Clinical Characterization of New-Onset Chronic Musculoskeletal Pain in Long COVID: A Cross-Sectional Study

Abstract

Omar Khoja,1 Bárbara Silva-Passadouro,1 Elena Cristescu,2 Katie McEwan,3 Derek Doherty,4 Fiona O’Connell,5 Frederique Ponchel,1 Matthew Mulvey,6 Sarah Astill,7 Ai Lyn Tan,1,8 Manoj Sivan1,3,8 1Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; 2Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK; 3COVID Rehabilitation Service, Leeds Community Healthcare NHS Trust, Leeds, UK; 4School of Medicine, Trinity College Dublin, Trinity Translational Medicine Institute, St. James’s Hospital, Dublin, Ireland; 5Department of Surgery, Trinity St. James’s Cancer Institute, Trinity Translational Medicine Institute, St. James’s Hospital, Dublin, Ireland; 6Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK; 7School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK; 8NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UKCorrespondence: Manoj Sivan, Clinical Professor and Honorary Consultant, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Floor D Martin Wing, Leeds General Infirmary, Leeds, LS1 3EX, UK, Tel [phone], Email [email protected]: New-onset chronic musculoskeletal (MSK) pain is one of the common persistent symptoms in Long COVID (LC). This study investigated its clinical characteristics, underlying mechanisms, and impact on function, psychological health, and quality of life.Patients and Methods: Thirty adults (19 female, 11 male) with LC and new-onset chronic MSK pain underwent clinical examination, Quantitative Sensory Testing (QST), and blood tests for inflammatory markers and completed the following outcome measures: Timed Up and Go test (TUG), handgrip strength test, COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), Brief Pain Inventory (BPI), Pain Self-Efficacy Questionnaire (PSEQ), Pain Catastrophizing Scale (PCS), International Physical Activity Questionnaire-short form (IPAQ-sf), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and EuroQol Five Dimensions health-related quality of life (EQ-5D-5L).Results: New-onset chronic MSK pain was widespread and continuous in nature, and worse in the joints. When compared to normative values reported in the literature: a) QST revealed mechanical hyperalgesia, heightened temporal summation of pain, and hypoesthesia to vibration stimuli, which is strongly suggestive of central sensitization; b) Plasma cytokine assays indicated distinct pro-inflammatory profiles; c) TUG time indicated reduced balance and mobility; d) handgrip strength revealed general weakness; e) physical activity was lower; and f) there were moderate levels of depression and anxiety with lower self-efficacy scores and lower levels of pain catastrophizing. LC symptoms were of moderate severity (44.8/100), moderate functional disability (22.8/50) and severely compromised overall health (2.6/10) when compared to pre-COVID scores.Conclusion: New-onset chronic MSK pain in LC tends to be widespread, constant, and associated with weakness, reduced function, depression, anxiety, and reduced quality of life. There is associated central sensitization and proinflammatory state in the condition. Further research is essential to explore the longitudinal progression and natural evolution of the new-onset chronic MSK pain in LC.Keywords: post-COVID-19 syndrome, post-COVID-19 condition, post-acute sequelae of COVID-19, chronic widespread pain

Keywords

• post-covid-19 syndrome
• post-covid-19 condition
• post-acute sequelae of covid-19
• chronic widespread pain