Background/Purpose: SARS-CoV-2 infection has been increasingly recognized for its potential neurological manifestations. Fibromyalgia (FM) patients, who already experience neuropathic pain, may be particularly vulnerable to the impact of COVID-19 on their symptoms.

This study aims to investigate the specific influence of SARS-CoV-2 infection on the neuropathic component of pain in Fibromyalgia patients, shedding light on potential interactions between COVID-19 and FM.

Methods: We conducted a prospective cohort study enrolling FM patients who met the ACR 2016. The cohort was divided into two groups: patients who tested positive for SARS-CoV-2 infection and a matched cohort of uninfected FM patients. Neuropathic pain was assessed using the PainDetect Questionnaire (PDQ) at baseline (t0) and after six months (t1). Prevalence, incidence, and worsening of neuropathic pain were evaluated in both groups. Patients were considered to have neuropathic pain if the PDQ score was > 20, and data were analyzed by Chi-Square and paired T student test as appropriate

Results: We conducted a cohort study involving 58 FM patients (median age: 47 years; 2 males, 56 females). All patients were receiving treatment with SNRI antidepressants and Pregabalin, except for one patient who solely underwent physical therapy. At baseline, there were no significant differences in clinical or demographic characteristics between the infected and uninfected groups (table 1).

As assessed by PDQ, the prevalence of neuropathic pain did not differ significantly between the two groups at baseline (36.21% vs 27.59%, p=0.17). However, patients who experienced SARS-CoV-2 infection had a significantly higher incidence of neuropathic pain at the six-month follow-up compared to the uninfected controls (46.55% vs. 31.03%, p=0.004, Relative Risk 5.5, 95% CI [1.5;21.1]).

When analyzing the sequential changes in PDQ scores, we found no statistically significant alteration in neuropathic pain severity over the six-month observation period among the uninfected group (t0 PDQ mean 20,1 (SD 6.7) vs. t1 20.72 (SD 7.4), p =0.37). Conversely, the infected group demonstrated a significant worsening of neuropathic pain at six months post-infection, as indicated by higher mean PDQ scores (t0 21.1 (SD 5.8) vs. t1 26.9 (SD 5.3) p < 0.0005).

Conclusion: This study indicates a potential link between infections and chronic pain in FM patients, as evidenced by the associations observed between SARS-CoV-2 infection and increased incidence and worsening of neuropathic pain. Further research is required to confirm these findings and explore potential interventions for FM patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/associations-between-sars-cov-2-infection-and-neuropathic-pain-in-fibromyalgia-patients-a-cohort-study/