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Zhai X, Wu W, Zeng S, Miao Y. Advance in the mechanism and clinical research of myalgia in long COVID. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL IMMUNOLOGY 2024; 13:142-164. [PMID: 39310121 PMCID: PMC11411160 DOI: 10.62347/txvo6284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 07/18/2024] [Indexed: 09/25/2024]
Abstract
As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to evolve, mortality rates of coronavirus disease 2019 (COVID-19) have significantly decreased. However, a variable proportion of patients exhibit persistent prolonged symptoms of COVID-19 infection (long COVID). This virus primarily attacks respiratory system, but numerous individuals complain persistent skeletal muscle pain or worsening pre-existing muscle pain post COVID-19, which severely affects the quality of life and recovery. Currently, there is limited research on the skeletal muscle pain in long COVID. In this brief review, we review potential pathological mechanisms of skeletal muscle pain in long COVID, and summarize the various auxiliary examinations and treatments for skeletal muscle pain in long COVID. We consider abnormal activation of inflammatory response, myopathy, and neurological damages as pivotal pathological mechanisms of skeletal muscle pain in long COVID. A comprehensive examination is significantly important in order to work out effective treatment plans and relieve skeletal muscle pain. So far, rehabilitation interventions for myalgia in long COVID contain but are not limited to drug, nutraceutical therapy, gut microbiome-targeted therapy, interventional therapy and strength training. Our study provides a potential mechanism reference for clinical researches, highlighting the importance of comprehensive approach and management of skeletal muscle pain in long COVID. The relief of skeletal muscle pain will accelerate rehabilitation process, improve activities of daily living and enhance the quality of life, promoting individuals return to society with profound significance.
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Affiliation(s)
- Xiuyun Zhai
- Department of Rehabilitation, Shanghai General Hospital, Shanghai Jiaotong UniversityNo. 100, Haining Road, Shanghai 200080, China
| | - Weijun Wu
- Department of Rehabilitation, Shanghai General Hospital, Shanghai Jiaotong UniversityNo. 100, Haining Road, Shanghai 200080, China
| | - Siliang Zeng
- Department of Rehabilitation Therapy, School of Health, Shanghai Normal University Tianhua CollegeNo. 1661, North Shengxin Road, Shanghai 201815, China
| | - Yun Miao
- Department of Rehabilitation, Shanghai General Hospital, Shanghai Jiaotong UniversityNo. 100, Haining Road, Shanghai 200080, China
- Department of Rehabilitation, School of International Medical Technology, Shanghai Sanda UniversityNo. 2727, Jinhai Road, Shanghai 201209, China
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Topal İ, Yılmaz O. Effectiveness of Mesotherapy in Post-COVID Pain Syndrome: Retrospective Cohort Study of 96 Patients. Clin Ther 2024; 46:e1-e5. [PMID: 38910071 DOI: 10.1016/j.clinthera.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 04/04/2024] [Accepted: 05/11/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE Musculoskeletal pain may occur after becoming infected with SARS-Cov2. This study was designed to evaluate the efficacy of mesotherapy in treating chronic pain following COVID-19 infection. METHODS A retrospective review was conducted of the records of 96 patients with post-COVID pain syndrome. Those who were eligible for oral therapy or mesotherapy, included in the study. Patients receiving oral treatment with diclofenac potassium, thiocolchicoside and cyanocobalamin were included in one group (n = 46), and patients receiving intradermal mesotherapy with 2% lidocaine + cyanocobalamin were included in another group (n = 50). The results of the Visual Analogue Scale (VAS) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were individually assessed before and one week after the treatment. FINDINGS The participants were 40.2 ± 11.1 years old on average. Of the participants, 35.4% (n = 34) were male and 64.6% (n = 62) were female. Before treatment, there was no statistically significant difference between the patients in terms of VAS and LANSS scores. Following the treatment, a notable positive response was observed in both groups. Nevertheless, when compared to the oral treatment group, the mesotherapy group exhibited a more pronounced enhancement in VAS and LANSS scores (P < 0.001, P < 0.001, respectively). IMPLICATIONS While both mesotherapy and oral therapy offer benefits in reducing pain and alleviating neuropathic symptoms in post-COVID pain syndrome, mesotherapy stands out as an especially effective and well-tolerated treatment method, surpassing the efficacy of the oral alternative.
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Affiliation(s)
- İlknur Topal
- Department of Physical Medicine and Rehabilitation, Istanbul Medipol University, International School of Medicine, Istanbul, Turkey.
| | - Onur Yılmaz
- Çukurova State Hospital, Physical Medicine and Rehabilitation Clinic, Adana, Turkey
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Sánchez-García JC, Rentero Moreno M, Piqueras-Sola B, Cortés-Martín J, Liñán-González A, Mellado-García E, Rodriguez-Blanque R. Physical Therapies in the Treatment of Post-COVID Syndrome: A Systematic Review. Biomedicines 2023; 11:2253. [PMID: 37626749 PMCID: PMC10452406 DOI: 10.3390/biomedicines11082253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION Several days to months after diagnosis of SARS-CoV-2, 35% of patients have persistent symptoms in high incidence. This is referred to as post-COVID-19 Syndrome. There is a pressing need to find a way to help patients with the manifested symptoms. OBJECTIVE To show the different therapies that exist for post-COVID Syndrome and their efficacy. METHODOLOGY A systematic review of the scientific literature was carried out. The data search was carried out in Scopus, PubMed, Cinahl, and Web of Science. Of the 106 articles found, 12 articles were obtained after applying the following eligibility criteria. RESULTS Interventions related to respiratory musculature and moderate intensity exercise both in supervised face-to-face sessions and in supervised home sessions led patients to a significant improvement in the symptoms presented. CONCLUSION Physical therapies significantly reduce fatigue and dyspnea as well as other symptoms related to quality of life.
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Affiliation(s)
- Juan Carlos Sánchez-García
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, School of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (A.L.-G.); (E.M.-G.); (R.R.-B.)
- School of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
| | - María Rentero Moreno
- School of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
| | - Beatriz Piqueras-Sola
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, School of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (A.L.-G.); (E.M.-G.); (R.R.-B.)
- University Hospital Virgen de las Nieves, 18014 Granada, Spain
| | - Jonathan Cortés-Martín
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, School of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (A.L.-G.); (E.M.-G.); (R.R.-B.)
- School of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
| | - Antonio Liñán-González
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, School of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (A.L.-G.); (E.M.-G.); (R.R.-B.)
- School of Nursing, Faculty of Health Sciences, Melilla Campus, University of Granada, 52005 Melilla, Spain
| | - Elena Mellado-García
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, School of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (A.L.-G.); (E.M.-G.); (R.R.-B.)
- Costa del Sol Health District, 29640 Fuengirola, Spain
| | - Raquel Rodriguez-Blanque
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, School of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (A.L.-G.); (E.M.-G.); (R.R.-B.)
- School of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
- University Hospital San Cecilio, 18071 Granada, Spain
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Hamzoian H, Zograbyan V. Trigger Point Injections Versus Medical Management for Acute Myofascial Pain: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e43424. [PMID: 37706133 PMCID: PMC10497070 DOI: 10.7759/cureus.43424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/15/2023] Open
Abstract
Myofascial pain is a common problem resulting in musculoskeletal pain characterized by myofascial trigger points. These trigger points can cause substantial discomfort and functional limitations. This meta-analysis aims to assess the effectiveness and safety of trigger point injections versus medical management alone in treating acute onset myofascial pain. A thorough search was conducted across four databases, namely, PubMed, SCOPUS, Web of Science (WOS), and Cochrane Library, to identify randomized controlled trials that compared the effectiveness of trigger point injections versus medical management for the treatment of acute myofascial pain. The search encompassed articles published from the databases' inception until June 2023. The relevant data were extracted and analyzed using the standardized mean difference (SMD) and 95% confidence interval (CI). Of the 1151 records identified, four met the inclusion criteria for the systematic review, and all were included in the meta-analysis. The analysis of four randomized controlled trials (RCTs) showed that trigger point injections were effective in reducing pain scores compared to medical treatment (SMD = -2.09 (95% CI: -3.34 to -0.85, P = 0.001)). The data revealed a negative standardized mean difference, which was significant and consistent in favor of trigger point injections. Overall, these findings highlight the beneficial impact of trigger point injections in reducing acute myofascial pain when compared to isolated medical management.
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Affiliation(s)
- Haroutiun Hamzoian
- Neurology, Orlando Health / Orlando Regional Medical Center, Orlando, USA
| | - Vahe Zograbyan
- Emergency Medicine, Eisenhower Health, Palm Springs, USA
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Plaut S. “Long COVID-19” and viral “fibromyalgia-ness”: Suggesting a mechanistic role for fascial myofibroblasts (Nineveh, the shadow is in the fascia). Front Med (Lausanne) 2023; 10:952278. [PMID: 37089610 PMCID: PMC10117846 DOI: 10.3389/fmed.2023.952278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 02/27/2023] [Indexed: 04/08/2023] Open
Abstract
The coronavirus pandemic has led to a wave of chronic disease cases; “Long COVID-19” is recognized as a new medical entity and resembles “fibromyalgia” which, likewise, lacks a clear mechanism. Observational studies indicate that up to 30%–40% of convalescent COVID-19 patients develop chronic widespread pain and fatigue and fulfill the 2016 diagnostic criteria for “fibromyalgia.” A recent study suggested a theoretical neuro-biomechanical model (coined “Fascial Armoring”) to help explain the pathogenesis and cellular pathway of fibromyalgia, pointing toward mechanical abnormalities in connective tissue and fascia, driven by contractile myo/fibroblasts and altered extracellular matrix remodeling with downstream corresponding neurophysiological aberrations. This may help explain several of fibromyalgia’s manifestations such as pain, distribution of pain, trigger points/tender spots, hyperalgesia, chronic fatigue, cardiovascular abnormalities, metabolic abnormalities, autonomic abnormalities, small fiber neuropathy, various psychosomatic symptoms, lack of obvious inflammation, and silent imaging investigations. Pro-inflammatory and pro-fibrotic pathways provide input into this mechanism via stimulation of proto/myofibroblasts. In this hypothesis and theory paper the theoretical model of Fascial Armoring is presented to help explain the pathogenesis and manifestations of “long COVID-19” as a disease of immuno-rheumo-psycho-neurology. The model is also used to make testable experimental predictions on investigations and predict risk and relieving factors.
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Lucena-Anton D, Luque-Moreno C, Valencia-Medero J, Garcia-Munoz C, Moral-Munoz JA. Effectiveness of Dry Needling of Myofascial Trigger Points in the Triceps Surae Muscles: Systematic Review. Healthcare (Basel) 2022; 10:healthcare10101862. [PMID: 36292308 PMCID: PMC9602116 DOI: 10.3390/healthcare10101862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
This study aims to analyze the effects of Dry Needling (DN) for the release of myofascial trigger points (MTrPs) in the triceps surae muscles (TSM). A systematic review was performed up to February 2022 in PubMed, PEDro, Scopus, CENTRAL, and Web of Science. Selection criteria were studies involving subjects older than 18 years presenting MTrPs in the TSM, without any concomitant acute or chronic musculoskeletal conditions; DN interventions applied to the MTrPs of the TSM; and results on pain, range of motion (ROM), muscle strength, muscle stiffness, and functional outcomes. The PEDro scale was used to assess the methodological quality of the studies, and the Risk of Bias Tool 2.0 to assess risk of bias. A total of 12 studies were included in the systematic review, involving 426 participants. These results suggest that DN of MTrPs in TSM could have a positive impact on muscle stiffness and functional outcomes. There are inconclusive findings on musculoskeletal pain, ROM, and muscle strength. Significant results were obtained in favor of the control groups on pressure pain thresholds. Despite the benefits obtained on muscle stiffness and functional performance, the evidence for the use of DN of MTrPs in the TSM remains inconclusive.
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Affiliation(s)
- David Lucena-Anton
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
| | - Carlos Luque-Moreno
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
- Correspondence:
| | - Jesus Valencia-Medero
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
| | - Cristina Garcia-Munoz
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
| | - Jose A. Moral-Munoz
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), University of Cadiz, 11009 Cadiz, Spain
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