Long COVID is a new disease, with musculoskeletal pain being one of the common presentingsymptoms. This longitudinal study will explore the long COVID musculoskeletal painaetiology, pathophysiology, impact on function and quality of life, prognosis and itsnatural evolution.
Long COVID is defined as signs and symptoms that develop during or after an infection
consistent with COVID-19, continue for more than four weeks and are not explained by an
alternative diagnosis. It has been estimated there are 2 million people in the UK alone
with long COVID symptoms. Most people with long COVID experience some limitation to their
daily activities. This causes new challenges to the patients and their families as well
as to the healthcare system. Musculoskeletal (MSK) pain is one of the most common
reported symptoms in long COVID. The causes and underlying mechanisms of MSK pain in long
COVID are not fully understood yet. A few underlying mechanisms have been hypothesised to
cause the pain including detrimental impacts of the virus on neurological functions and
central nervous system; immunologic aberrations and inflammatory damage in response to
the acute infection; expected sequelae of post-critical illness involving deconditioning
process following a period of inactivity, bed rest or sedentary lifestyle associated with
the viral infection.
The purpose of this study is to investigate the clinical characteristics,
etiopathological mechanisms and the natural course of pain, and to understand its
physical and psychosocial consequences. We will also analyse the correlation of pain to
clusters of long COVID symptoms. We anticipate the results of this study will help the
healthcare providers to deliver adequate management for patients with long COVID.
This is a longitudinal study to observe 100 patients with long COVID pain throughout an
18-month period. Pain assessment will be undertaken using validated methods, that include
blood tests to detect inflammatory biomarkers, clinical examination, standardised pain
instruments/scales, Quantitative Sensory Testing to measure changes in sensitivity, and
electroencephalography to measure brain network activity. Physical activity measurements
include Timed Up and Go Test to assess balance and mobility, Rated Perceived Exertion
Scale to measure exercise intensity, and Hand-Grip Dynamometer test to measure handgrip
strength. In addition, we will use psychological assessment tools to assess the severity
of depression and anxiety, and self-efficacy and pain-related thoughts.
Inclusion Criteria:
1. Individuals who have tested positive for COVID-19 or self-reported symptoms of
COVID-19 confirmed by an independent clinician.
2. New onset musculoskeletal pain that develops during or following an infection
consistent with COVID-19, continues for 4 weeks or more and is not explained by an
alternative diagnosis.
3. Age 18 years or older.
4. Ability of participant to understand and the willingness to sign a written informed
consent document.
5. Stated willingness to comply with all study procedures and availability for the
duration of the study.
6. Ability of participant to read and understand English.
Exclusion Criteria:
1. People with pre-covid chronic pain syndrome.
2. Unable to provide informed consent.
3. Specific exclusion for Electroencephalogram (EEG): Patients with history of
epileptic seizures.
Leeds Teaching Hospitals NHS Trust
Leeds, England, United Kingdom
Leeds Community Healthcare NHS Trust
Leeds, England, United Kingdom
Manoj Sivan, MD
01133922564
m.sivan@leeds.ac.uk
Ai Lyn Tan, FRCP
01133438545
a.l.tan@leeds.ac.uk
Manoj Sivan, MD, Principal Investigator
University of Leeds