Background & Aims

Patients previously infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can develop long-lasting symptoms after the acute phase of the infection up to two years after (1). Pain is one of five most prevalent post-COVID symptoms (2) and can be present in both hospitalized and non-hospitalized patients (3). Pain symptomatology ranges from headache, neuralgias, neuropathies, and muscle or joint arthralgic pain, to widespread pain symptoms (4).
The trophism of the SARS-CoV-2 virus has resulted in the appearance of several variants in a short period of time, and several reinfections have been described. Data about post-COVID symptoms and reinfections is still in its infancy with few heterogeneous results reported (5,6).
This study aimed to analyze the prevalence of post-COVID pain symptoms 20 months after the first infection in a large cohort of hospitalized and non-hospitalized COVID-19 survivors according to the number of SARS-CoV-2 reinfections.

Methods

Participants were included if they had at least one SARS-CoV-2 infection (a positive reverse transcription polymerase chain reaction test, RT-PCR) between March 2020 and December 2021. Both hospitalized and non-hospitalized patients were included. A peer-reviewed self-administered survey (SurveyXact, Rambøll Management Consulting A/S) was sent via Digital Post (a national emailing system) to all participants and was open for five weeks. The survey asked for the presence, location, and features of pain symptoms developed after infection, as well as the number of SARS-CoV-2 infections. Clinical and hospitalization data were collected from hospital medical records of hospitalized patients and from the Danish Health Data Authority (DHDA). The presence and characteristics of post-COVID pain were analyzed with the number of reinfections (one, two, or more) as dependent factor.

Results

Data from 17,938 COVID-19 survivors (1,687 hospitalized and 16,296 non-hospitalized) were included. The prevalence of post-COVID pain was higher with a greater number of reinfections at all locations (Headache, migraine, joint pain, widespread pain, neck or shoulder pain, back pain, abdominal pain, chest pain, and sore throat pain) (all, P<0.01) except for joint pain (P=0.887). Severe pain intensity was reported by a significantly greater number of patients with reinfections (P<0.001). Participants rated severe pain from 19.7%, over 20.5% to 21.3% for 1, 2, or 3+ reinfections, respectively. For the participants rating the pain as very severe, there was also an increase from 2.5%, over 2.8%, to 5.6% according to 1, 2, or 3+ reinfections, respectively.

Conclusions

To our knowledge, this study is the first to investigate the prevalence of post-COVID pain in a large cohort nationwide survey in both hospitalized and non-hospitalized individuals considering the number of reinfections. This study found that the prevalence and the severity of post-COVID pain were higher in individuals (on average 20 months after the infection), with a higher number of reinfections.

References

1: Fernández-de-las-Peñas C, Notarte KI, Macasaet R, Velasco JV, Catahay JA, Therese Ver A, Chung W, Valera-Calero JA, Navarro-Santana M. Persistence of post-COVID symptoms in the general population two years after SARS-CoV-2 infection: A systematic review and meta-analysis. J Infect. 2023 Dec 13:S0163-4453(23)00590-X.
2: Fernández-de-las-Peñas C, Navarro-Santana M, Plaza-Manzano G, Palacios-Ceña D, Arendt-Nielsen L. Time course prevalence of Post-COVID pain symptoms of musculoskeletal origin in patients who had survived to SARS-CoV-2 infection: A systematic review and meta-analysis. Pain. 2022; 163: 1220-1231.
3: Yuan N, Lv ZH, Sun CR, Wen YY, Tao TY, Qian D, Tao FP, Yu JH. Post-acute COVID-19 symptom risk in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis. Front Public Health. 2023; 11: 1112383.
4: Castaldo M, Ebbesen BD, Fernández-de-las-Peñas C, Arendt-Nielsen L, Giordano R. COVID-19 and musculoskeletal pain: An overview of the current knowledge. Minerva Anestesiol. 2023; 89: 1134-1142.
5: Boufidou F, Medi? S, Lampropoulou V, Siafakas N, Tsakris A, Anastassopoulou C. SARS-CoV-2 reinfections and long COVID in the post-Omicron phase of the pandemic. Int J Mol Sci. 2023; 24: 12962
6: Bosworth ML, Shenhuy B, Walker AS, Nafilyan V, Alwan NA, O’Hara ME, Ayoubkhani D. Risk of new-onset long COVID following reinfection with Severe Acute Respiratory Syndrome Coronavirus 2: A community-based cohort study Open Forum Infect Dis. 2023; 10: ofad493.

Presenting Author

Brian Duborg Ebbesen

Poster Authors

Brian Ebbesen

MSc

Aalborg University

Lead Author

E-mail

Rocco Giordano

Center for Neuroplasticity and Pain, HST, Faculty of Medicine, Aalborg University, Aalborg, DK

Lead Author

E-mail

Bodil Steen Rasmussen

Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark

Lead Author

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Henrik Nielsen

prof

Aalborg University Hospital, Aalborg, Denmark

Lead Author

E-mail

Berit Schiøttz-Christensen

prof

University of Southern Denmark, Odense, Denmark

Lead Author

E-mail

Pernille Lykke Petersen

Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark

Lead Author

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Juan Antonio Valera-Calero

prof

Universidad Complutense de Madrid, Madrid, Spain

Lead Author

E-mail

César Fernández-de-las-Peñas

dr med sci

Universidad Rey Juan Carlos (URJC), Madrid, Spain

Lead Author

E-mail

Matteo Castaldo

dr

Aalborg University, Aalborg, Denmark

Lead Author

E-mail

Lars Arendt-Nielsen

PhD

Aalborg University

Lead Author

E-mail

Topics

  • Epidemiology