Post-COVID-19 Musculoskeletal Pain Often Fulfills Fibromyalgia Criteria

In a new study, fibromyalgia syndrome (FMS) developed in most people surveyed with post-COVID-19 syndrome (PCS), new-onset musculoskeletal (MSK) pain, underscoring the syndrome’s potential as a long-term sequalae of viral infections.¹

“Recent research has identified a notable overlap in the symptoms and pathophysiological mechanisms of PCS and FMS, suggesting that the SARS-CoV-2 virus could play a pivotal role in mediating FMand expanding our understanding of how infections might trigger its development. This emerging evidence points to a substantial occurrence of FMS among those recovering from COVID-19, underlining the need for further investigation into the relationship between infectious diseases and chronic pain syndromes,” lead investigator Omar Khoja, PhD candidate, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and colleagues wrote.¹

Khoja and colleagues analyzed data from 18 patients with MSK pain, 12 female (66.7%), with a mean age of 49.6 years (standard deviation [SD], 11.8). Participants had a mean body mass index of 31.7 (SD, 8.6). Investigators evaluated patients’ pain with the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) and FMS assessment using the American College of Rheumatology (ACR) 2010 criteria (Widespread Pain Index (WPI) ≥ 7 and symptoms severity (SS) score ≥ 5, or WPI between 3 and 6 and SS score ≥ 9; symptoms consistent for at least 3 months; no alternative diagnosis).^1w

MSK pain included myalgia (n = 17; 94.4%) and generalized widespread pain (n = 14; 77.8%); of participants experiencing myalgia, 15 (83.3%) also experienced arthralgia. The investigators found that participants had an average symptom duration of 27.9 (SD 6.97) months post-infection. Out of the assessed participants, 13 (72.2%) met the FMS criteria, with an average WPI score of 8.8 and an average SS score of 8.2, which indicate a high level of pain and a significant impact on quality of life. Five participants (27.8%) did not meet the ACR criteria for FMS, 4 of which were male.¹

“Given these findings, it is critical to consider and screen for FMS in patients presenting with persistent PCS symptoms, particularly chronic pain and fatigue. This understanding not only challenges the current vagueness in validating PCS and FMS but also emphasizes the need for further investment in clinical services and research to investigate the underlying mechanisms through which viral infections could lead to chronic conditions like FMS. The appropriate validation and management of FMS could potentially enhance patients’ understanding of the condition and the outcomes seen in services managing these conditions,” Khoja and colleagues concluded.¹

Diagnosis has often stood as a barrier to care to patients with FMS. Recent research in the field has looked at improving the diagnosis of FMS with the help of artificial intelligence. Investigators from University of Bari "Aldo Moro", Bari, Italy, developed a large language model (LLM) that performed sentiment analysis utilizing prompt engineering which was able to facilitate FMS diagnosis by detecting subtle differences in pain expression.²

The prompt-engineered model had an accuracy of 0.87, precision of 0.92, recall of 0.84, specificity of 0.82 and AUROC of 0.86 for distinguishing fibromyalgia from other chronic pain conditions. In comparison, the ablated approach had an accuracy of 0.76, precision of 0.75, recall of 0.77, specificity of 0.75 and AUROC of 0.76 (McNemar’s test P <.001).²

“... LLM-driven sentiment analysis could be a useful tool to complement clinical assessment in diagnosing complex conditions like FM. Further validation in larger prospective cohorts is warranted. Additionally, optimizing model interpretability and integrating findings with patient-reported outcomes data could help translate these analytics into clinical impact for patients,” the investigators concluded.²

REFERENCES

1. Khoja O, Mulvey M, Astill S, Tan AL, Sivan M. New-Onset Chronic Musculoskeletal Pain Following COVID-19 Infection Fulfils the Fibromyalgia Clinical Syndrome Criteria: A Preliminary Study. Biomedicines. 2024;12(9):1940. Published 2024 Aug 23. doi:10.3390/biomedicines12091940

2. Venerito V, Iannone F. Large language model-driven sentiment analysis for facilitating fibromyalgia diagnosis. RMD Open 2024;10:e004367. doi: 10.1136/rmdopen-2024-004367