Characteristics and influence on quality of life of new‐onset pain in critical COVID‐19 survivors

Abstract

Background: Pain is a clinical feature of COVID-19, however, data about persistent pain after hospital discharge, especially among ICU survivors is scarce. The aim of this study was to explore the incidence and characteristics of new-onset pain and its impact on Health-Related Quality of Life (HRQoL), and to quantify the presence of mood disorders in critically ill COVID-19 survivors.Methods: This is a preliminary report of PAIN-COVID trial (NCT04394169) presenting a descriptive analysis in critically ill COVID-19 survivors, following in person interview 1 month after hospital discharge. Pain was assessed using the Brief Pain Inventory, the Douleur Neuropathique 4 questionnaire and the Pain Catastrophizing Scale. HRQoL was evaluated with the EQ 5D/5L, and mood disorders with the Hospital Anxiety and Depression Scale (HADS).Results: From 27 May to 19 July 2020, 203 patients were consecutively screened for eligibility, and 65 were included in this analysis. Of these, 50.8% patients reported new-onset pain; 38.5% clinically significant pain (numerical rating score ≥3 for average pain intensity); 16.9% neuropathic pain; 4.6% pain catastrophizing thoughts, 44.6% pain in ≥2 body sites and 7.7% widespread pain. Patients with new-onset pain had a worse EQ-VAS and EQ index value (p < 0.001). Pain intensity was negatively correlated to both the former (Spearman ρ: −0.546, p < 0.001) and the latter (Spearman ρ: −0.387, p = 0.001). HADS anxiety and depression values equal or above eight were obtained in 10.8% and 7.7% of patients, respectively. Conclusion: New-onset pain in critically ill COVID-19 survivors is frequent, and it is associated with a lower HRQoL. Trial registration No.: NCT04394169. Registered 19 May 2020. https://clini caltr ials.gov/ct2/show/NCT04 394169. Significance: A substantial proportion of severe COVID-19 survivors may develop clinically significant persistent pain, post-intensive care syndrome and chronic ICU-related pain. Given the number of infections worldwide and the unprecedented size of the population of critical illness survivors, providing

Prevalence of Neuropathic Component in Post-COVID Pain Symptoms in Previously Hospitalized COVID-19 Survivors

“…First, current results can be only applicable to previously hospitalized COVID-19 survivors with mild-to-moderate severity. In fact, critically ill COVID-19 survivors also exhibit “de novo” post-COVID pain symptoms [ 27 ]. It is probably that severely ill patients can exhibit a higher prevalence of neuropathic pain.…”

The COVID‐19 pandemic and its consequences for chronic pain: a narrative review

“…Hence, pain consequences are described in different terms, such as post‐acute coronavirus disease 2019/COVID‐19 syndrome, COVID‐19 long‐haulers, post‐acute sequelae of SARS‐CoV‐2 infection and long COVID [ 6 , 12 ]. Some consider the constellation of symptoms similar to ‘post‐intensive care syndrome’ [ 9 , 13 ]. Although there is no established terminology or criteria for diagnosis of post‐COVID‐19 pain, most consider this to be the persistence of mental and physical health consequences after initial infection, and according to the Centers for Disease Control and Prevention (CDC) the criteria are met if symptoms persist for >4 weeks [ 14 ].…”

“…Studies reporting pain after SARS‐CoV‐2 infection are primarily surveys carried out at various intervals, either after diagnosis, admission or discharge from hospital [ 13 ], with few cohort [ 12 ] and case control studies [ 21 ]. It is difficult to know the specific number of studies capturing the post‐COVID‐19 pain burden and characteristics accurately since pain has been captured as one of the symptoms in many studies [ 22 ] and as the primary outcome in some [ 23 , 24 ].…”

Correlations between Electro-Diagnostic Findings, the Severity of Initial Infection, and the Rehabilitation Outcomes among COVID-19 Patients

“…Each subject marked the perceived level of pain, which is one of the clinical features of COVID-19 [ 21 ]) on a Visual Analogue Scale (VAS) rated from ‘0′ (no pain) to ‘10′ (worst imaginable pain). Clinical evaluation distinguished between nociceptive (musculoskeletal) and neuropathic pain types [ 22 ].…”