Pain Manifestations of COVID-19 and Their Association With Mortality: A Multi-Center Prospective Observational Study

Knox, Nigel; Lee, Chang-Soon; Moon, Jee Youn; Cohen, Steven P.

Objectives To determine the prevalence and breakdown of pain complaints among COVID-19 patients admitted for non-pain symptoms, and the association between the presence of pain and ICU admission and death. Patients and Methods In this multi-center prospective study, data on the intensity and type of pain was collected on 169 patients with active SARS-CoV-2 infection at 2 teaching hospitals in the U.S. and Korea and on 8 patients with acute pain at another large teaching hospital between February 1, 2020 and June 15, 2020. Results Sixty-five (38.5%) of 169 patients reported an active pain condition. The most common pain complaints were headache (n=22, 30.1%), chest pain (n=17, 23.6%), spinal pain (n=18, 24.7%), myalgia (n=13, 18.1%), abdominal or pelvic pain (n=13, 17.8%), arthralgia (n=11, 15.3%), and generalized pain (n=9, 12.5%). Those reporting headache as their main complaint were less likely to require intensive care unit (ICU) admission (P = .003). Acetaminophen or NSAIDs were prescribed to 80.8%, opioids to 17.8%, adjuvants to 8.2% and ketamine to 5.5% of pain patients. When age ≥ 65 years and sex were controlled for in multivariable analysis, the absence of pain was associated with ICU admission (OR 2.92; 95% CI 1.42–6.28; P = .004) and death (OR 3.49; 95% CI 1.40–9.76; P = .01). Conclusions Acute pain is common during active COVID-19, and may affect multiple organ systems. Reasons why pain may be associated with reduced mortality include that an intense systemic stimulus (e.g. respiratory distress) might inhibit pain signals or that the catecholamine surge associated with severe respiratory distress might attenuate nociceptive signaling.