Covid 19 and its consequences, chronic pain in 4% of the most serious patients

Tiredness and breathlessness, but above all pain in the joints, muscles, chest that do not pass even weeks or months after the diagnosis of Covid-19: it is the post-coronavirus syndrome that is estimated to concern, with at least one symptom, up to ‘80% of the infected. The 4% of the most serious patients, who after contracting SARS CoV-2 were hospitalized and needed help with breathing or were even intubated in intensive care, once recovered have to deal with very painful sequelae heavy that remain chronic for months even after the infection resolves. This is at least 3,000 from Campania, in addition to the 200,000 who already suffer from chronic pain, for example from low back pain or arthrosis. The experts gathered on the occasion of the “X Advanced training course on acute and chronic pain, from research to clinical “, organized by the National Cancer Institute Irccs Pascale Foundation of Naples by Mcm Congressi, in digital version from 4 to 6 March. Due to inadequate lifestyles and the average increase in life expectancy, chronic pain strikes more and more and sooner with considerable consequences on the productivity, social relationships and quality of life of those who suffer from it, for example anxiety or depression in 20% of cases and, in an equally considerable percentage, disorders affecting the sexual sphere. Intervening with an all-round approach is the solution, today more than ever: in recent months many patients with chronic pain have remained without adequate therapies due to the Covid-19 emergency and it is therefore essential to return to take charge of them through dedicated multidisciplinary teams .

“Chronic pain is defined as continuous pain, lasting more than three months, associated with significant emotional stress and functional and / or physical disability. It can be independent of other diseases, such as in the case of fibromyalgia, chronic pelvic pain, irritable bowel, or it can be secondary to other pathologies such as tumors, osteoarticular disorders, surgery “, explains Arturo Cuomo (in the photo), director of the complex structure of Anesthesia, resuscitation and analgesic therapy of Pascale and scientific coordinator of the course .. “We are observing that chronic pain can also be a sequela of Covid-19: 4% of the most serious patients, who have been hospitalized and have needed help with breathing or have even been intubated in intensive care, experience chronic pain weeks or months after the infection resolves. These patients are in addition to the many Italians with chronic pain, who now more than ever need adequate management”.

There are about 2 million Italians with chronic pain (between 160,000 and 200,000 from Campania), of which at least half have severe or very severe painful symptoms; however, chronic pain not only causes physical symptoms, but worsens the quality of life with severe psychological impairment, a consistent loss of productivity and difficulties in social relationships and relationships: it is estimated, for example, that one in five patients develops anxiety and / or depression and an equally considerable percentage of sexual disorders. The average age of patients has dropped, also thanks to earlier diagnoses than in the past; the spread of unhealthy lifestyles, such as smoking habits, sedentary lifestyle, incorrect postures and lengthening of the average life span, are also favoring the chronicity of pain.

“Today, with the pandemic, the challenge is twofold “, Marco Cascella, medical director of the same Pascale facility, intervenes. “On the one hand, in fact, we must learn to manage patients who have developed chronic pain as a consequence of the infection, on the other we must resume correctly managing the many patients who, especially in the first months of the pandemic, faced considerable difficulties in accessing care: many centers they remained closed or reduced activity to allow anesthesiologists to increase care in the resuscitation wards, so performance decreased and many patients found themselves in difficulty. Adequate pain management is undoubtedly one of the post-pandemic emergencies we face”.

“To succeed -Cuomo resumes- a multidimensional approach is essential: chronic pain is a biopsychosocial disease in which not only physical symptoms and functional limitations but also mood alterations must be addressed. Taking charge therefore must be multidisciplinary, by a team of experts who can intervene on the complexity of the patient’s needs in a structured and also differentiated path over time. The pandemic – concludes Cuomo – is having a major impact on chronic pain and its management, but it can be an opportunity to be seized: the acceleration of innovation, thanks to the possibilities offered by telemonitoring, tele-assistance, telemedicine and artificial intelligence in general, is an opening to the future that can help manage patients with chronic pain in an even more timely and effective way”.

“The pandemic –says Attilio Bianchi, director general of the National Cancer Institute IRCCS Pascale Foundation– it is teaching us to think about multiple aspects of the welfare dimension that lead us to implement innovative options not all imaginable before this authentic tsunami that hit our welfare services. Occasions like this are welcome when the best intelligence and skills meet to identify and share innovative care processes and care settings. Heartfelt congratulations to Dr. Cuomo and all his splendid team for what they do and will continue to build in the interest of patients “.

“Particular attention from the researchers of our Institute – Professor Gerardo Botti, scientific director of Irccs Pascale, adds– is aimed at chronic pain syndrome, which has come to the fore in this last year as a sequel to the Covid 19 infection. This syndrome is also quite frequent in cancer patients and the spread of the pandemic requires us to pay particular attention to monitoring our patients . Thanks to a multidisciplinary approach that includes a particular specialized competence in the treatment of physical and psychological disorders generated by chronic pain, we can control the aforementioned syndrome with sufficient certainty, with the addition of the indispensable support of the means of health technology, which end up supporting and implement our vocation for translational research “.