Musculoskeletal Disorders, Pain Medication, and in-Hospital Mortality among Patients with COVID-19 in South Korea: A Population-Based Cohort Study

Abstract

We aimed to investigate whether comorbid musculoskeletal disorders (MSD)s and pain medication use was associated with in-hospital mortality among patients with coronavirus disease 2019 (COVID-19). Adult patients (≥20 years old) with a positive COVID-19 diagnosis until 5 June 2020 were included in this study, based on the National Health Insurance COVID-19 database in South Korea. MSDs included osteoarthritis, neck pain, lower back pain, rheumatoid arthritis, and others, while pain medication included paracetamol, gabapentin, pregabalin, glucocorticoid, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids (strong and weak opioids), and benzodiazepine. Primary endpoint was in-hospital mortality. A total of 7713 patients with COVID-19 were included, and in-hospital mortality was observed in 248 (3.2%) patients. In multivariate logistic regression analysis, no MSDs (p > 0.05) were significantly associated with in-hospital mortality. However, in-hospital mortality was 12.73 times higher in users of strong opioids (odds ratio: 12.73, 95% confidence interval: 2.44–16.64; p = 0.002), while use of paracetamol (p = 0.973), gabapentin or pregabalin (p = 0.424), glucocorticoid (p = 0.673), NSAIDs (p = 0.979), weak opioids (p = 0.876), and benzodiazepine (p = 0.324) was not associated with in-hospital mortality. In South Korea, underlying MSDs were not associated with increased in-hospital mortality among patients with COVID-19. However, use of strong opioids was significantly associated with increased in-hospital mortality among the patients.

What Do We Need to Know About Musculoskeletal Manifestations of COVID-19?

“…Twenty literature reviews were identified2, 12-30 . Of the remaining studies, 31 presented original research 31-61 , 6 were case series 62-67 , 24 were case reports 68-91 , 1 provided a specialist’s opinion 92 , 4 were editorials 93-96 , and 2 were letters to the editor 97,98 .…”

Opioid usage and COVID-19 prognosis: A systematic review and meta-analysis

“…A full text review of the remaining 52 studies was then conducted, and 47 records were eliminated since they were reviews, abstract, letters, conferences, without comparison between opioid use and no-opioid use, or without clinical outcomes reported. Therefore, a total of 5 studies with 1,023,224 patients were included in the final analysis [ [22] , [23] , [24] , [25] , [26] ]. The process of study retrieval is shown in Fig.…”

A COVID-19 mortality prediction model for Korean patients using nationwide Korean disease control and prevention agency database

“…Oh et al aimed to investigate whether comorbid musculoskeletal disorders (MSD)s and pain medication use was associated with in-hospital mortality among patients with COVID-19. They found MSDs were not associated with increased in-hospital mortality among patients with COVID-19 19 . Lee et al found potential associations between physical activity and risk of infection, severe illness from COVID-19 and COVID-19 mortality using a nationwide cohort from South Korea 20 .…”