A comparison of pain, fatigue, and function between post–COVID-19 condition, fibromyalgia, and chronic fatigue syndrome: a survey study

Haider, Saman; Janowski, Adam; Lesnak, Joseph B.; Hayashi, Kazuhiro; Dailey, Dana L.; Chimenti, Ruth L.; Frey-Law, L.; Sluka, Kathleen A.; Berardi, Giovanni

doi:10.1097/j.pain.0000000000002711

Cited by 32 publications

(22 citation statements)

References 147 publications

(263 reference statements)

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“…However, Schulze and colleagues demonstrated that fatigue was not associated with symptoms of anxiety or depression in males and females with post-COVID-19 symptoms (Schulze et al 2022 ). Moreover, Peterson et al demonstrated that conditioned pain modulation was impaired in people who had symptomatic acute COVID-19 (Peterson et al 2022 ) and Haider et al found that pain levels in people with post-COVID-19 symptoms are comparable to people with fibromyalgia and chronic fatigue syndrome (Haider et al 2022 ), which is line with the results of the current study. Additionally, it has been suggested that self-reporting post-COVID-19 symptoms may be influenced by one’s perception of the COVID-19 pandemic and apprehension about developing post-COVID-19 symptoms (Engelmann et al 2022 ; Matta et al 2022 ).…”

Section: Discussionsupporting

confidence: 90%

“…The main findings were that subjects with post-COVID-19 symptoms reported higher levels of fatigue and perceived fatigability than subjects without post-COVID-19 symptoms, but there were no differences in objective fatigability between the groups. Furthermore, people with post-COVID-19 symptoms reported worse fatigue-related factors, such as increased pain and decreased quality of life, which has been demonstrated in other studies in people with post-COVID-19 symptoms (Haider et al 2022 ; Peterson et al 2022 ) and is common in other neurological disorders (e.g., multiple sclerosis and chronic fatigue syndrome) (Harrison et al 2015 ; Heitmann et al 2016 ; Workman et al 2020a , 2020c ). These findings support our hypothesis regarding perceived and objectively determined fatigability.…”

Section: Discussionsupporting

confidence: 63%

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Fatigue and perceived fatigability, not objective fatigability, are prevalent in people with post-COVID-19

2022

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Persistent symptoms after acute COVID-19 infection, termed post-COVID-19 fatigue, occur in 44–70% of patients. Characterizing fatigue in this population is vital to determine the etiology of post-COVID-19 fatigue symptoms and to assess the effectiveness of potential interventions. The purpose of this study was to assess differences in perceived and objective fatigability between people with post-COVID-19 symptoms ( N = 29, 20 females) and people who had COVID-19 but are not experiencing persistent symptoms ( N = 20, 12 females). Perceived fatigability, fatigue, pain, and quality of life were assessed with the Fatigue Severity Scale (FSS), Fatigue Assessment Scale (FAS), Visual Analog Scale for Pain (VAS), and the EQ-5D-5L, respectively. Objective fatigability was evaluated with torque and work fatigue indices (FI-T and FI-W), calculated via an isokinetic fatigue task. The results revealed that, the subjects with post-COVID-19 symptoms had significantly higher FAS ( p < 0.01), FSS ( p < 0.01), VAS ( p < 0.01), and EQ-5D-5L VAS ( p < 0.01) scores compared to subjects without post-COVID-19 symptoms, indicating greater fatigue and perceived fatigability, increased pain, and worse quality of life. However, there were no differences between the two groups for the FI-Ts (all p ≥ 0.07) or FI-W (all p ≥ 0.08), indicating no differences in objective fatigability. This study found that people with post-COVID-19 symptoms have increased fatigue and perceived fatigability, but not objective fatigability, compared to subjects without post-COVID-19 symptoms.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 63%

Fatigue and perceived fatigability, not objective fatigability, are prevalent in people with post-COVID-19

2022

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“…If the results of this RCT are strong enough in terms of efficacy and cost-utility, FIBRO-Out and/or FIBRO-On could be considered for their inclusion in the public healthcare Spanish system to treat individuals suffering from FM. Additionally, this RCT may also pave the way for further RCTs testing the efficacy of these interventions in other chronic diseases cursing with central sensitization (e.g., irritable bowel syndrome, chronic headache, temporomandibular disorder, pelvic pain syndromes), along with other emerging conditions such as persistent post-COVID syndrome which may display overlapped symptoms with FM ( Haider et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness, cost-utility and physiological underpinnings of the FIBROWALK multicomponent therapy in online and outdoor format in individuals with fibromyalgia: Study protocol of a randomized, controlled trial (On&Out study)

et al. 2022

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Introduction: The On&Out study is aimed at assessing the effectiveness, cost-utility and physiological underpinnings of the FIBROWALK multicomponent intervention conducted in two different settings: online (FIBRO-On) or outdoors (FIBRO-Out). Both interventions have proved to be efficacious in the short-term but there is no study assessing their comparative effectiveness nor their long-term effects. For the first time, this study will also evaluate the cost-utility (6-month time-horizon) and the effects on immune-inflammatory biomarkers and Brain-Derived Neurotrophic Factor (BDNF) levels of both interventions. The objectives of this 6-month, randomized, controlled trial (RCT) are 1) to examine the effectiveness and cost-utility of adding FIBRO-On or FIBRO-Out to Treatment-As-Usual (TAU) for individuals with fibromyalgia (FM); 2) to identify pre–post differences in blood biomarker levels in the three study arms and 3) to analyze the role of process variables as mediators of 6-month follow-up clinical outcomes.Methods and analysis: Participants will be 225 individuals with FM recruited at Vall d’Hebron University Hospital (Barcelona, Spain), randomly allocated to one of the three study arms: TAU vs. TAU + FIBRO-On vs. TAU + FIBRO-Out. A comprehensive assessment to collect functional impairment, pain, fatigue, depressive and anxiety symptoms, perceived stress, central sensitization, physical function, sleep quality, perceived cognitive dysfunction, kinesiophobia, pain catastrophizing, psychological inflexibility in pain and pain knowledge will be conducted pre-intervention, at 6 weeks, post-intervention (12 weeks), and at 6-month follow-up. Changes in immune-inflammatory biomarkers [i.e., IL-6, CXCL8, IL-17A, IL-4, IL-10, and high-sensitivity C-reactive protein (hs-CRP)] and Brain-Derived Neurotrophic Factor will be evaluated in 40 participants in each treatment arm (total n = 120) at pre- and post-treatment. Quality of life and direct and indirect costs will be evaluated at baseline and at 6-month follow-up. Linear mixed-effects regression models using restricted maximum likelihood, mediational models and a full economic evaluation applying bootstrapping techniques, acceptability curves and sensitivity analyses will be computed.Ethics and dissemination: This study has been approved by the Ethics Committee of the Vall d’Hebron Institute of Research. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and various community engagement activities. Trial registration number NCT05377567 (clinicaltrials.gov).

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“…The same type of symptomatology resembles features of another nociplastic pain condition such as fibromyalgia syndrome. Haider et al have recently confirmed that patients with long-COVID share a similar phenotype to those with fibromyalgia or chronic fatigue syndrome, but with less severe pain and fatigue overall (Haider et al, 2023).…”

Section: Nociplastic Painmentioning

confidence: 93%

Precision management of post‐COVID pain: An evidence and clinical‐based approach

Fernández‐de‐las‐Peñas

Nijs

Giordano

et al. 2023

European Journal of Pain

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BackgroundPain after a SARS‐CoV‐2 acute infection (post‐COVID pain) is becoming a new healthcare emergency but remains underestimated and most likely undertreated due to a lack of recognition of the phenomenon and knowledge of the underlying pain mechanisms. Evidence supporting any particular treatment approach for the management of post‐COVID pain is lacking. Large variability in the patient response to any standard pain treatments is clinically observed, which has led to calls for a personalized, tailored approach to treating patients with chronic post‐COVID pain (i.e. ‘precision pain medicine’). Applying the global concerted action towards precision medicine to post‐COVID pain could help guide clinical decision‐making and aid in more effective treatments.MethodsThe current position paper discusses factors to be considered by clinicians for managing post‐COVID pain ranging from identification of the pain phenotype to genetic consideration.ResultsThe ability of clinicians to phenotype post‐COVID pain into nociceptive, neuropathic, nociplastic or mixed type is suggested as the first step to better planification of a treatment programme. Further, the consideration of other factors, such as gender, comorbidities, treatments received at the acute phase of infection for onset‐associated COVID‐19 symptoms, factors during hospitalization or the presence of emotional disturbances should be implemented into a treatment programme.ConclusionsAccordingly, considering these factors, management of post‐COVID pain should include multimodal pharmacological and non‐pharmacological modalities targeting emotional/cognitive aspects (i.e. psychological and/or coping strategies), central sensitization‐associated mechanisms (i.e. pain neuroscience education), exercise programmes as well as lifestyle interventions (e.g. nutritional support and sleep management).SignificanceThis position paper presents an evidence‐based clinical reasoning approach for precision management of post‐COVID pain.

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A comparison of pain, fatigue, and function between post–COVID-19 condition, fibromyalgia, and chronic fatigue syndrome: a survey study

Abstract: Supplemental Digital Content is Available in the Text.Individuals with post–Coronavirus-19 condition report elevated pain, fatigue, psychological impact, and functional limitation similar, but less severe, than those with fibromyalgia and chronic fatigue syndrome.

Cited by 32 publications

References 147 publications

Fatigue and perceived fatigability, not objective fatigability, are prevalent in people with post-COVID-19

Fatigue and perceived fatigability, not objective fatigability, are prevalent in people with post-COVID-19

Effectiveness, cost-utility and physiological underpinnings of the FIBROWALK multicomponent therapy in online and outdoor format in individuals with fibromyalgia: Study protocol of a randomized, controlled trial (On&Out study)

Precision management of post‐COVID pain: An evidence and clinical‐based approach

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