Decrease in Pain Perception During Acute SARS-CoV-2 Infection

A Case Series

Lisa Hentsch; Patrick Stancu; Gilles Allali; Karl-Olof Lövblad; Johannes A. Lobrinus; Sara Cocetta; Sophie Pautex; Marjolaine Uginet; Jacques Serratrice; Matteo Coen

Disclosures

Pain. 2022;163(6):1019-1022.

Materials and Methods

Clinical information was personally retrieved by the authors, who also examined the patients. Brain MRI was performed when deemed necessary by the referring physician. Autopsy, when conducted, was performed at the request of family members. All 3 patients were hospitalized between October 2020 and January 2021, ie, at the peak of the second wave of the COVID-19 pandemic, at the University Hospitals of Geneva, Switzerland. A summary of all 3 cases can be found in Table 1.

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Table 1. Characteristics of 3 patients with diminished chronic pain associated with a SARS-CoV-2 infection.
Patient no.	Pain characteristics	Comorbidities	Pain score (0–10)*	Onset of pain alteration	Pain score after SARS-CoV-2 infection (0–10)*	Asymptomatic hypoxaemia	Outcome
1	Lumbar nociceptive pain	Neuroendocrine carcinoma of unknown origin metastatic to the bone†. Pathological fracture of D2 with medullary compression	6 (at rest) 8 (with movement)	3 days after a positive COVID-19 test (no COVID-19 symptoms)	0 (at rest) 2 (with movement)	Yes	Death 51 days after a positive SARS-CoV-2 test
2	Thoracic and scapular nociceptive pain	Metastatic thyroid epithelioma (métastasis in the bone‡, pleura, lungs, and liver)	8 (at rest) 9 (with movement)	3 days after the onset of COVID-19 symptoms	0 (at rest) 3 (with movement)	Yes	Death on day 5 of fever onset
3	Anal and rectal nociceptive and neurogenic pain	Tolosa–Hunt syndrome Urothelial bladder carcinoma COPD	6 (at rest)	5 days after the onset of COVID-19 symptoms	1 (at rest)	Yes	Reappearance of pain after 20 days of blunting

*Scale interpretation: high score worse, measured by the Numerical Rating Scale (NRS).
‡Bone metastasis were located in the spine, ribs, and pelvis.
†Bone metastasis were located in the spine.
COPD, chronic obstructive pulmonary disease; D2, dorsal vertebra 2; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.