Prevalence and characteristics of new‐onset pain in COVID‐19 survivours, a controlled study

Abstract

We assessed whether COVID‐19 is associated with de novo pain and de novo chronic pain (CP). This controlled cross‐sectional study was based on phone interviews of patients discharged from hospital after COVID‐19 compared to control group composed of individuals hospitalized during the same period due to non‐COVID‐19 causes. Patients were classifyed as having previous CP based on the ICD‐11/IASP criteria, de novo pain (i.e., any new type of pain, irrespective of the pain status before hospital stay), and de novo CP (i.e. persistent or recurring de novo pain, lasting more than 3 months) after COVID‐19. We asssessed pain prevalence and its characteristics, including headache profile, pain location, intensity, interference, and its relationship with fatigue, and persistent anosmia. Forty‐six COVID‐19 and 73 control patients were included. Both groups had similar sociodemographic characteristics and past medical history. Length of in‐hospital‐stay and ICU admission rates were significantly higher among COVID‐19 survivors, while mechanical ventilation requirement was similar between groups. Pre‐hospitalization pain was lower in COVID‐19 compared to control group (10.9% vs. 42.5%; P=0.001). However, COVID‐19 group had a significantly higher prevalence of de novo pain (65.2% vs. 11.0%, P=0.001), as well as more de novo headache (39.1%) compared to controls (2.7%, p=0.001). New‐onset CP was 19.6% in COVID‐19 patients and 1.4% (P=0.002) in controls. These differences remained significant (p=0.001) even after analyzing exclusively (COVID: n=40; controls: n=34) patients who did not report previous pain before hospital stay. No statistically significant differences were found for mean new‐onset pain intensity and interference with daily activities between both groups. COVID‐19 pain was more frequently located in the head/neck and lower limbs (P<0.05). New‐onset fatigue was more common in COVID‐19 survivors necessitating inpatient hospital care (66.8%) compared to controls (2.5%, p=0.001). COVID‐19 patients who reported anosmia had more new‐onset pain (83.3%) compared to those who did not (48.0%, P=0.024). COVID‐19 was associated with a significantly higher prevalence of de novo CP, chronic daily headache, and new‐onset pain in general, which was associated with persistent anosmia.

Incidence of Long-term Post-acute Sequelae of SARS-CoV-2 Infection Related to Pain and Other Symptoms: A Living Systematic Review and Meta-analysis

“…54,55 It can persist over the period of the initial infection, 56 or it can develop as a new-onset form during healing. 11 Proposed mechanisms include direct invasion of trigeminal nerve endings by SARS-CoV-2 via disruption of the brain-blood barrier, trigeminovascular activation via involvement of endothelial cells with ACE2 expression, or triggering of perivascular trigeminal nerve endings by release of cytokines and pro-inflammatory mediators. 56 Among other symptoms, almost half of the patients developed fatigue.…”

Insight into pain syndromes in acute phase of mild‐to‐moderate COVID‐19: Frequency, clinical characteristics, and associated factors

“…Most of the collected data on pain focused on headache and little is known about overall pain syndromes. A previous study by Soares et al ( 2021 ) reported that patients with COVID‐19 had a higher prevalence of de novo pain (65.2%) and de novo headache (39.1%) when compared with a control group and they found de novo chronic pain in 19.6% of patients with COVID‐19. Another study revealed pain in 69.3% of patients with COVID‐19 with 69.2% of those reporting myalgia/arthralgia, 50.4% headache, 43.6% back pain, and 33.1% reporting low back pain (Murat et al, 2020 ).…”

“…Another study revealed pain in 69.3% of patients with COVID‐19 with 69.2% of those reporting myalgia/arthralgia, 50.4% headache, 43.6% back pain, and 33.1% reporting low back pain (Murat et al, 2020 ). Although research has focused on individual pain syndromes, there is still a gap regarding the overall pain symptoms and characteristics, leaving many unresolved questions concerning the characteristics of pain in patients with COVID‐19 (Magdy et al, 2020 ; Murat et al, 2020 ; Soares et al, 2021 ; Uygun et al, 2020 ). Describing the characteristics of pain syndromes, which may result from different mechanisms, will help to better understand the different mechanisms of pain and will improve the choice of pain medication.…”

“Post-COVID syndrome”: The focus is on musculoskeletal pain

“…Soares и соавт. [37] сравнили наличие скелетномышечной боли у 46 пациентов, находившихся в стационаре для лечения COVID-19, и 73 лиц, госпитализированных в тот же период по другим причинам. После выписки из стационара частота хронической боли (продолжавшейся более 3 месяцев) у пациентов после COVID-19 составила 19,6%, в контрольной группе -1,4% (р=0,002).…”