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. 2024 Sep 1;165(9):2002-2010.
doi: 10.1097/j.pain.0000000000003259. Epub 2024 May 7.

Small fibre neuropathy frequently underlies the painful long-COVID syndrome

Pietro Falco  1 , Daniel Litewczuk  1 , Giulia Di Stefano  1 , Eleonora Galosi  1 , Caterina Leone  1 , Gianfranco De Stefano  1 , Giuseppe Di Pietro  1 , Lorenzo Tramontana  1 , Maria Rosa Ciardi  2 , Patrizia Pasculli  2 , Maria Antonella Zingaropoli  2 , Lars Arendt-Nielsen  3   4   5 , Andrea Truini  1
Affiliations

Small fibre neuropathy frequently underlies the painful long-COVID syndrome

Pietro Falco et al. Pain. .

Abstract

Approximately 10% to 20% of individuals with previous SARS-CoV-2 infection may develop long-COVID syndrome, characterized by various physical and mental health issues, including pain. Previous studies suggested an association between small fibre neuropathy and pain in long-COVID cases. In this case-control study, our aim was to identify small fibre neuropathy in patients experiencing painful long-COVID syndrome. Clinical data, quantitative sensory testing, and skin biopsies were collected from 26 selected patients with painful long-COVID syndrome. We also examined 100 individuals with past COVID-19 infection, selecting 33 patients with painless long-COVID syndrome, characterized mainly by symptoms such as brain fog and fatigue, and 30 asymptomatic post-COVID-19 controls. Demographic and clinical variables were compared among these groups. Among the 26 patients with painful long-COVID syndrome, 12 had skin biopsy and/or quantitative sensory testing abnormalities compatible with small fibre neuropathy. Demographic and clinical data did not differ across patients with small fibre neuropathy, patients with painless long-COVID syndrome, and asymptomatic post-COVID-19 controls. This case-control study showed that approximately 50% of patients experiencing painful long-COVID syndrome had small fibre neuropathy. However, in our patient cohort, this specific post-COVID-19 complication was unrelated to demographic and COVID-19 clinical variables. Approximately half of our sample of patients with painful long-COVID symptoms met diagnostic criteria for small fibre neuropathy.

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