Prevalence and predictors of persistent post-COVID pain: a population-based prospective cohort study with 1.5-year follow-up

Abstract

The global SARS-CoV-2 pandemic has led to a significant portion of COVID-19 survivors experiencing prolonged symptoms, including persistent pain. Although previous research has identified sociodemographic and clinical predictors for post-COVID pain, the impact of psychological factors remains elusive. This study investigated the prevalence, predictors, and characteristics of persistent musculoskeletal pain and headache 1.5 years after SARS-CoV-2 infection, focusing on the impact of psychological distress during acute infection. From an initial pool of 548 cases reported as SARS-CoV-2 positive to local health authorities, 422 individuals (58% female, median age: 52 years) were prospectively examined. Screening during acute infection included assessment of somatic symptoms and psychological distress. At 18 months postinfection, a follow-up evaluated self-reported long-term symptoms. Minimum possible prevalence rates (assuming all non-responders had fully recovered) of patient-attributed post-COVID de novo pain were 5.0% for musculoskeletal pain and 5.5% for headache. De novo musculoskeletal pain commonly affected the lower extremities, shoulders, and neck, whereas de novo headache primarily involved frontoparietal and fronto-orbital regions, with predominantly bilateral distribution. Both acute SARS-CoV-2 symptom severity and psychological factors were associated with spatial distribution of musculoskeletal pain and impact of musculoskeletal pain and headache. Firth regression with exploratory backward elimination identified depressiveness, posttraumatic stress, and average level of psychological distress perceived during the acute infection as potentially relevant predictors for patient-attributed post-COVID pain. This study provides preliminary evidence that psychological distress during acute infection may contribute to persistent patient-attributed post-COVID pain and headache, either as a predictor for its occurrence or by shaping pain perception.

Keywords: Epidemiology; Headache; Musculoskeletal pain; Post-COVID-syndrome; Predictors; Risk factor.