Exploring the trajectory curve of long-term musculoskeletal post-COVID pain symptoms in hospitalized COVID-19 survivors: a multicenter study

Fernández‐de‐las‐Peñas, César; Cancela-Cilleruelo, Ignacio; Moro-López-Menchero, Paloma; Rodríguez‐Jiménez, Jorge; Pellicer-Valero, Óscar J.; Martín-Guerrero, José D.; Arendt-Nielsen, Lars

doi:10.1097/j.pain.0000000000002718

Cited by 19 publications

(40 citation statements)

References 33 publications

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“…D’Souza et al observed that the most common type of post-COVID pain described by patients themselves on social media resembles a musculoskeletal/nociceptive pain phenotype [ 26 ]. In fact, a large cohort study reported that post-COVID pain in previously hospitalized COVID-19 survivors was of musculoskeletal origin in 45% of subjects at eight [ 27 ] and twelve [ 28 ] months after hospitalization. These authors stated that 30% of COVID-19 survivors with post-COVID pain reported the presence of symptoms solely in localized body areas (e.g., neck, shoulder, elbow, knee, or hip), another 30% exhibited pain in the extremities, and 20% in the spine, whereas the remaining 20% had widespread symptoms [ 27 , 28 ]; however, these authors did not differentiate between pain from muscular or articular origin.…”

Section: Phenotyping Post-covid Painmentioning

confidence: 99%

“…A primary feature of nociplastic pain is the presence of regional or widespread pain symptoms [ 19 ]. The presence of regional, including widespread, pain can reach up to 70% of COVID-19 survivors [ 27 , 28 ]. Generalized pain symptoms, combined with central sensitization-associated symptoms (e.g., higher CSI scores) could help identify nociplastic pain in the IASP-established criteria.…”

Section: Phenotyping Post-covid Painmentioning

confidence: 99%

“…For instance, fibromyalgia syndrome, a nociplastic pain condition, has a female predominance. Similarly, female sex has been clearly identified as a risk factor for the development of long COVID symptomatology [ 54 ] and also specifically for post-COVID pain [ 27 , 28 ]. The role of age as a risk factor for long COVID is not yet clear [ 54 ].…”

Section: Clinical Criteria/grading System For Nociplastic Pain In Pos...mentioning

confidence: 99%

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Phenotyping Post-COVID Pain as a Nociceptive, Neuropathic, or Nociplastic Pain Condition

Fernández‐de‐las‐Peñas

Nijs

Neblett

et al. 2022

Biomedicines

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Pain after an acute Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) condition (post-COVID pain) is becoming a new healthcare emergency. Precision medicine refers to an evidence-based method of grouping patients based on their diagnostic/symptom presentation and then tailoring specific treatments accordingly. Evidence suggests that post-COVID pain can be categorized as nociceptive (i.e., pain attributable to the activation of the peripheral receptive terminals of primary afferent neurons in response to noxious chemical, mechanical, or thermal stimuli), neuropathic (i.e., pain associated with a lesion or disease of the somatosensory nervous system and limited to a “neuroanatomically plausible” distribution of the system), nociplastic (i.e., pain arising from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain), or mixed type (when two pain phenotypes co-exist). Each of these pain phenotypes may require a different treatment approach to maximize treatment effectiveness. Accordingly, the ability to classify post-COVID pain patients into one of these phenotypes would likely be critical for producing successful treatment outcomes. The 2021 International Association for the Study of Pain (IASP) clinical criteria and grading system provide a framework for classifying pain within a precision pain medicine approach. Here we present data supporting the possibility of grouping patients with post-COVID pain into pain phenotypes, using the 2021 IASP classification criteria, with a specific focus on nociplastic pain, which is probably the primary mechanism involved in post-COVID pain. Nociplastic pain, which is usually associated with comorbid symptomology (e.g., poor sleep quality, fatigue, cognitive–emotional disturbances, etc.) and is considered to be more difficult to treat than other pain types, may require a more nuanced multimodal treatment approach to achieve better treatment outcomes.

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Section: Phenotyping Post-covid Painmentioning

confidence: 99%

Section: Phenotyping Post-covid Painmentioning

confidence: 99%

Section: Clinical Criteria/grading System For Nociplastic Pain In Pos...mentioning

confidence: 99%

See 1 more Smart Citation

Phenotyping Post-COVID Pain as a Nociceptive, Neuropathic, or Nociplastic Pain Condition

Fernández‐de‐las‐Peñas

Nijs

Neblett

et al. 2022

Biomedicines

View full text Add to dashboard Cite

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“…In the face of a high-severity pandemic (such as COVID-19), keeping patients alive is of absolute importance, and pain assessment may not be a priority. However, if patients' pain is undertreated and underestimated, it can become chronic and strongly interfere with their post-COVID lives (Kemp et al 2020 ; Fernández-de-las-Peñas et al 2021a , 2023 ). Although studies report days of hospitalization as a risk factor for the development of post-COVID-19 musculoskeletal pain symptoms (Kemp et al 2019 ; Fernández-de-las-Peñas et al 2021b , a ), the chronic pain and persistent poor health after COVID-19 may not necessarily be associated with respiratory complications, initial disease severity, or the need for hospital care (Logue et al 2021 ; Townsend et al 2021 ).…”

Section: Covid-19 Symptoms and Their Relation With Chronic Painmentioning

confidence: 99%

“…In this sense, a subset of patients who faced non-severe COVID-19 disease has reported persistent painful symptoms, which included fatigue/muscle weakness (70.6%), trouble with mobility (7%), headaches (68%), and myalgias (55%) (Graham et al 2021 ; Nehme et al 2021 ; Moghimi et al 2021 ). Moreover, it has been shown that painful symptoms might persist for 7–12 months, ranging from one to five complaints (Huang et al 2021b ; Nehme et al 2021 ; Fernández-de-las-Peñas et al 2023 ). Some symptoms, such as myalgia, arthralgia, and fatigue, appear early in the infection and persist.…”

Section: Covid-19 Symptoms and Their Relation With Chronic Painmentioning

confidence: 99%

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

Fialho

Oliveira

2023

Inflammopharmacol

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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

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Risk Factors Associated With Post−COVID-19 Condition

et al. 2023

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ImportancePost−COVID-19 condition (PCC) is a complex heterogeneous disorder that has affected the lives of millions of people globally. Identification of potential risk factors to better understand who is at risk of developing PCC is important because it would allow for early and appropriate clinical support.ObjectiveTo evaluate the demographic characteristics and comorbidities that have been found to be associated with an increased risk of developing PCC.Data sourcesMedline and Embase databases were systematically searched from inception to December 5, 2022.Study SelectionThe meta-analysis included all published studies that investigated the risk factors and/or predictors of PCC in adult (≥18 years) patients.Data Extraction and SynthesisOdds ratios (ORs) for each risk factor were pooled from the selected studies. For each potential risk factor, the random-effects model was used to compare the risk of developing PCC between individuals with and without the risk factor. Data analyses were performed from December 5, 2022, to February 10, 2023.Main Outcomes and MeasuresThe risk factors for PCC included patient age; sex; body mass index, calculated as weight in kilograms divided by height in meters squared; smoking status; comorbidities, including anxiety and/or depression, asthma, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, immunosuppression, and ischemic heart disease; previous hospitalization or ICU (intensive care unit) admission with COVID-19; and previous vaccination against COVID-19.ResultsThe initial search yielded 5334 records of which 255 articles underwent full-text evaluation, which identified 41 articles and a total of 860 783 patients that were included. The findings of the meta-analysis showed that female sex (OR, 1.56; 95% CI, 1.41-1.73), age (OR, 1.21; 95% CI, 1.11-1.33), high BMI (OR, 1.15; 95% CI, 1.08-1.23), and smoking (OR, 1.10; 95% CI, 1.07-1.13) were associated with an increased risk of developing PCC. In addition, the presence of comorbidities and previous hospitalization or ICU admission were found to be associated with high risk of PCC (OR, 2.48; 95% CI, 1.97-3.13 and OR, 2.37; 95% CI, 2.18-2.56, respectively). Patients who had been vaccinated against COVID-19 with 2 doses had a significantly lower risk of developing PCC compared with patients who were not vaccinated (OR, 0.57; 95% CI, 0.43-0.76).Conclusions and RelevanceThis systematic review and meta-analysis demonstrated that certain demographic characteristics (eg, age and sex), comorbidities, and severe COVID-19 were associated with an increased risk of PCC, whereas vaccination had a protective role against developing PCC sequelae. These findings may enable a better understanding of who may develop PCC and provide additional evidence for the benefits of vaccination.Trial RegistrationPROSPERO Identifier: CRD42022381002

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Exploring the trajectory curve of long-term musculoskeletal post-COVID pain symptoms in hospitalized COVID-19 survivors: a multicenter study

Abstract: Female sex, previous history of pain symptoms, pain symptoms at onset, and days at hospital were factors associated with highly prevalent musculoskeletal post-COVID pain 1 year after hospitalization.

Cited by 19 publications

References 33 publications

Phenotyping Post-COVID Pain as a Nociceptive, Neuropathic, or Nociplastic Pain Condition

Phenotyping Post-COVID Pain as a Nociceptive, Neuropathic, or Nociplastic Pain Condition

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

Risk Factors Associated With Post−COVID-19 Condition

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