LIM-62, Pain Center, Department of Neurology, University of São Paulo, São Paulo, Brazil.
Pain Treatment Center, Sao Paulo State Cancer Institute, São Paulo, Brazil.
Eur J Pain. 2023 May;27(5):636-650. doi: 10.1002/ejp.2094. Epub 2023 Mar 7.
New-onset chronic pain has been acknowledged as part of the post-COVID-19 condition. However, available fine-grained data about its clinical phenotype, trajectories and main associated characteristics remain scarce. We described the distinct temporal evolutions of post-COVID-19 pain and their epidemiological and phenotypical features.
A prospective cross-sectional study enrolled post-COVID-19 condition patients (i.e. who had persisting COVID-19-related symptoms over 30 days since their first positive laboratory test), whose COVID-19 diagnosis had been supported by RT-PCR of oral/nasopharyngeal swab or serology. They underwent in-person evaluations with a structured interview, pain and quality-of-life-related questionnaires and thorough physical examination. Chronic pain (CP) and probable neuropathic pain (NP) were defined according to IASP criteria.
The present study included 226 individuals, 177 (78.3%) of whom presented over 3 months since their first COVID-19 symptom. New-onset pain occurred in 170 (75.2%) participants and was chronic in 116 (68.2%). A chronic course was associated with COVID-19-related hospitalization, new-onset fatigue, lower cognitive performance, motor and thermal sensory deficits, mood and sleep impairments and overall lower quality-of-life levels. Probable NP occurred in only 7.6% new-onset pain patients, and was associated with pain chronification, new-onset fatigue, motor and thermal sensory deficits, mechanical allodynia and lower rates of SARS-CoV-2 vaccination. Previous CP was reported by 86 (38.1%) individuals and had aggravated after the infection in 66 (76.7%) of them, which was associated with orthostatic hypotension.
Post-COVID pain phenomena follow different paths, which are associated with specific clinical and epidemiological features, and possibly distinct underlying mechanisms, prognostic and therapeutic implications.
COVID-19-related pain usually follows a chronic course and is non-neuropathic. Its possible courses and phenotypes are associated with distinct clinical and epidemiological features. This suggests differing underlying mechanisms, which may have significant prognostic and therapeutic implications.
新发慢性疼痛已被认为是新冠病毒感染后(post-COVID-19)综合征的一部分。然而，关于其临床表型、轨迹和主要相关特征的详细数据仍然很少。我们描述了新冠病毒感染后(post-COVID-19)疼痛的不同时间演变及其流行病学和表型特征。
一项前瞻性横断面研究纳入了新冠病毒感染后(post-COVID-19)条件的患者（即自首次实验室检测阳性以来，持续 COVID-19 相关症状超过 30 天的患者），其 COVID-19 诊断得到了口腔/鼻咽拭子 RT-PCR 或血清学的支持。他们接受了面对面的评估，包括结构化访谈、疼痛和生活质量相关的问卷以及全面的体格检查。根据 IASP 标准定义慢性疼痛（CP）和可能的神经病理性疼痛（NP）。
本研究共纳入 226 名患者，其中 177 名（78.3%）在首次 COVID-19 症状后超过 3 个月。170 名（75.2%）参与者出现新发疼痛，116 名（68.2%）为慢性疼痛。慢性病程与 COVID-19 相关住院、新发疲劳、认知功能下降、运动和温度感觉缺陷、情绪和睡眠障碍以及整体生活质量下降有关。新发疼痛患者中仅有 7.6%为可能的 NP，与疼痛慢性化、新发疲劳、运动和温度感觉缺陷、机械性痛觉过敏和 SARS-CoV-2 疫苗接种率较低有关。86 名（38.1%）患者报告有既往 CP，其中 66 名（76.7%）在感染后加重，与直立性低血压有关。
新冠病毒感染后(post-COVID-19)疼痛表现出不同的模式，与特定的临床和流行病学特征相关，并可能具有不同的潜在机制、预后和治疗意义。
新冠病毒相关疼痛通常呈慢性病程，且为非神经病理性。其可能的病程和表型与不同的临床和流行病学特征相关。这表明存在不同的潜在机制，可能具有重要的预后和治疗意义。
