Pain Intensity and Distribution at Rest and with Movement in COVID-19 Survivors and Matched Controls

ABSTRACT Introduction Persistent symptoms following severe acute respiratory syndrome coronavirus 2 (the virus that causes coronavirus disease 2019 (COVID-19)) infection frequently include pain that interferes with activities of daily living. The primary aim of this study was to assess current and past pain intensity and body distribution in nonhospitalized COVID-19 (COV) survivors and control (CON) participants matched for sex, age, and body mass index (BMI). A secondary aim was to compare endogenous pain inhibition (i.e., conditioned pain modulation (CPM)) in COV and CON participants, including relationships with pre-COVID-19 physical activity (PA) levels (COV only). Methods Participants (42 COV: 30 women, 37.4 ± 16.8 yr old, BMI 24.3 ± 4.0 kg·m −2 ; 42 CON: 30 women, 37.9 ± 16.5 yr old, BMI 23.7 ± 4.4 kg·m −2 ) completed one session that included the following assessments: pain intensity and distribution during COVID-19 (COV only), at rest, and during tests of pulmonary function, lower extremity strength, and submaximal aerobic cycling; CPM measured by pressure pain thresholds at upper trapezius and quadriceps muscles with and without cool water foot submersion; and pre-COVID-19 PA (COV only). Results Average and worst pain were greater in COV than CON, and COV reported more widespread pain ( n = 10 vs n = 2). At the time of testing (7.9 ± 3.6 months post-infection), pain intensity at rest and during functional tasks and CPM were similar between the groups except during pulmonary function testing; COV reported higher peak pain intensity and chest pain that negatively impacted their ability to forcibly exhale. Higher PA pre-COVID-19 was associated with lower pain intensity at the time of testing. Conclusion From a clinical perspective, COV appeared to recover with minimal pain intensity 8 months post-infection and had similar pain distribution at rest to CON, although COV reported greater pain with deep breathing that may impact their ability to participate in therapeutic exercise.