Could the fibromyalgia syndrome be triggered or enhanced by COVID-19?

Abstract

Fibromyalgia (FM) is a complex disease with an uncertain aetiology and intricate pathophysiology. Although its genesis is not fully explained, potential environmental factors, such as viral infections might trigger FM or worsen patients' clinical outcomes. The SARS-CoV-2 virus may affect central and peripheral nervous systems, leading to musculoskeletal, neurological, and psychological disturbances. These symptoms might persist at least 12 months beyond the recovery, often referred to as post-COVID syndrome, which resembles FM syndrome. In this sense, we argued the potential consequences of COVID-19 exclusively on FM syndrome. First, we have described post-COVID syndrome and its painful symptoms. Afterwards, we argued whether FM syndrome could be triggered or enhanced by COVID-19 infection or by numerous and persistent stressors imposed daily by the pandemic setting (isolation, uncertainty, depression, mental stress, generalized anxiety, and fear of the virus). In addition, we have demonstrated similarities between pathophysiological mechanisms and cardinal symptoms of FM and COVID-19, speculating that SARS-CoV-2 might represent a critical mediator of FM or an exacerbator of its symptoms once both syndromes share similar mechanisms and complaints. Therefore, pharmacologic and non-pharmacological approaches commonly used to treat FM could serve as strategic therapies to attenuate painful and neurological manifestations of post-COVID syndrome. Although it is still theoretical, clinicians and researchers should be alert of patients who develop symptoms similar to FM or those who had their FM symptoms increased post-COVID to manage them better. Graphical Abstract

Clinical characterization of new-onset chronic musculoskeletal pain in Long COVID: a cross-sectional study

“…The widespread nature of new-onset MSK pain has many parallels to FMS and the possible post-viral infection etiology proposed in FMS. 79–81 Central sensitization and raised cytokines have been reported in FMS and CFS/ME studies. 82 This also helps us validate some of the conditions which have been poorly understood so far and are associated with considerable social stigma and disbelief, including from healthcare professionals.…”

From Viral Infection to Autoimmune Reaction: Exploring the Link between Human Herpesvirus 6 and Autoimmune Diseases

“…Additionally, HHV-6 infection correlated with nerve fiber damage [ 144 ]. Although the evidence is lacking now, the research interest in fibromyalgia is on the rise both in the field of pathogenetic mechanisms and better diagnostics, with much of this new attention deriving from the observations of FM following COVID-19 and similarities between FM and post-COVID syndrome [ 145 ].…”

A systematic review of quantitative EEG findings in Long COVID, Fibromyalgia and Chronic Fatigue Syndrome

“…Long COVID is a complex condition characterised by a multitude of heterogenous symptoms including fatigue, shortness of breath, pain, cognitive disturbances, sleep problems and postexertional malaise (Davis et al, 2021). The clinical manifestations of LC show similarities to the symptom phenotypes of other chronic conditions, namely Fibromyalgia Syndrome (FMS) and Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) (Bierle et al, 2021;Fialho et al, 2023). Fibromyalgia is a common chronic and widespread musculoskeletal pain condition, in which fatigue is also commonly reported.…”