of minor side-effects was significantly higher in group C and no block-related complications were noted. Conclusions: We were unable to establish the non-inferiority of a 4 mL volume for sympathetic blockade of the hand. The clinical significance of these findings is unclear as success rates were similar between the different groups. In contrast, the 6- and 8 mL volumes were not associated with greater temperature changes in the face and axilla.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.