Clinical profile of pain in post-COVID-19 patients: systematic review

Santos, Pammela Weryka da Silva; Baptista, Abrahão Fontes; Santos, Thalyta Cibele Passos dos; Hazime, Fuad Ahmad

doi:10.5935/2595-0118.20230031-en

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REVIEW ARTICLE • BrJP 6 (2) • Apr-Jun 2023 • https://doi.org/10.5935/2595-0118.20230031-en copy

Clinical profile of pain in post-COVID-19 patients: systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHTS

This study reinforces the importance of knowing the clinical profile of pain after COVID-19 infection, as it will guide strategies for prevention and rehabilitation of pain complaints.
There is an increase in pain severity in all body regions during COVID-19 infection, when compared to the pre-infection state, and it is maintained after infection.
Biological, psychological, and social factors influence the intensity of pain.

ABSTRACT

BACKGROUND AND OBJECTIVES:

Although research shows that pain is more frequent during COVID-19 infection, little is known about the characterization of pain and factors that influence its permanence after infection. Therefore, the objective of this study was to describe the clinical profile of pain in post-COVID-19 patients.

This is a systematic review conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. Articles were searched from November 2021 to November 2022 in the Pubmed, Embase, Web of Science, Scopus, Cochrane and PsycINFO databases. Five observational studies were included for qualitative synthesis. There was an increase in the intensity of pain in all regions of the body during the infection when compared to the pre-infection state, remaining after the infection. The most reported post-COVID-19 pains are: neuropathic pain, generalized pain and pain in the cervical region. The average duration of post-COVID-19 pain was six months.

CONCLUSION:

There is persistence of pain after infection with the new coronavirus, with the presence of “new pain” and “new chronic pain”, and the worsening of pain in specific groups that had COVID-19.

Keywords
COVID-19; Pain; Pain measurement

Sahin et al.¹⁴14 Şahin T, Ayyildiz A, Gencer-Atalay K, Akgün C, Özdemir HM, Kuran B. Pain symptoms in COVID-19. American J Phys Med Rehabil. 2021;100(4):307-12.	Observational study	Investigating the painful body regions and their severity before, during and post-COVID-19, as well as revealing the relationship between pain intensity and disease characteristics	206 patients, mean age 56.24±16.99 years, 51% female.	Location; intensity; correlations with anxiety, depression and and quality of life
Soares et al.¹⁵15 Soares FHC, Kubota GT, Fernandes AM, Hojo B, Couras C, Costa BV, Lapas JDDS, Braga LM, Almeida MM, Cunha PHMD, Pereira VHH, Morais ADS, Teixeira MJ, Ciampi de Andrade D. Prevalence and characteristics of new-onset pain in COVID-19 survivors, a controlled study. Eur J Pain. 2021;25(6):1342-54.	Cross-sectional observational study	Investigating the presence of new pain symptoms in post-COVID-19 patients	46 patients, mean age 56.30±15.00 years, 45.7% male	Location; intensity; correlations with activities of daily living, presence of fatigue, headache and chronic pain
Bilgin, Kesik and Özdemir¹⁶16 Bilgin A, Kesik G, Özdemir L. Biopsychosocial factors predicting pain among individuals experiencing the novel coronavirus disease (COVID-19). Pain Manag Nurs. 2022;23(1):79-86.	Retrospective observational study	To evaluate pain intensity in patients diagnosed with COVID-19 and correlate with biological, psychological and social factors	149 patients, mean age 32.87±11.32 years, 75.2% were female.	Pain intensity; correlations with biological, social and psychological factors (anxiety); presence of fatigue; level of activity
Büyükşireci et al.¹⁷17 Büyükşireci DE, Türk AÇ, Erden E, Erden E. Evaluation of pain, disease activity, anxiety, depression, and neuropathic pain levels after COVID-19 infection in fibromyalgia patients. Ir J Med Sci. 2023;192(3):1387-93.	Cross-sectional observational study	To assess pain intensity, anxiety, depression, disease activity, and post-COVID-19 neuropathic pain in patients with fibromyalgia (FM)	77 patients, mean age 46.92 ± 8.72, female only.	Pain intensity and location; symptom severity; disease activity (FM); anxiety and depression; neuropathic signs and symptoms
Herrero- -Montes et al.¹⁸18 Herrero-Montes M, Fernández-de-las-Peñas C, Ferrer-Pargada D, Tello-Mena S, Cancela-Cilleruelo I, Rodríguez-Jiménez J, Palacios-Ceña D, Parás-Bravo P. Prevalence of neuropathic component in post-COVID pain symptoms in previously hospitalized COVID-19 survivors. Int J Clin Pract. 2022;16;2022:3532917.	Cross-sectional observational study	To investigate the prevalence of neuropathic pain symptoms and to analyze the correlation with pain-related, cognitive and psychological variables in patients with post-COVID-19 pain complaint	77 patients, mean age 60 ± 11.5 years, 37.6% were female.	Pain intensity and location neuropathic pain symptoms anxiety and depression, pain catastrophizing, kinesiophobia

Authors	Variables	Instruments
Sahin et al.¹⁴14 Şahin T, Ayyildiz A, Gencer-Atalay K, Akgün C, Özdemir HM, Kuran B. Pain symptoms in COVID-19. American J Phys Med Rehabil. 2021;100(4):307-12.	Socio-demographic and clinical data Location of pain Pain intensity Anxiety and depression Quality of life	Records and Interview (via telephone) Numeric Rating Scale (NRS) Hospital Anxiety and Depression Scale (HADS), (Turkish version). Short from Survey (SF-12) (Turkish version)
Soares et al.¹⁵15 Soares FHC, Kubota GT, Fernandes AM, Hojo B, Couras C, Costa BV, Lapas JDDS, Braga LM, Almeida MM, Cunha PHMD, Pereira VHH, Morais ADS, Teixeira MJ, Ciampi de Andrade D. Prevalence and characteristics of new-onset pain in COVID-19 survivors, a controlled study. Eur J Pain. 2021;25(6):1342-54.	Sociodemographic and clinical data Interferences in activities of daily living Presence of fatigue, headache and chronic pain Pain intensity and location	Interview (via telephone and/or video call), REDCap software platform Brief Pain Inventory (BPI) adapted to Portuguese Use of a mannequin
Bilgin, Kesik and Özdemir¹⁶16 Bilgin A, Kesik G, Özdemir L. Biopsychosocial factors predicting pain among individuals experiencing the novel coronavirus disease (COVID-19). Pain Manag Nurs. 2022;23(1):79-86.	Pain intensity Biological factors Social factors Presence of fatigue Psychological factors (anxiety) Activity level	Visual Analog Scale (VAS) Online survey (on Google Forms) Chalder Fatigue Scale (CFS) Anxiety Scale (CAS) Pain-Activity Standards Measurement Scale (POAM-P) (Turkish version)
Büyükşireci et al.¹⁷17 Büyükşireci DE, Türk AÇ, Erden E, Erden E. Evaluation of pain, disease activity, anxiety, depression, and neuropathic pain levels after COVID-19 infection in fibromyalgia patients. Ir J Med Sci. 2023;192(3):1387-93.	Pain intensity and location Severity of symptoms Disease activity (FM) Anxiety and depression Neuropathic signs and symptoms	Numerical Rating Scale (NRS) Widespread Pain Index (WPI) Symptom Severity Scale (SSS) Fibromyalgia Impact Questionnaire (FIQ) Hospital Anxiety and Depression Scale (HADS) Leeds Neuropathic Signs and Symptoms Assessment Scale (LANSS) (Turkish version)
Herrero- -Montes et al.¹⁸18 Herrero-Montes M, Fernández-de-las-Peñas C, Ferrer-Pargada D, Tello-Mena S, Cancela-Cilleruelo I, Rodríguez-Jiménez J, Palacios-Ceña D, Parás-Bravo P. Prevalence of neuropathic component in post-COVID pain symptoms in previously hospitalized COVID-19 survivors. Int J Clin Pract. 2022;16;2022:3532917.	Pain intensity and location Neuropathic pain symptoms Anxiety and depression Pain catastrophizing and kinesiophobia	Numerical Rating Scale (NRS) Self-Report Leeds Assessment of Neuropathic symptoms (S-LANSS) Hospital Anxiety and Depression Scale (HADS) Pain Catastrophizing Scale (PCS) Tampa Scale for Kinesiophobia (TSK -11) (Spanish version)

	Yes	No	Confusing
1- Is there congruence between the stated philosophical perspective and the research methodology?
2- Is there congruence between the research methodology and the research question or objectives?
3- Is there congruence between the research methodology and the methods used to collect the data?
4- Is there congruence between the research methodology and the data representation and analysis?
5- Is there congruence between the research methodology and the interpretation of the results?
6-Is there a statement locating the researcher culturally or theoretically?
7- Is the influence of the researcher on the research and vice-versa addressed?
8- Are the participants and their voices adequately represented?
9- Is the research ethical according to current criteria or, for recent studies, and is there evidence of ethical approval by a competent body?
10- Do the conclusions drawn in the research report flow from the analysis or interpretation of the data?
11- Were the specific guidelines used by the research appropriate?	Include	Exclude	Search for more information
General Evaluation
Comments (including reason for exclusion)

General evaluation	Include	Exclude	Search for more information
Sahin et al.¹⁴14 Şahin T, Ayyildiz A, Gencer-Atalay K, Akgün C, Özdemir HM, Kuran B. Pain symptoms in COVID-19. American J Phys Med Rehabil. 2021;100(4):307-12.	X
Soares et al.¹⁵15 Soares FHC, Kubota GT, Fernandes AM, Hojo B, Couras C, Costa BV, Lapas JDDS, Braga LM, Almeida MM, Cunha PHMD, Pereira VHH, Morais ADS, Teixeira MJ, Ciampi de Andrade D. Prevalence and characteristics of new-onset pain in COVID-19 survivors, a controlled study. Eur J Pain. 2021;25(6):1342-54.	X
Bilgin, Kesik and Özdemir¹⁶16 Bilgin A, Kesik G, Özdemir L. Biopsychosocial factors predicting pain among individuals experiencing the novel coronavirus disease (COVID-19). Pain Manag Nurs. 2022;23(1):79-86.	X
Büyükşireci et al.¹⁷17 Büyükşireci DE, Türk AÇ, Erden E, Erden E. Evaluation of pain, disease activity, anxiety, depression, and neuropathic pain levels after COVID-19 infection in fibromyalgia patients. Ir J Med Sci. 2023;192(3):1387-93.	X
Herrero-Montes et al.¹⁸18 Herrero-Montes M, Fernández-de-las-Peñas C, Ferrer-Pargada D, Tello-Mena S, Cancela-Cilleruelo I, Rodríguez-Jiménez J, Palacios-Ceña D, Parás-Bravo P. Prevalence of neuropathic component in post-COVID pain symptoms in previously hospitalized COVID-19 survivors. Int J Clin Pract. 2022;16;2022:3532917.	X

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Clinical profile of pain in post-COVID-19 patients: systematic review

HIGHLIGHTS

ABSTRACT

BACKGROUND AND OBJECTIVES:

CONTENTS:

CONCLUSION: