Pain Burden in Post-COVID-19 Syndrome following Mild COVID-19 Infection

Abstract

The global pandemic of SARS-CoV-2 has affected several hundred million people, and many infected people have suffered from a milder initial infection but have never fully recovered. This observational study investigates the pain burden in sufferers of post-COVID-19 syndrome after a milder initial infection. One hundred post-COVID-19 patients filled out questionnaires regarding sociodemographic data, previous comorbidities, present pharmacological treatment, pain intensity and pain localisation. Health-related quality of life, fatigue, emotional status, and insomnia were measured by validated questionnaires. Multiple post-COVID-19 symptoms, including post-exertional malaise, were evaluated by a symptom questionnaire. Among the 100 participants (mean age 44.5 years), 82% were women, 61% had higher education, and 56% were working full or part time. Nine participants reported previous pain or inflammatory conditions. Among the most painful sites were the head/face, chest, lower extremities, and migrating sites. Generalised pain was self-reported by 75 participants and was estimated in 50 participants. Diagnosis of fibromyalgia according to the 2016 criteria was suspected in 40 participants. Subgroup analyses indicated that comorbidities might play a role in the development of pain. In conclusion, a major part of sufferers from post-COVID-19 syndrome develop pain, and in addition to its many disabling symptoms, there is an urgent need for pain management in post-COVID-19 syndrome.

Clinical Characteristics and Mechanisms of Musculoskeletal Pain in Long COVID

“…Only 6 of the 35 studies reported risk factors associated with the prevalence of MSK symptoms in Long COVID patients. 27 , 30 , 31 , 38–40 Sex differences were found in 3 studies, with females being significantly more likely to report myalgia ( p = 0.022 in Iqbal et al); 41 p < 0.01 in Taquet et al, 40 and arthralgia (p < 0.05 in Sykes et al) 42 than males. Two studies reported opposite trends for the association between age and prevalence of MSK pain of different origin, with increasing age associated with increased prevalence of arthralgia (p < 0.001 in Iqbal et al), 41 and decreased prevalence of myalgia (p < 0.05 in Taquet et al).…”

“… Not available Bellan et al (2021) 89 Italy 200 (122/78) Yes Prospective longitudinal study Baseline, 17 weeks and 52 weeks. Arthralgia/myalgia Baseline (19.3%) At week 17 (6.5%) At week 52 (21.9%) Not available Not available Not available Bileviciute-ljungar et al (2022) 31 Sweden 100 (18/82) No (90%) Yes (10%) Cross-sectional study A mean of 47 weeks since the start of the infection. Head/face 27% Throat/neck 5% Shoulder/arms 5% Chest 16% Legs 12% Pain sites varied 15% The mean value of pain intensity during the last week was 4.4/10 75% reported generalized pain.…”

“…Only 8 studies described the characteristics of pain, 4 of which found pain localized to a particular region to be most common, 26–29 while others reported a higher prevalence of widespread and generalized pain. 30 , 31 Of the studies that reported localized pain symptoms, cervical spine and lower extremities were the most affected regions followed by lumbar spine and upper extremities. 26 One study showed that nociceptive-type pain was considerably more common than neuropathic-type pain.…”

Prevalence of Musculoskeletal Post-COVID Pain in Hospitalized COVID-19 Survivors Depending on Infection with the Historical, Alpha or Delta SARS-CoV-2 Variant

“…This prevalence rate was based on studies investigating general post-COVID symptomatology. In fact, the prevalence of musculoskeletal post-COVID pain raised to rates ranging from 45% to 60% in studies focusing on or specifically investigating this symptom [ 5 , 6 , 7 , 8 , 9 ]. Further, Yelin et al have defined the so-called “pain-syndrome pattern”, a subgroup of subjects with pain as the main post-COVID symptom [ 10 ].…”

The Self-Reported Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and PainDETECT Questionnaires in COVID-19 Survivors with Post-COVID Pain

“…To date, it seems that post-COVID pain has a musculoskeletal origin [ 4 ]; however, a neuropathic pain origin is also plausible [ 5 ]. An increasing number of studies reported the presence of musculoskeletal post-COVID pain in up to 60% of the COVID-19 survivors [ 6 , 7 , 8 , 9 ]. The number of studies investigating the prevalence of neuropathic post-COVID pain is lower in relation to those assessing musculoskeletal post-COVID pain [ 10 , 11 ].…”