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Published on: December 19, 2020
Pain Manifestations of COVID-19 and Their Association With Mortality: A Multicenter Prospective Observational Study
Nigel Knox1, Chang-Soon Lee2, Jee Youn Moon3
1Department of Anesthesiology, Westchester Medical Center, New York Medical College, Westchester, NY.
Insights
Pain is a common symptom in COVID-19 patients, with headache, chest pain, and spine pain being most frequent. Absence of pain was linked to higher intensive care unit admission and mortality rates in coronavirus disease 2019 patients.
Area of Science:
- Infectious Diseases
- Pain Medicine
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) infection can present with various symptoms, including pain.
- Understanding the prevalence and characteristics of pain in COVID-19 patients is crucial for patient management.
Purpose of the Study:
- To determine the prevalence and types of pain symptoms in patients with COVID-19.
- To investigate the association between pain and the need for intensive care unit (ICU) admission and mortality.
Main Methods:
- A multicenter prospective study was conducted involving 169 patients with active COVID-19 infection.
- Data on pain intensity and type were collected, and associations with ICU admission and death were analyzed.
Main Results:
- 38.5% of patients reported active pain conditions.
- The most common pain symptoms were headache (30.1%), spinal pain (24.7%), and chest pain (23.3%).
- Absence of pain was significantly associated with increased odds of ICU admission (OR, 2.92) and death (OR, 3.49).
Conclusions:
- Acute pain is a frequent manifestation of COVID-19, with headache, chest pain, and spine pain being the most common.
- Patients without pain were more likely to require intensive care and experience mortality.
- Potential mechanisms for reduced mortality in painful COVID-19 cases may involve pain perception modulation during severe illness.
Objectives:
To determine the prevalence and breakdown of pain symptoms among patients with coronavirus disease 2019 (COVID-19) infection admitted for nonpain symptoms and the association between the presence of pain and intensive care unit (ICU) admission and death.
Patients And Methods:
In this multicenter prospective study, data on the intensity and type of pain were collected on 169 patients with active severe acute respiratory syndrome coronavirus 2 infection at 2 teaching hospitals in the United States and Korea and on 8 patients with acute pain at another large teaching hospital between February 1, 2020, and June 15, 2020.
Results:
Sixty-five of 169 patients (38.5%) reported an active pain condition. Among the 73 patients with pain, the most common pain symptoms were headache (n=22; 30.1%), chest pain (n=17; 23.3%), spinal pain (n=18; 24.7%), myalgia (n=13; 17.8%), abdominal or pelvic pain (n=13; 17.8%), arthralgia (n=11; 15.1%), and generalized pain (n=9; 12.3%). Those reporting headache as their main symptom were less likely to require ICU admission (P=.003). Acetaminophen or nonsteroidal anti-inflammatory drugs were prescribed to 80.8% (n=59), opioids to 17.8% (n=13), adjuvants to 8.2% (n=6), and ketamine to 5.5% (n=4) of patients with pain. When age 65 years and older and sex were controlled for in multivariable analysis, the absence of pain was associated with ICU admission (odds ratio, 2.92; 95% CI, 1.42 to 6.28; P=.004) and death (odds ratio, 3.49; 95% CI, 1.40 to 9.76; P=.01).
Conclusion:
Acute pain is common during active COVID-19 infection with the most common manifestations being headache, chest pain and spine pain. Individuals without pain were more likely to require intensive care and expire than those with pain. Reasons why pain may be associated with reduced mortality include that an intense systemic stimulus (eg, respiratory distress) might distract pain perception or that the catecholamine surge associated with severe respiratory distress might attenuate nociceptive signaling.
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