Staring Down the Barrel of a Gun: A Potential Pain Pandemic Following COVID-19 Infection.

Journal article


Thacker, M and Mansfield, M (2020). Staring Down the Barrel of a Gun: A Potential Pain Pandemic Following COVID-19 Infection. Pain and Rehabilitation. 2020 (49), pp. 1-8.
AuthorsThacker, M and Mansfield, M
Abstract

In December 2019 several people presented with an acute atypical respiratory disease in Wuhan, China. Soon after, several new cases of infection were reported across mainland China and then spread rapidly across the globe. Following extensive research, it was established that a novel (to humans) coronavirus was responsible, the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2, 2019-nCoV); the virus was named due to its high homology (~80%) to Severe Acute Respiratory Syndrome (SARS-CoV), which caused acute respiratory distress syndrome (ARDS) and high mortality during 2002–2003 (25, 36). The human disease caused by this virus was given the name Coronavirus disease 19 (abbreviated to COVID-19) and eventually a global pandemic was declared by The World Health Organization (WHO). COVID-19 has had, and is still having, a massive impact, being reported in approximately 200 countries and territories and infecting a huge number of people worldwide. As of June 12th 2020, 7.27 million people world-wide have had a confirmed diagnosis of COVID-19, which includes 293 000 confirmed cases and 41 481 deaths in the United Kingdom (UK), with these figures continue continuing to grow.

Coronaviruses have been identified in several non-human mammalian species, including rats, mice, cattle, swine, cats, dogs, rabbits and horses and, notably for this infection, bats. In these species (36), Coronavirus infection often causes devastating respiratory or enteric diseases (25,36). Several coronaviruses have been identified since the mid-1960s. Prior to the SARS-CoV outbreak in the early 2000s, coronaviruses were only thought to cause mild, self-limiting respiratory infections in humans, commonly referred to as “colds”. These viruses are endemic among the human populations, causing 15–30 % of respiratory tract infections each year (25,36). Whilst rare, it is known that these viruses can cause lower respiratory tract infections (25,36).

The majority of people with SARS-CoV-2 virus who become symptomatic, report a typical presentation of fever, dry cough and dyspnoea consistent with the primary viral effects on the respiratory system (24). The developed respiratory symptoms of Covid-19 are extremely heterogeneous, ranging from minimal to significant hypoxia and in severe cases the development of Adult Respiratory Distress Syndrome (ARDS) (26). In addition, there is increasing evidence that other organ systems may be either primarily or subsequently involved, including renal, cardiac, hepatic and the nervous systems (15,21,22,24). Several symptoms associated with COVID-19 including, headache, dizziness, generalized weakness and fatigue as well as vomiting and loss of taste and/or smell have been linked to alterations within the Central Nervous System (CNS) (25). It has been suggested that about 88% among severely affected patients (those requiring respiratory support) display neurologic manifestations including acute cerebrovascular disease and impaired consciousness (23,31,32) and there is now an agreement that the headache reported by around 8% of infected individuals is of neural origin (22,29,36,39).

The exact pathophysiological mechanisms operating outside of the pulmonary system in COVID-19 are currently undetermined but are thought to involve an interplay between the primary actions of the virus and the body’s defensive systems with a particular emphasis on the immune system (15,22,31,38). COVID-19 leads to a fast activation of innate immune cells following viral contact and the magnitude of this response has been shown to be greater in those patients who develop more severe disease/symptoms (15,21,31,38). Indicators of immune facilitation in COVID-19 include an increase in the number of circulating neutrophil and a marked lymphocytopenia that mostly targets all the sub-types (effector, memory and regulatory) of CD4+ T cells (38,40). These changes are consistent with neuro-immune alterations that have been observed following somatic injury/inflammation and associated with nociception (8,17,19,20,35). It is this nervous system-immune system interaction and their potential involvement in the development of clinical pain that caught our attention in the early phase of COVID-19.

Here we outline our hypothesis that those who have been infected with SARS-CoV-2 and developed symptoms may have an increased propensity to develop a clinically significant pain state/s due to the associated neuro-immune interactions. These interactions and the subsequent neuro-inflammation produce a series of neuroplastic responses within the nervous system that are well established as important mechanisms in the generation and maintenance of several clinical pain states (8,17,19,20,35). A full exposition of neuroimmune interactions in both pain and COVID-19 are beyond the scope of this extended editorial so here we briefly highlight several important features of COVID-19 infection that mirror neuroimmune mechanisms associated with the development and maintenance of pain. We aim to demonstrate our concern that we are potentially on the brink of a POST COVID-19 “pain pandemic” as a result of the neuroinvasive potential of the SARS-CoV-2 virus (see also 40 & 41).

KeywordsPain; COVID-19
Year2020
JournalPain and Rehabilitation
Journal citation2020 (49), pp. 1-8
PublisherThe Physiological Pain Association
ISSN2051-0047
Publication dates
Print01 Jul 2020
Publication process dates
Accepted10 Jul 2020
Deposited13 Aug 2020
Accepted author manuscript
License
File Access Level
Open
Permalink -

https://openresearch.lsbu.ac.uk/item/8q462

Download files

  • 345
    total views
  • 39
    total downloads
  • 12
    views this month
  • 2
    downloads this month

Export as

Related outputs

Changes in pain catastrophization and neuropathic pain following operative stabilisation for patellofemoral instability: a prospective cohort with 12-month follow-up
Smith, TO., Choudhury, A., Fletcher, J., Choudary, Z., Mansfield, M., Tennent, D. and Hing, CB (2021). Changes in pain catastrophization and neuropathic pain following operative stabilisation for patellofemoral instability: a prospective cohort with 12-month follow-up. International Orthopaedics. https://doi.org/10.1007/s00264-021-05046-w
A systematic review and meta-analysis of cannabis-based medicines, cannabinoids and endocannabinoid system modulators tested for antinociceptive effects in animal models of injury-related or pathological persistent pain
Soliman, N., Haroutounian, H., Hohmann, A., Krane, E., Liao, J., Macleod, M., Segelcke, D., Sena, C., Thomas, J., Vollert, J., Wever, K., Alaverdyan, H., Barakat, A., Barthlow, T., Harris Bozer, A. L., Davidson, A., Diaz-delCastillo, M., Dolgorukova, A., Ferdousi, M., Healy, C., Hong, S., Hopkins, M., James, A., Leake, H. B., Malewicz, N., Mansfield, M., Mardon, A., Mattimoe, D., McLoone, D. P., Noes-Holt, G., Pogatzki-Zahn, E. M., Power, E., Pradier, B., Romanos-Sirakis, E., Segelcke, A., Vinagre, R., Yanes, J. A., Zhang, J., Zhang, X. J., Finn, D. and Rice, A. S. C. (2021). A systematic review and meta-analysis of cannabis-based medicines, cannabinoids and endocannabinoid system modulators tested for antinociceptive effects in animal models of injury-related or pathological persistent pain. Pain. https://doi.org/10.1097/j.pain.0000000000002269
Identifying consistent biomechanical parameters across rising-to-walk subtasks to inform rehabilitation in practice: A systematic literature review
Jones, GD, Jones, GL, James, DC, Thacker, M and Green, DA (2021). Identifying consistent biomechanical parameters across rising-to-walk subtasks to inform rehabilitation in practice: A systematic literature review. Gait and Posture. 83, pp. 67-82. https://doi.org/10.1016/j.gaitpost.2020.10.001
Cervical spine radiculopathy epidemiology: A systematic review
Mansfield, M., Smith, T., Spahr, Nicolas and Thacker, Mick (2020). Cervical spine radiculopathy epidemiology: A systematic review. Musculoskeletal Care. 18 (4), pp. 555-567. https://doi.org/10.1002/msc.1498
Going solo? Mining the learning gaps in a pandemic
Mansfield, M., Mansfield, A. and Thacker, M. (2020). Going solo? Mining the learning gaps in a pandemic.
Association between psychosocial factors and mental health symptoms to cervical spine pain with or without radiculopathy on health outcomes: systematic review protocol
Mansfield, M., Spahr, N., Smith, T., Stubbs, B., Haig, L. and Thacker, M. (2020). Association between psychosocial factors and mental health symptoms to cervical spine pain with or without radiculopathy on health outcomes: systematic review protocol. PAIN Reports. 6 (1), p. e870. https://doi.org/10.1097/PR9.0000000000000870
Quantitative sensory testing and association with cervical spine radiculopathy disability: Systematic review.
Mansfield, M., Vollert, J. and Thacker, M. (2020). Quantitative sensory testing and association with cervical spine radiculopathy disability: Systematic review. Pain and Rehabilitation. 2021 (50), pp. 33-46(14).
Cervical spine radiculopathy epidemiology
Mansfield, M, Smith, T, Spahr, N and Thacker, M (2020). Cervical spine radiculopathy epidemiology. International Association of the Study of Pain (IASP) 2020 World Congress on Pain. Amsterdam, Netherlands 04 - 08 Aug 2020
Is there an association between metabolic syndrome and rotator cuff related shoulder pain? A systematic review
Burne, G., Mansfield, M., Gaida, J. and Lewis, J. (2019). Is there an association between metabolic syndrome and rotator cuff related shoulder pain? A systematic review. BMJ Open Sport and Exercise Medicine.
Who seeks physiotherapy or exercise treatment for hip and knee osteoarthritis? A cross-sectional analysis of the English Longitudinal Study of Ageing cohort.
Smith, T, Collier, T, Smith, B and Mansfield, M. (2019). Who seeks physiotherapy or exercise treatment for hip and knee osteoarthritis? A cross-sectional analysis of the English Longitudinal Study of Ageing cohort. International Journal of Rheumatic Diseases. 22 (5), pp. 897-904. https://doi.org/10.1111/1756-185X.13480
Uptake of the OMERACT-OARSI Hip and Knee Osteoarthritis Core Outcome Set: review of randomised controlled trials from 1997 to 2017
Smith, T, Mansfield, M., Hawker, G, Hunter, D, March, L, Boers, M, Shea, B, Christensen, R, Guillemin, F, Terwee, C, Williamson, P, Roos, E, Loeser, R, Schnitzer, T, Kloppenburg, M, Neogi, T, Ladel, C, Kalsi, G, Kaiser, U, Buttel, T, Ashford, A, Mobasheri, A, Arden, N, Tennant, A, Hochberg, M, de Wit, M, Tugwell, P and Conaghan, P (2019). Uptake of the OMERACT-OARSI Hip and Knee Osteoarthritis Core Outcome Set: review of randomised controlled trials from 1997 to 2017. Journal of Rheumatology. https://doi.org/10.3899/jrheum.181066
Somatosensory Profiling in Cervical Spine and Radicular Pain
Mansfield, M. and Thacker, M (2019). Somatosensory Profiling in Cervical Spine and Radicular Pain. Physio First Conference 2019. Nottingham, UK 05 - 06 Apr 2019
Is there an association between metabolic syndrome and rotator cuff related shoulder pain?
Burne, G, Mansfield, M., Gaida, J and Lewis, J (2019). Is there an association between metabolic syndrome and rotator cuff related shoulder pain? Physiotherapy UK 2019. NEC, Birmingham, UK 01 - 02 Nov 2019
Parameters that remain consistent independent of pausing before gait-initiation during normal rise-to-walk behaviour delineated by sit-to-walk and sit-to-stand-and-walk.
Jones, GD, James, DC, Thacker, M and Green, DA (2018). Parameters that remain consistent independent of pausing before gait-initiation during normal rise-to-walk behaviour delineated by sit-to-walk and sit-to-stand-and-walk. PLoS ONE. 13 (10). https://doi.org/10.1371/journal.pone.0205346
Factors associated with physical activity participation in adults with chronic cervical spine pain: a systematic review.
Mansfield, M., Thacker, M, Spahr, N and Smith, T (2017). Factors associated with physical activity participation in adults with chronic cervical spine pain: a systematic review. Physiotherapy. 104 (1), pp. 54-60. https://doi.org/10.1016/j.physio.2017.01.004
Physical Activity Participation and The Association With Work Related Upper Quadrant Disorders (WRUQDs). A Systematic Review
Mansfield, M., Thacker, M and Smith, TO (2017). Physical Activity Participation and The Association With Work Related Upper Quadrant Disorders (WRUQDs). A Systematic Review. Musculoskeletal Care. 16 (1), pp. 178-187. https://doi.org/10.1002/msc.1204
Does physical activity change following hip and knee replacement? Matched case-control study evaluating Physical Activity Scale for the Elderly data from the Osteoarthritis Initiative.
Smith, TO, Mansfield, M., Dainty, J, Hilton, G, Mann, CJV and Sackley, CM (2017). Does physical activity change following hip and knee replacement? Matched case-control study evaluating Physical Activity Scale for the Elderly data from the Osteoarthritis Initiative. Physiotherapy. 104 (1), pp. 80-90. https://doi.org/10.1016/j.physio.2017.02.001
Psychosocial Risk Factors and the Association With Carpal Tunnel Syndrome: A Systematic Review
Mansfield, M., Thacker, M and Sandford, F (2017). Psychosocial Risk Factors and the Association With Carpal Tunnel Syndrome: A Systematic Review. Hand. 13 (5). https://doi.org/10.1177/1558944717736398
Effectiveness of acupuncture in the treatment of shoulder pain: A systematic review of published randomised clinical trials
Rubio, A, Mansfield, M. and Lewis, J (2017). Effectiveness of acupuncture in the treatment of shoulder pain: A systematic review of published randomised clinical trials. Physiotherapy UK 2017. Birmingham, UK 10 - 11 Nov 2017
Factors influencing physical activity participation in adults with chronic cervical spine pain
Mansfield, M., Thacker, M, Spahr, N and Smith, TO (2017). Factors influencing physical activity participation in adults with chronic cervical spine pain. Physiotherapy U.K. 2017. Birmingham, UK 10 - 11 Nov 2017
Is there an increased risk of falls and fractures in people with early diagnosed hip and knee osteoarthritis? Data from the Osteoarthritis Initiative.
Smith, TO, Higson, E, Pearson, M and Mansfield, M. (2016). Is there an increased risk of falls and fractures in people with early diagnosed hip and knee osteoarthritis? Data from the Osteoarthritis Initiative. International Journal of Rheumatic Diseases. 21 (6), pp. 1193-1201. https://doi.org/10.1111/1756-185X.12871
Sit-to-walk and sit-to-stand-and-walk task dynamics are maintained during rising at an elevated seat-height independent of lead-limb in healthy individuals
Jones, GD, James, DC, Thacker, M, Jones, EJ and Green, DA (2016). Sit-to-walk and sit-to-stand-and-walk task dynamics are maintained during rising at an elevated seat-height independent of lead-limb in healthy individuals. Gait and Posture. 48 (July), pp. 226 - 229. https://doi.org/10.1016/j.gaitpost.2016.06.005
Sit-to-stand-and-walk from 120% knee height: A novel approach to assess dynamic postural control independent of lead-limb
Jones, GD, James, DC, Thacker, M and Green, DA (2016). Sit-to-stand-and-walk from 120% knee height: A novel approach to assess dynamic postural control independent of lead-limb. Journal of Visualized Experiments. 2016 (114). https://doi.org/10.3791/54323
Distinguishing between nociceptive and neuropathic components in chronic low back pain using behavioural evaluation and sensory examination
Spahr, N, Hodkinson, D, Jolly, K, Williams, S, Howard, M and Thacker, M (2016). Distinguishing between nociceptive and neuropathic components in chronic low back pain using behavioural evaluation and sensory examination. Musculoskeletal Science and Practice. 27, pp. 40-48. https://doi.org/10.1016/j.msksp.2016.12.006