Exacerbation of Pre-Existing Chronic Pain in Older Adults After SARS-CoV-2 Infection: A Single-Center, Cross-Sectional, Observational Study

Abstract

Purpose

To identify the prevalence of exacerbation of pre-existing chronic pain after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and investigate the impact of exacerbated previous chronic pain on quality of life, sleep quality, anxiety and depression levels and risk factors associated with exacerbated chronic pain among elderly coronavirus disease of 2019 (COVID-19) survivors.

Patients and Methods

In this cross-sectional study, elderly COVID-19 survivors with chronic pain residing in Continuing Care Retirement Community (CCRC) were recruited from April 2023 to June 2023. Eligible individuals were divided into exacerbation and non-exacerbation groups based on the patient-reported worsening symptoms of previous chronic pain after SARS-CoV-2 infection. Baseline information, COVID-19 symptoms, laboratory parameters, characteristics of exacerbated chronic pain, quality of life, anxiety and depression levels were systematically collected.

Results

Ninety-five (95/441, 21.5%) older adults suffered from exacerbated chronic pain with a median numerical rating scale (NRS) score of 6 (4–7) on a median duration of 4.9 (4.3–5.6) months after SARS-CoV-2 infection. More participants were not vaccinated against COVID-19 (46.5%, 40/86 vs 26.1%, 86/330, P < 0.001) in exacerbation group. Exacerbation group exhibited poor quality of life (EQ5D index: 0.734 [0.536–0.862] vs 0.837 [0.716–0.942], P < 0.001), more severe anxiety (GAD-7: 2 [0–5] vs 0 [0–3], P < 0.001) and depression (PHQ-9: 4 [2–7] vs 2.5 [0–5], P < 0.001) than non-exacerbation group. Risk factors significantly associated with exacerbation of pre-existing chronic pain were neuropathic pain (aOR 4.81, 95% CI 1.73–13.32, P = 0.003), lymphocyte count (aOR 0.31, 95% CI 0.12–0.78, P = 0.013) and D-dimer levels (aOR 6.46, 95% CI 1.92–21.74, P = 0.003).

Conclusion

Our study observed a prevalence of 21.5% exacerbation of pre-existing chronic pain after SARS-CoV-2 infection, with a consequence of poor quality of life, more severe anxiety and depression. Previous chronic neuropathic pain, lower lymphocyte count and higher D-dimer levels were risk factors associated with the development of exacerbated previous chronic pain.

Keywords:

• post-COVID-19
• older adults
• chronic pain
• exacerbated symptoms

Ethics Approval and Consent to Participate

The study complied with the Declaration of Helsinki and was approved by the Ethics Committee of Sanbo Brain Hospital, Capital Medical University (SBNK-YJ-2023-013-01). Informed consent was obtained from all participants or their legally authorized representatives before enrollment.

Consent for Publication

The authors confirm that all the contents in this article can be published.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by the National Key Research and Development Program of China (2018YFC2000704).