Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjane.2023.08.001
Brazilian Journal of Anesthesiology
Original Investigation

Chronic pain after hospital discharge on patients hospitalized for COVID-19: an observational study

Dor crônica após alta hospitalar em pacientes internados por COVID-19: estudo observacional

Guilherme Antonio Moreira de Barros, Douglas Inomata Cardoso da Silva, Mariana Lopes Amaral Barbosa, Rafael Abbud Soares, Rodrigo Leal Alves, Claudio Lucas Miranda, Paula Danieli Lopes da Costa, Paulo do Nascimento Júnior, Norma Sueli Pinheiro Módolo

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Abstract

Background

There are few studies related to Coronavirus Disease 2019 (COVID-19) on the prevalence and nature of pain symptoms after hospital discharge, especially in individuals who develop moderate to severe disease forms. Therefore, this study aimed to evaluate the presence of chronic pain in patients discharged after hospitalization for COVID-19, and the relationship between the presence of chronic pain and intensive care stay, demographics, and risk factors for the worst Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outcome.

Methods

A cross-sectional observational study was carried out on patients with COVID-19 who recovered after hospitalization. Patients were recruited at the least 3 months after discharge and their hospital's health files were prospected. The variables evaluated were demographics, the severity of SARS-CoV-2 infection (considering the need for intensive care), and the presence of chronic pain. The results were shown in a descriptive manner, and multivariate analysis expressed as Odds Ratios (ORs) and respective Confidence Intervals (CIs) for the outcomes studied. Statistical significance was set at p < 0.05.

Results

Of 242 individuals included, 77 (31.8%) reported chronic pain related to COVID-19, with no correlation with the severity of infection. Female sex and obesity were associated with a higher risk for chronic pain with ORs of 2.69 (Confidence Interval [95% CI 1.4 to 5.0]) and 3.02 (95% CI 1.5 to 5.9). The limbs were the most affected areas of the body.

Conclusion

Chronic pain is common among COVID-19 survivors treated in hospital environments. Female sex and obesity are risk factors for its occurrence.

Keywords

Chronic pain; COVID-19; Post-COVID syndrome; Post-intensive care syndrome; SARS-CoV-2; Survivors

Resumo

Introdução

Existem poucos estudos relacionados à Doença do Coronavírus 2019 (COVID-19) sobre a prevalência e a natureza dos sintomas dolorosos após a alta hospitalar, especialmente em indivíduos que desenvolvem formas moderadas a graves da doença. Portanto, este estudo teve como objetivo avaliar a presença de dor crônica em pacientes que receberam alta após internação por COVID-19, e a relação entre a presença de dor crônica e internação em terapia intensiva, dados demográficos e fatores de risco para pior Síndrome Respiratória Aguda Grave Coronavírus 2 (SARS-CoV-2).

Métodos

Foi realizado um estudo observacional transversal em pacientes com COVID-19 que se recuperaram após hospitalização. Os pacientes foram recrutados pelo menos 3 meses após a alta e os arquivos de saúde do hospital foram prospectados. As variáveis ​​avaliadas foram dados demográficos, gravidade da infecção por SARS-CoV-2 (considerando a necessidade de cuidados intensivos) e presença de dor crônica. Os resultados foram apresentados de forma descritiva e a análise multivariada expressa em Odds Ratios (OR) e respectivos Intervalos de Confiança (IC) para os desfechos estudados. A significância estatística foi estabelecida em p < 0,05.

Resultados

Dos 242 indivíduos incluídos, 77 (31,8%) relataram dor crônica relacionada à COVID-19, sem correlação com a gravidade da infecção. Sexo feminino e obesidade foram associados a um maior risco de dor crônica com OR de 2,69 (Intervalo de confiança [IC 95% 1,4 a 5,0]) e 3,02 (IC 95% 1,5 a 5,9). Os membros foram as áreas do corpo mais afetadas.

Conclusão

A dor crônica é comum entre sobreviventes de COVID-19 tratados em ambientes hospitalares. O sexo feminino e a obesidade são fatores de risco para sua ocorrência.

Palavras-chave

Dor crônica; COVID 19; Síndrome pós-COVID; Síndrome pós-terapia intensiva; SARS-CoV-2; Sobreviventes

References

1. World Health Organization. Coronavirus disease (COVID-19) - events as they happen.

2. Kamal M, Abo Omirah M, Hussein A, Saeed H. Assessment and characterization of post-COVID-19 manifestations. Int J Clin Pract. 2021;75:e13746.

3. Carfì A, Bernabei R, Landi F. Persistent symptoms in patients after acute COVID-19. JAMA. 2020;324:603.

4. Lauwers M, Au M, Yuan S, Wen C. COVID-19 in joint ageing and osteoarthritis: Current status and perspectives. Int J Mol Sci. 2022;23:720.

5. Kemp HI, Corner E, Colvin LA. Chronic pain after COVID-19: Implications for rehabilitation. Br J Anaesth. 2020;125:436−40.

6. Rawal G, Yadav S, Kumar R. Post-intensive care syndrome: An overview. J Transl Intern Med. 2017;5:90−2.

7. Greenhalgh T, Knight M, A’Court C, Buxton M, Husain L. Management of post-acute COVID-19 in primary care. BMJ. 2020;370: m3026.

8. Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27:601−15.

9. del Rio C, Collins LF, Malani P. Long-term health Consequences of COVID-19. JAMA. 2020;324:1723.

10. Raja SN, Carr DB, Cohen M, et al. The revised international association for the study of pain definition of pain: Concepts, challenges, and compromises. Pain. 2020;161:1976−82.

11. Treede RD, Rief W, Barke A, et al. Chronic pain as a symptom or a disease: The IASP classification of chronic pain for the International Classification of Diseases (ICD-11). Pain. 2019;160:19−27.

12. Ashby DR, Caplin B, Corbett RW, et al. Severity of COVID-19 after vaccination among hemodialysis patients. Clin J Am Soc Nephrol. 2022;17:843−50.

13. von Elm E, DG Altman, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. BMJ. 2007;335(7624):806−8.

14. Benchimol EI, Smeeth L, Guttmann A, et al. The reporting of studies conducted using observational routinely collected health data (RECORD) Statement. PLOS Med. 2015;12:e1001885.

15. Ferreira KA, Teixeira MJ, Mendonza TR, Cleeland CS. Validation of brief pain inventory to Brazilian patients with pain. Support Care Cancer. 2011;19:505−11.

16. Garg S, Kim L, Whitaker M, et al. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019 ‒ COVID-NET, 14 States, March 1−30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:458−64.

17. Carr ECJ, Worth A. The use of the telephone interview for research. NT Res. 2001;6:511−24.

18. Abas TE, Mawuntu AHP, Sekeon SAS. Chronic pain in post COVID19 patients. Med Scope J. 2021;3:121−9.

19. Soares FHC, Kubota GT, Fernandes AM, et al. Prevalence and characteristics of new-onset pain in COVID-19 survivours, a controlled study. Eur J Pain. 2021;25:1342−54.

20. Fernandez-de-las-Pe  nas C, Par ~ as-Bravo P, Ferrer-Pargada D,  et al. Sensitization symptoms are associated with psychological and cognitive variables in COVID-19 survivors exhibiting postCOVID pain. Pain Pract. 2023;23:23−31.

21. Fernandez-de-las-Pe  nas C, Palacios-Ce ~ na D, G ~ omez-Mayordomo  V, et al. Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis. Eur J Intern Med. 2021;92:55−70.

22. Bileviciute-Ljungar I, Norrefalk JR, Borg K. Pain burden in postCOVID-19 syndrome following mild COVID-19 infection. J Clin Med. 2022;11:771.

23. Tetik B, Demir G, Kurt O, Derya S. Post-COVID pain frequency and affecting factors. Med Sci Int Med J. 2021;10:1304.

24. Stam H, Stucki G, Bickenbach J. COVID-19 and post intensive care syndrome: A call for action. J Rehabil Med. 2020;52:jrm00044.

25. Halpin SJ, McIvor C, Whyatt G, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. J Med Virol. 2021;93:1013−22.

26. Peghin M, Palese A, Venturini M, et al. Post-COVID-19 symptoms 6 months after acute infection among hospitalized and non-hospitalized patients. Clin Microbiol Infect. 2021;27:1507−13.

27. Malik GR, Wolfe AR, Soriano R, et al. Injury-prone: Peripheral nerve injuries associated with prone positioning for COVID-19- related acute respiratory distress syndrome. Br J Anaesth. 2020;125:e478−80.

28. Dmytriiev D, Dobrovanov O. Post-COVID pain syndrome. Anesth Pain Int Care. 2021;25:505−12.

29. Rousseau AF, Minguet P, Colson C, et al. Post-intensive care syndrome after a critical COVID-19: Cohort study from a Belgian follow-up clinic. Ann Intensive Care. 2021;11:118.

30. Calder PC. Dietary factors and low-grade inflammation in relation to overweight and obesity revisted. Br J Nutr. 2022;127:1455−7.

31. Meyer-Frießem CH, Gierthmuhlen J, Baron R, Sommer C, € U€ceyler N, Enax-Krumova EK. Pain during and after COVID-19 in ¸ Germany and worldwide: A narrative review of current knowledge. PAIN Reports. 2021;6:e893.

32. Puntillo F, Giglio M, Brienza N, et al. Impact of COVID-19 pandemic on chronic pain management: Looking for the best way to deliver care. Best Pract Res Clin Anesthesiol. 2020; 34:529−37.

33. Hastie CE, Foster HME, Jani BD, et al. Chronic pain and COVID19 hospitalisation and mortality: A UK Biobank cohort study. Pain. 2023;164:84−90.


Submitted date:
03/29/2023

Accepted date:
08/01/2023

64efb966a9539566033edd12 rba Articles
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