Evaluation of pain in patients with COVID-19

Bangladesh Journal of Pain, 2023

Background: The COVID-19 pandemic has created a huge impact on the lives and health of persons worldwide, with potential for developing further effects in coming days. The long-term complications of COVID-19 are starting to emerge and a large number of patients may experience continued effects including pain. The number of patients affected by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS CoV-2) is much greater than other corona viruses, so spectrum of long term post COVID-19 pain may produce huge burden. So, it is vital to assess the pain in post COVID-19 patients. This study is aimed to assess pain among the patients recovered from COVID-19. Methods: This cross sectional observational study was carried out in pain medicine Out Patient Unit, Department of Anaesthesia, Analgesia & Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University for a period of one year following ethical approval. A total of 76 patients were included in this study according to the selection criteria. Data were collected using a pre-designed data collection sheet. Assessment of pain was carried out by Brief Pain Inventory (BPI) questionnaire. Collected data were analysed by statistical software SPSS 23. Results: A total of 225 patients were assessed and the study period prevalence of post COVID-19 pain was 33.78 percent. The average age of the participants was 46.8±14.3 years with a male to female ratio of 43:33. After COVID-19, 49 (64.5%) patients had new onset pain, whereas 27 (35.5%) had exaggerated chronic pain. Most 21 (27.6%) patients was found in chest pain, 20 (26.3%) neck pain, 19 (25.0%) headache and 19 (25.0%) low back pain. Most of the patients (50.0%) had mild pain in intensity right now. Mean pain interference score was 3.8±2.0. The mean pain intensity was considerably higher in older patients (age>50 years), female gender, patients with two or more co-morbidities, and severe COVID-19 infection. Conclusion: Both new onset of pain and exaggeration of chronic pain were observed among the patients recovered from covid-19 disease.

PAIN MANAGEMENT DURING THE COVID-19 PANDEMIC: A LITERATURE REVIEW (Atena Editora), 2021

Chronic pain is a prevalent condition worldwide and causes suffering, limited daily activities and reduced quality of life. There is growing evidence that COVID-19 infection is associated with myalgias, referred pain, and generalized hyperalgesia. The aim of the present study is to analyze the management of chronic pain during the COVID-19 pandemic. A systematic search was carried out in the Medline database. The following descriptors were used: “Pain Management” AND “coronavirus 2019″ OR “SARS-CoV-2″ OR “COVID-19″ and “Pain” and articles on the topic published within the time frame (2019- 2021) and in the English language. Telemedicine can help provide ongoing services to patients; assessments, treatment and follow-up. Patients with chronic pain may also be at increased risk for COVID-19 due to several factors. Important considerations for health professionals who care for people with chronic pain are: ensuring continuity of care and pain medications; use of telemedicine; maintenance of the biopsychosocial management approach; evaluation and safe conduction of urgent and semi-urgent procedures to avoid morbidity in patients with chronic pain; and the need to modify current therapies to decrease the risk of COVID-19.

The Egyptian Journal of Neurology, Psychiatry and Neurosurgery

Coronavirus disease 2019 (COVID-19) is a current global pandemic. The case number has increased since December 31, 2019. It has been reported that COVID-19 patients have been giving pain complaints, one of which is muscular pain. Other types of pain that have also been reported by COVID-19 patients are joint pain, stomach pain, and testicular pain. Neuropathic pain is the rarest case among others. COVID-19 mechanisms in the nerve and musculoskeletal damage are believed to be caused by the expression and distribution of angiotensin-converting enzyme 2 (ACE-2). Patients with pain, especially neuropathic pain, normally do not respond well to various therapies, and experience psychiatric disorders such as depression, which leads to a decrease in the patient’s quality of life. Important considerations for health professionals in terms of pain management during this pandemic include ensuring treatment continuity, painkillers, utilization of telemedicine, biopsychosocial management approac...

European Journal of Pain, 2021

Background: We assessed whether COVID-19 is associated with de novo pain and de novo chronic pain (CP). Methods: This controlled cross-sectional study was based on phone interviews of patients discharged from hospital after COVID-19 compared to the control group composed of individuals hospitalized during the same period due to non-COVID-19 causes. Patients were classified 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 assessed 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. Results: Length of in-hospital-stay and ICU admission rates were significantly higher amongst COVID-19 survivours, while mechanical ventilation requirement was similar between groups. Pre-hospitalisation pain was lower in COVID-19 compared to control group (10.9% vs. 42.5%; p = 0.001). However, the 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 analysing exclusively (COVID: n = 40; controls: n = 34) patients who did not report previous pain before the hospital stay. No statistically significant differences were found for mean new-onset pain intensity and interference with daily activities between both groups. COVID-19 | 1343 SOARES Et Al.

Journal of Clinical Medicine

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 extremit...

European Journal of Pain, 2021

Background: Pain has been frequently described as a clinical feature of COVID-19, and the main pain syndromes that have been associated with the acute phase of this disease so far are headache, myalgia, arthralgia, and neuropathic pain. Understanding the characteristics of pain symptoms is crucial for a better clinical approach. Methods: Patients who were diagnosed as having COVID-19 using reverse transcription-polymerase chain reaction were included in the study. Patients were asked to complete a 51-item questionnaire via a phone interview, which included questions on demographics, acute COVID-19 symptoms, the presence of pain symptoms, and their characteristics in the acute phase of COVID-19. Results: A total of 222 out of 266 patients with COVID-19 participated in the study, yielding a response rate of 83.5%. A total of 159 patients reported at least one kind of pain syndrome with a prevalence of 71.6%. Myalgia was reported in 110 (49.6%) patients, headache in 109 (49.1%), neuropathic pain symptoms in 55 (24.8%), and polyarthralgia in 30 (13.5%) patients. A total of 66 patients reported only one type of pain, 46 reported two types, 42 reported three types, and five patients reported all four types of pain. Logistic regression analysis showed that there were significant associations between these pain syndromes and a strong association was found between neuropathic pain and headache. Conclusion: Pain is a frequently observed symptom of mild-to-moderate COVID-19. There are significant relationships between pain syndromes in COVID-19, which may be due to a sequence of common etiologic factors. Significance: This study described the main pain syndromes associated acute phase of mild-to-moderate COVID-19 and its associated features. Headaches and pain of neuropathic characteristics were prevalent in this sample.

Academia Letters, 2021

The novel coronavirus pandemic had a great socioeconomic impact all over the world. In the health field, resources were redirected and the treatment of other diseases was affected. This study is a brief review about the situation of chronic pain patients during the pandemic. A few articles were selected in online databases and their content was analyzed, synthetized and associated in this article.

Irish Journal of Medical Science (1971 -)

Background Pain can be considered an early sign of COVID-19 infection. There are no studies that specifically investigate the frequency, characteristics, and presentation patterns of pain in COVID-19 infection. Aims Our aim is to evaluate the frequency, localization, and severity of pain among the presenting signs and symptoms in patients with COVID-19. Methods Patients with the diagnosis of COVID-19 who were admitted to our hospital between March and June 2020 were retrospectively analyzed. Patients' general symptoms at the first admission to the hospital, presence of pain at admission, localization, severity, and persistence of pain were queried by phone call. Results A total of 210 inpatients diagnosed with COVID-19 were recruited from the hospitals database. Complaints of the patients were 76.6% fatigue, 69.3% pain, 62% fever, 45.3% cough, 43.5% loss of taste and/or smell, 25% diarrhea, and 0.5% skin lesions respectively. Pain was the chief complaint in of 46.61% of the patients. Pain complaints had started on average 2.2 (± 2.8) days before admission. Among 133 patients reporting pain, the distribution of site was 92 (69.2%) myalgia/arthralgia; 67 (50.4%) headache; 58 (43.6%) back pain; 44 (33.1%) low back pain; 33 (25.0%) chest pain; 28 (21.1%) sore throat; and 18 (13.6%) abdominal pain. Conclusions The most common pain symptoms were myalgia/arthralgia and headache (69.17% and 50.37%) and found to be much higher than previously reported. Pain is one of the most common complaints of admission to the hospital in patients with COVID-19. Patients who apply to health institutions with pain complaints should be evaluated and questioned in suspicion of COVID-19 infection.

Journal of Clinical Medicine

Introduction: Chronic pain is increasingly recognized as part of long COVID syndrome, mainly in the form of myalgias. However, chronic pain has several forms, and according to our clinical experience, COVID-19 survivors suffer from numerous painful syndromes, other than myalgias. The aim of our study was to estimate the prevalence of chronic pain, describe the commonest painful syndromes and identify pain determinants in a random population of COVID-19 survivors. Methods: This was a cross-sectional study conducted at the Medical School, University of Cyprus. A random population of 90 COVID-19 survivors was recruited. Demographic and COVID-19 related clinical characteristics were recorded. The painDETECT and DN4 questionnaires were used to evaluate the painful syndromes. Results: The prevalence of chronic pain was estimated to be 63.3%. The most common site of pain was low back (37.8%), followed by joints (28.9%) and neck (12.2%). Patients with chronic pain compared to subjects witho...

Anaesthesia

The COVID-19 pandemic transformed everyday life, but the implications were most impactful for vulnerable populations, including patients with chronic pain. Moreover, persistent pain is increasingly recognised as a key manifestation of long COVID. This narrative review explores the consequences of the COVID-19 pandemic for chronic pain. Publications were identified related to the COVID-19 pandemic influence on the burden of chronic pain, development of new-onset pain because of long COVID with proposed mechanisms and COVID-19 vaccines and pain interventions. Broadly, mechanisms underlying pain due to SARS-CoV-2 infection could be caused by`systemic inflammatory-immune mechanisms´,`direct neuropathic mechanisms´or`secondary mechanisms due to the viral infection or treatment´. Existing chronic pain populations were variably impacted and social determinants of health appeared to influence the degree of effect. SARS-CoV-2 infection increased the absolute numbers of patients with pain and headache. In the acute phase, headache as a presenting symptom predicted a milder course. New-onset chronic pain was reportedly common and likely involves multiple mechanisms; however, its prevalence decreases over time and symptoms appear to fluctuate. Patients requiring intensive support were particularly susceptible to long COVID symptoms. Some evidence suggests steroid exposure (often used for pain interventions) may affect vaccine efficacy, but there is no evidence of clinical repercussions to date. Although existing chronic pain management could help with symptomatic relief, there is a need to advance research focusing on mechanism-based treatments within the domain of multidisciplinary care.