Neuropathic Pain in Critical Covid-19 illness Survivors: A Narrative Review
Main Article Content
Abstract
Introduction: The COVID-19 pandemic has resulted in a significant number of cases worldwide, leading to a substantial increase in Intensive care unit (ICU) admissions. Survivors of critical illness are known to experience long-term physical, cognitive, and psychological impairments. Chronic pain is also a prevalent complication, and specifically, neuropathic pain (NP) is strongly linked to a diminished quality of life. This narrative review aims to investigate the incidence, causes and manifestations of NP in critical illness COVID survivors.
Methods: A comprehensive search of the Pubmed database was conducted on May 31, 2023, using the keywords "Covid-19" OR "Sars-cov-2" combined with "neuropathic pain" and "critical care" OR "intensive care unit" to identify relevant publications in English or Spanish pertaining to adult human subjects. The search process adhered to the recommended flowchart format outlined in the PRISMA 2020 statement.
Results: The primary search yielded 26 results. Eight results were excluded as they did not pertain to COVID-19 pain.
Discussion: Intensive care survivors can develop new onset pain and chronic pain though various mechanisms. In the case of critical illness COVID-19 survivors, pain may arise due to viral neurotropic potential, immune-mediated reactions, and microvascular complications. Studies have reported new-onset upper extremity NP, with ulnar neuropathy being the most prevalent, followed by brachial plexus, axillary, and median neuropathies. Lower limb NP particularly sciatic neuropathy has also been documented, along with peroneal nerve, meralgia paresthetica, and femoral neuropathy. Cranial neuropathies, such as facial palsy and trigeminal neuralgia, have been observed in case series. Additionally, widespread pain frequently associated with critical illness neuromyopathy may be present. Notably, COVID-19 survivors with critical illness may experience nociplastic pain and conditions related to central sensitization, posing challenges in distinguishing them from those with Long-COVID syndrome.
Conclusion: Further research is crucial to gain a comprehensive understanding of the neurological consequences arising from critical COVID-19 illness. Healthcare professionals should maintain a high suspicion index for NP in this population. Advancing our knowledge of NP in COVID-19 survivors can help develop effective strategies to enhance overall patient outcomes.
Keywords:
Critical Care Outcomes, Critical Illness survivors, COVID-19, Neuropathic Pain, Chronic Pain, Post Intensive Care Unit Syndrome
Article Details
How to Cite
ALIAGA, Jorge et al.
Neuropathic Pain in Critical Covid-19 illness Survivors: A Narrative Review.
Medical Research Archives, [S.l.], v. 11, n. 10, oct. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4316>. Date accessed: 21 nov. 2024.
doi: https://doi.org/10.18103/mra.v11i10.4316.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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4. Kemp HI, Corner E, Colvin LA. Chronic pain after COVID-19: implications for rehabilitation. Br J Anaesth. 2020;125(4):436-440. doi:10.1016/j.bja.2020.05.021
5. Elliott D, Davidson JE, Harvey MA, et al. Exploring the Scope of Post–Intensive Care Syndrome Therapy and Care. Crit Care Med. 2014;42(12):2518-2526. doi:10.1097/CCM.0000000000000525
6. Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders’ conference. Crit Care Med. 2012;40(2):502-509. doi:10.1097/CCM.0b013e318232da75
7. Kemp HI, Laycock H, Costello A, Brett SJ. Chronic pain in critical care survivors: a narrative review. Br J Anaesth. 2019;123(2):e372-e384. doi:10.1016/j.bja.2019.03.025
8. Rousseau AF, Prescott HC, Brett SJ, et al. Long-term outcomes after critical illness: recent insights. Crit Care. 2021;25(1):108. doi:10.1186/s13054-021-03535-3
9. Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host-Virus Interaction, and Proposed Neurotropic Mechanisms. ACS Chem Neurosci. 2020;11(7):995-998. doi:10.1021/acschemneuro.0c00122
10. Terminology | International Association for the Study of Pain. International Association for the Study of Pain (IASP). Accedido el 19 de mayo de 2023. https://www.iasp-pain.org/resources/terminology/.
11. Post COVID-19 condition (Long COVID). World Health Organization (WHO). Accessed March 1, 2023. https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition.
12. Cabrera Martimbianco AL, Pacheco RL, Bagattini ÂM, Riera R. Frequency, signs and symptoms, and criteria adopted for long COVID-19: A systematic review. Int J Clin Pract. 2021;75(10). doi:10.1111/ijcp.14357
13. Novak P, Mukerji SS, Alabsi HS, et al. Multisystem Involvement in Post-Acute Sequelae of Coronavirus Disease 19. Ann Neurol. 2022;91(3):367-379. doi:10.1002/ana.26286
14. Jensen MP, Chodroff MJ, Dworkin RH. The impact of neuropathic pain on health-related quality of life: Review and implications. Neurology. 2007;68(15):1178-1182. doi:10.1212/01.wnl.0000259085.61898.9e
15. Torrance N, Smith BH, Bennett MI, Lee AJ. The Epidemiology of Chronic Pain of Predominantly Neuropathic Origin. Results From a General Population Survey. Journal of Pain. 2006;7(4):281-289. doi:10.1016/j.jpain.2005.11.008
16. Colloca L, Ludman T, Bouhassira D, et al. Neuropathic pain. Nat Rev Dis Primers. 2017;3. doi:10.1038/nrdp.2017.2
17. Attal N, Lanteri-Minet M, Laurent B, Fermanian J, Bouhassira D. The specific disease burden of neuropathic pain: Results of a French nationwide survey. Pain. 2011;152(12):2836-2843. doi:10.1016/j.pain.2011.09.014
18. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. Published online March 29, 2021:n71. doi:10.1136/bmj.n71
19. Mitsikostas DD, Moka E, Orrillo E, et al. Neuropathic Pain in Neurologic Disorders: A Narrative Review. Cureus. Published online February 21, 2022. doi:10.7759/cureus.22419
20. Fernández-de-las-Peñas C, Nijs J, Neblett R, et al. Phenotyping Post-COVID Pain as a Nociceptive, Neuropathic, or Nociplastic Pain Condition. Biomedicines. 2022;10(10). doi:10.3390/biomedicines10102562
21. Miller C, O’Sullivan J, Jeffrey J, Power D. Brachial Plexus Neuropathies during the COVID-19 Pandemic: A Retrospective Case Series of 15 Patients in Critical Care. Phys Ther. 2021;101(1):1-8. doi:10.1093/ptj/pzaa191
22. Ojeda A, Calvo A, Cuñat T, et al. Characteristics and influence on quality of life of new-onset pain in critical COVID-19 survivors. European Journal of Pain (United Kingdom). 2022;26(3):680-694. doi:10.1002/ejp.1897
23. Guerrero M, Castroman P, Quiroga O, et al. Pain Management and COVID-19: A Latin American Perspective. Cureus. 2022;14(3):e23100. doi:10.7759/cureus.23100
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