Musculoskeletal pain in Post-Covid-19 syndrome: An integrative review
DOI:
https://doi.org/10.21527/2176-7114.2023.47.13880Keywords:
Covid-19, SARS-CoV-2, Musculoskeletal pain, Pain, Referred, ReviewAbstract
Post-Covid-19 Syndrome is characterized by the persistence and/or appearance of new symptoms and abnormalities that persist beyond 12 weeks from the onset of acute Covid-19 and are not attributable to alternative diagnoses. Among the symptoms described in the literature regarding Post-Covid-19 Syndrome, musculoskeletal pain is among the most frequent. The present study aimed to review the literature and identify the form of presentation and predictive factors for musculoskeletal pain in Post-Covid-19 Syndrome. A comprehensive literature search was performed in the following databases: Medline (via PubMed), Embase, PEDro, Lilacs, Scopus, Web of Science and Cinahl from April 22 to June 14, 2022. Of the 2,044 articles found, 16 were included, comprising a total of 13,089 patients. The results showed that myalgia (27.12%, 11 studies), arthralgia (28.88%, 9 studies), arthromyalgia (43.07%, two studies) and musculoskeletal pain (15.3%, one study) were the pain musculoskeletal symptoms disorders present in Post-Covid-19 Syndrome. Female gender was a risk factor for the presence of arthralgia and myalgia in the Post-Covid-19 Syndrome, while age between 40 and 59 years was associated with persistence of arthromyalgia. And high body mass index (BMI) was a predictive factor for the presence of myalgia. The severity of the infection and the need for hospitalization were not predictors for the presence of myalgia and arthralgia in the Post-Covid-19 Syndrome. Future studies with a higher level of evidence and greater methodological rigor are encouraged.
References
Zhou P, Yang X-L, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020 Feb. 3;579(7798):270-273. DOI: 10.1038/s41586-020-2012-7
Hayes LD, Ingram J, Sculthorpe NF. More than 100 persistent symptoms of SARS-CoV-2 (Long COVID): a scoping review. Front Med. 2021 Nov. 1;8(750378). DOI: 10.3389/fmed.2021.750378
National Institute for Health and Care Excellence. Covid-19 rapid guideline: managing the long-term effects of Covid-19 [Internet]. 2022 [cited 2022 Nov. 25]. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33555768/
Shiers S, Ray PR, Wangzhou A, Sankaranarayanan I, Tatsui CE, Rhines LD, et al. ACE2 and SCARF expression in human dorsal root ganglion nociceptors: implications for SARS-CoV-2 virus neurological effects. Pain. 2020 Aug. 18;161(11):2494-501. DOI: 10.1097/j.pain.0000000000002051
Vasic V, Schmidt M. Resilience and vulnerability to pain and inflammation in the hippocampus. Int J Mol Sci. 2017 Mar. 31;18(4):739. DOI: 10.3390/ijms18040739
Blyth FM, Huckel SC. Global burden of pain and global pain policy-creating a purposeful body of evidence. Pain. 2018;159:S43-S48. DOI: 10.1097/j.pain.0000000000001311
Soares FHC, Kubota GT, Fernandes AM, Hojo B, Couras C, Costa BV, et al. Prevalence and characteristics of new‐onset pain in COVID‐19 survivors, a controlled study. EJP. 2021 Apr. 8;25(6):1.342-1.354. DOI: 10.1002/ejp.1755
Karaarslan F, Güneri FD, Kardeş S. Long COVID: rheumatologic/musculoskeletal symptoms in hospitalized Covid-19 survivors at 3 and 6 months. Clin Rheumatol. 2021 Oct. 29;41(1):289-296. DOI: 10.1007/s10067-021-05942-x
Sousa LMMS, Marques-Vieira C, Severino S, Antunes V. A metodologia de revisão integrativa da literatura em enfermagem. Rev Investigação Enferm. 2017;2(21):17.
Huang L, Yao Q, Gu X, Wang Q, Ren L, Wang Y, et al. 1-year outcomes in hospital survivors with Covid-19: a longitudinal cohort study. The Lancet. 2021 Aug. 28;398(10302):747-758. DOI: 10.1016/S0140-6736(21)01755-4
Shoucri SM, Purpura L, DeLaurentis C, Adan MA, Theodore DA, Irace AL, et al. Characterising the long-term clinical outcomes of 1190 hospitalised patients with Covid-19 in New York City: a retrospective case series. BMJ Open. 2021 Jun. 2;11(6):e049488. DOI: 10.1136/bmjopen-2021-049488
Karaarslan F, Güneri FD, Kardeş S. Long COVID: rheumatologic/musculoskeletal symptoms in hospitalized Covid-19 survivors at 3 and 6 months. Clin Rheumatol. 2022 Jan. 41(1):289-296. DOI: 10.1007/s10067-021-05942-x
Asadi-Pooya AA, Akbari A, Emami A, Lotfi M, Rostamihosseinkhani M, Nemati H, et al. Risk factors associated with long COVID syndrome: a retrospective study. Iran J Med Sci. 2021 Nov. 1;46(6):428-436. DOI: 10.1002/jmv.27404
Nehme M, Braillard O, Chappuis F, Courvoisier DS, Guessous I. Prevalence of symptoms more than seven months after diagnosis of symptomatic Covid-19 in an outpatient setting. Ann Intern Med. 2021 Sep. 174(9):1.252-1.260. DOI: 10.7326/M21-0878
Lombardo MDM, Foppiani A, Peretti GM, Mangiavini L, Battezzati A, Bertoli S, et al. Long-term coronavirus disease 2019 complications in inpatients and outpatients: a one-year follow-up cohort study. Open Forum Infect Dis. 2021 Jul. 16;8(8):ofab384. DOI: 10.1093/ofid/ofab384
Zhang X, Wang F, Shen Y, Zhang X, Cen Y, Wang B, et al. Symptoms and health outcomes among survivors of Covid-19 infection 1 year after discharge from hospitals in Wuhan, China. Jama Network Open. 2021 Sep. 4;(9):e2127403. DOI: 10.1001/jamanetworkopen.2021.27403
Sykes DL, Holdsworth L, Jawad N, Gunasekera P, Morice AH, Crooks MG. Post-Covid-19 symptom burden: what is long-covid and how should we manage it? Lung. 2021 Apr.;199(2):113-119. DOI: 10.1007/s00408-021-00423-z
Scherlinger M, Felten R, Gallais F, Nazon C, Chatelus E, Pijnenburg L, et al. Refining “Long-COVID” by a prospective multimodal evaluation of patients with long-term symptoms attributed to SARS-CoV-2 infection. Infect Dis Ther. 2021 Sep.;10(3):1.747-1.763. DOI: 10.1007/s40121-021-00484-w
Zayet S, Zahra H, Royer P-Y, Tipirdamaz C, Mercier J, Gendrin V, et al. Post-Covid-19 syndrome: nine months after SARS-CoV-2 infection in a cohort of 354 patients: data from the first wave of Covid-19 in Nord Franche-Comté Hospital, France. Microorganisms. 2021 Aug. 12;9(8):17.19. DOI: 10.3390/microorganisms9081719
Kayaaslan B, Eser F, Kalem AK, Kaya G, Kaplan B, Kacar D, et al. Post‐Covid syndrome: a single‐center questionnaire study on 1007 participants recovered from COVID‐19. J Med Virol. 2021 Dec.;93(12):6.566-6.574. DOI: 10.1002/jmv.27198
Disser NP, De Micheli AJ, Schonk MM, Konnaris MA, Piacentini NA, Edon DL, et al. Musculoskeletal consequences of Covid-19. J Bone Joint Surg Am. 2020 Jul. 15;102(14):1.197-1.204. DOI: 10.2106/JBJS.20.00847
Buonsenso D, Piazza M, Boner AL, Bellanti JA. Long COVID: a proposed hypothesis-driven model of viral persistence for the pathophysiology of the syndrome. Allergy Asthma Proc. 2022 May. 1;43(3):187-193. DOI: 10.2500/aap.2022.43.220018
Chen X, Zheng F, Qing Y, Ding S, Yang D, Lei C, et al. Epidemiological and clinical features of 291 cases with coronavirus disease 2019 in areas adjacent to Hubei, China: a double-center observational study. MedRxiv; 2020. DOI: 10.1101/2020.03.03.20030353
Zhang X, Cai H, Hu J, Lian J, J Gu, Zhang S, et al. Epidemiological, clinical characteristics of cases of SARS-CoV-2 infection with abnormal imaging findings. Int J Infect Dis. 2020 May.;94:81-87. DOI: 10.1016/j.ijid.2020.03.040
Bai F, Tomasoni D, Falcinella C, Barbanotti D, Castoldi R, Mulè G, et al. Female gender is associated with “long COVID” syndrome: a prospective cohort study. Clin Microbiol Infect. 2022 Apr. 28;(4):611.e9-611.e16. DOI: 10.1016/j.cmi.2021.11.002
Ganesh R, Grach SL, Ghosh AK, Bierle DM, Salonen BR, Collins NM, et al. The female-predominant persistent immune dysregulation of the Post-COVID syndrome. Mayo Clinic Proceedings. 2022 Mar. 1;97(3):454-64. DOI: 10.1016/j.mayocp.2021.11.033
Da Silva NI, Sobrinho HMR, Blanch GT, Cruvinel WM, Gomes CM. Adipocinas e sua relação com a obesidade. RCA. 2019;46(1):1-12. DOI: 10.18224/evs.v46i1.7179
Dennis A, Wamil M, Alberts J, Oben J, Cuthbertson DJ, Wootton D, et al. Multiorgan impairment in low-risk individuals with post-Covid-19 syndrome: a prospective, community-based study. BMJ open. 2021 Mar. 30;11(3):e048391. DOI: 10.1136/bmjopen-2020-048391.30
Zhou F, Tao M, Shang L, Liu Y, Pan G, Jin Y, et al. Assessment of sequelae of Covid-19 nearly 1 year after diagnosis. Front Med. 2021 Nov. 23;8:717194. DOI: 10.3389/fmed.2021.717194
Fernández-de-las-Peñas C, Palacios-Ceña D, Gómez-Mayordomo V, Florencio LL, Cuadrado ML, Plaza-Manzano G, 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 Oct.;92:55-70. DOI: 10.1016/j.ejim.2021.06.009
Bowe B, Xie Y, Al-Aly Z. Acute and postacute sequelae associated with SARS-CoV-2 reinfection. Nat Med. 2022 Nov. 28;2.398-2.405. DOI: 10.1038/s41591-022-02051-3
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Revista Contexto & Saúde
This work is licensed under a Creative Commons Attribution 4.0 International License.
By publishing in Revista Contexto & Saúde, authors agree to the following terms:
The works are licensed under the Creative Commons Atribuição 4.0 Internacional (CC BY 4.0) license, which allows:
Share — to copy and redistribute the material in any medium or format;
Adapt — to remix, transform, and build upon the material for any purpose, including commercial.
These permissions are irrevocable, provided that the following terms are respected:
Attribution — authors must be properly credited, with a link to the license and indication of any changes made.
No additional restrictions — no legal or technological measures may be applied that restrict the use permitted by the license.
Notes:
The license does not apply to elements in the public domain or covered by legal exceptions.
The license does not grant all rights necessary for specific uses (e.g., image rights, privacy, or moral rights).
The journal is not responsible for opinions expressed in the articles, which are the sole responsibility of the authors. The Editor, with the support of the Editorial Board, reserves the right to suggest or request modifications when necessary.
Only original scientific articles presenting research results of interest that have not been published or simultaneously submitted to another journal with the same objective will be accepted.
Mentions of trademarks or specific products are intended solely for identification purposes, without any promotional association by the authors or the journal.
License Agreement (for articles published from September 2025): Authors retain copyright over their article and grant Revista Contexto & Saúde the right of first publication.
