Evaluation of pain, disease activity, anxiety, depression, and neuropathic pain levels after COVID-19 infection in fibromyalgia patients.

BACKGROUND: Psychological stressors may cause mental disorders such as anxiety, depression, and post-traumatic stress disorders and fibromyalgia (FM) patients could be affected by these stressors. AIM: To evaluate pain, disease activity, anxiety, depression, and neuropathic pain levels after COVID-19 infection in patients with FM. METHODS: According to the 2016 American College of Rheumatology (ACR) criteria, fifty-seven patients with FM alone and 77 patients with FM and recovering from COVID-19 infection were recruited to the study (group 1: patients with FM alone and group 2: patients with FM and recovering from COVID-19). Demographic and clinical characteristics were recorded. The pain level was determined by the Numerical Rating Scale (NRS), the pain regions by the Widespread Pain Index (WPI) of the 2016 ACR criteria, the severity of the symptoms by the Symptom Severity Scale (SSS) of the 2016 ACR criteria, the disease activity by the Fibromyalgia Impact Questionnaire (FIQ), the anxiety and depression levels by the Hospital Anxiety and Depression Scale (HADS), and the neuropathic pain level by Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS). RESULTS: Age, height, weight, Body Mass Index (BMI), and the duration of FM diagnosis were similar in both groups (p > 0.05). NRS, FIQ, HADS depression scale, and SSS and LANSS scores were similar between group 1 and group 2 (p > 0.05). HADS anxiety score and WPI were significantly increased in group 2 (p = 0.026 and p = 0.024 respectively). CONCLUSIONS: Anxiety and widespread pain levels were higher in patients with FM and recovering from COVID-19 infection.

Intestinal microbiota, pain, dementia

The review is dedicated the interconnection between neurodegenerative diseases, chronic pain and gut microbiota's structure and function. The gut microbiota's role in gut-brain axis, neuroimmune interaction is considered. The modern data about gut dysbiosis in Alzheimer disease, Parkinson disease, osteoarthrosis, neuropathic pain in COVID infection, muscular-skeletal pain in fibromyalgia, irritable bowel syndrome et cetera are provided. The gut microbiota's modification by means of pre and probiotics in combination with medicines and diet modification can be used for the treatment of chronic pain and dementia.Copyright © T.M. MANEVICH.

Autoimmune Peripheral Neuropathies

Autoimmune peripheral neuropathies (APNs) occur when immunological tolerance to peripheral nerve components (myelin, axon, or ganglionic neurons) is lost. The most common APNs are acute inflammatory polyneuropathies, such as Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), multifocal motor neuropathy (MMN), immunoglobulin M (IgM)–anti–myelin-associated glycoprotein (MAG) antibody–mediated paraproteinemic neuropathy, and those caused by vasculitis or viral infections. Both cellular and humoral factors, either independently or in concert with each other, appear to play a role, but the specific immune mechanisms have not been fully elucidated. Infectious agents, such as Campylobacter jejuni and Zika virus via molecular mimicry, and now COVID-19, are implicated in some GBS subtypes, but the factors that break tolerance in the other APNs remain unknown. In some acute or chronic APN, antibodies against peripheral nerve glycolipids or glycoproteins are pathogenic and well characterized. Pathogenic IgG4 antibodies against antigens at the nodes of Ranvier that cause disadhesion of nodal and paranodal proteins and conduction block define distinct CIDP subtypes, which respond only to rituximab. Some newly emerging, not pathogenic, autoantibodies more commonly seen in small fiber sensory neuropathies and neuropathic pains are briefly discussed. The current immunotherapies in all APNs are described based on controlled trials or clinical experience. © 2023 Elsevier Ltd. All rights reserved.

Advances and challenges in neuropathic pain: a narrative review and future directions.

Over the past few decades, substantial advances have been made in neuropathic pain clinical research. An updated definition and classification have been agreed. Validated questionnaires have improved the detection and assessment of acute and chronic neuropathic pain; and newer neuropathic pain syndromes associated with COVID-19 have been described. The management of neuropathic pain has moved from empirical to evidence-based medicine. However, appropriately targeting current medications and the successful clinical development of drugs acting on new targets remain challenging. Innovative approaches to improving therapeutic strategies are required. These mainly encompass rational combination therapy, drug repurposing, non-pharmacological approaches (such as neurostimulation techniques), and personalised therapeutic management. This narrative review reports historical and current perspectives regarding the definitions, classification, assessment, and management of neuropathic pain and explores potential avenues for future research.

Neurological Symptoms Common in Covid-19 Patients: A Retrospective Observational Study

In December 2019, a novel coronavirus outbreak spread rapidly all over the world. The virus is known to be neuroinvasive, but much is still unknown. In this study, we aimed to pres-ent the main neurologic symptoms in patients who were diagnosed with coronavirus disease 2019 (COVID-19). The study was conducted retrospectively by phoning 156 patients in Turkey diagnosed with COVID-19 through real-time polymerase chain reaction;only 100 patients could be reached. Data about their demographics, initial symptoms, neurological symptoms, and sleeping habits were collected. During the disease process, 66% had at least one neurological symptom, 55% had central nervous system symptoms, 42% had peripheral nervous system symptoms, and 64% had sleep disturbances and myalgia. Impaired consciousness, smell and taste impairments, and sleep disturbances were significantly higher in patients with positive chest computed tomography imaging (p < 0.05). Neurological symptoms were observed in COVID-19, as in other coronaviruses. Headache in particular was the most common symptom in our population. In patients with respiratory system findings, the detec-tion of certain neurological symptoms such as smell-taste impairments, impaired consciousness, and sleep disorders were more common. We concluded that COVID-19 patients should be approached in a more holistic way, taking the nervous system into account.Copyright © 2022, Dr. Mladen Stojanovic University Hospital. All rights reserved.

A rare case of central post-stroke pain in a patient with migraine and lacunar infarcts in the medulla oblongata

Studies about headaches associated with acute ischemic stroke in patients suffering from migraine were limited, and therefore we present a clinical case of central post-stroke pain (CPSP) in a 47-year-old woman with migraine and lacunar infarcts in the medulla oblongata and also possible mechanisms of CPSP in patients with migraine. Magnetic resonance imaging of the brain revealed lacunar infarction in the medulla oblongata on the right (vertebral artery basin) and a single focus of gliosis in the parietal lobe on the right. Magnetic resonance angiography of cerebral vessels showed the fetal type of structure of both posterior cerebral arteries. This clinical case is a complex clinical situation of a combination of secondary headaches (post-stroke) in a patient with a primary headache (migraine), which was successfully treated by the combined administration of first-line drugs for the treatment of neuropathic pain in a patient with lacunar infarcts in the medulla oblongata. The treatment of CPSP is a difficult task due to the insufficiently unexplored mechanisms of development, the most effective approaches are those aimed at reducing the increased excitability of neurons.Copyright © 2023, Indian Association of Biomedical Scientists. All rights reserved.

Post-Covid Neurological Effects Can Be Misguiding In Cases Of The Recovered Patients - A Case Study

In 2019, a new virus-A novel virus, COVID-19, bought disaster across the globe. The people were in great panic, death tolls crossed millions in number. Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. It is a debilitating disease-causing post covid effects too. Many of the cases have not yet recovered from the after effects of the disease. Many of the patients recovered instantaneously without any treatment, whereas many lost their lives. There was a chaos in all the countries across the globe. The patients recovered with the help of proper treatment and were back to their schedule and lifestyle. After, one year from the recovery, few patients started coming up with muscular fatigue, neurological deficits such as tingling in lower limbs, sharp shooting pain travelling throughout the legs. The patient seek treatment for Sciatica or any other nerve suppling the lower limb. The clinical features were misguiding and confused the clinicians. Some diagnosed it as PIVD, few others were confused with compressed and inflamed muscles. The diagnostic tests, including Haematological tests, MRI, CT-Scan, all went in vain.Later, the haematological tests for COVID-19 antibodies and other tests helped in coming up to a conclusion and start with subsequent treatment.This article focuses on the neuropathy and treatment of the same.Copyright © 2022, Anka Publishers. All rights reserved.

Neurological manifestations of COVID-19 infection in acute and late phases: A case-control study

Background & Objective: The late-term neurological effects of COVID-19 are not fully understood yet. Herein, we aimed to determine if COVID-19-related acute and late-term neurological symptoms exist in the patient group that differs from the general population during the pandemic period. Methods: Two hundred fifty patients with a history of COVID-19, whose treatments were completed at least one month before enrollment, were examined together with a control group consisting of 150 individuals that lived in the same socio-cultural environment during the same period. A survey that included questions about possible neurological symptoms that might be related to the COVID-19 infection was completed in both groups. Results: The patient and control groups were mostly similar regarding the neurological symptoms in the pre-pandemic period. The control group did not report any new symptoms except ageusia during the pandemic period. Whereas a number of neurological symptoms such as headache, ageusia and anosmia, difficulty in thinking and planning, forgetfulness, clumsiness of one or both hands, dizziness, unsteadiness, numbness in both hands and feet, and neuropathic pain occurred during the infection. Neurological symptoms, except headache and unsteadiness, prolonged to the late-term with a decreased prevalence. Conclusion: The emergence of new neurological symptoms during the pandemic in those with COVID-19 disease, unlike the control group, suggested that these symptoms are related to the infection itself. © 2023, ASEAN Neurological Association. All rights reserved.

Intractable Neuropathic Pain in COVID-19-Induced Guillain-Barré Syndrome: A Case Report.

There is limited literature specific to neuropathic pain in coronavirus disease 2019 (COVID-19)-induced acute inflammatory demyelinating polyneuropathy (AIDP). We present a unique case of a 20-year-old vaccinated female with a past medical history of chronic hepatitis B virus and untreated anxiety who presented to the emergency department due to an intractable headache and horizontal diplopia in the setting of active COVID-19 infection. During acute hospitalization, the patient was diagnosed with the Miller-Fisher variant of Guillain-Barré syndrome (GBS), a disease with a known association with COVID-19. While in the ICU, the patient developed severe, 10/10-rated, distal, symmetric burning pain with associated allodynia requiring a multimodal regimen with combinations of intravenous narcotics, neuropathic medications, topical agents, and desensitization training to attempt to control her pain. Rehabilitation psychology was consulted while she was in chronic ventilatory rehabilitation for supplementation of behavioral pain management strategies with pharmacological approaches for continued pain. After several months and completion of a comprehensive inpatient rehabilitation program, the patient was weaned off intravenous narcotics and prescribed oral pain medications. This patient had the optimal response to amitriptyline, which likely aided in the co-treatment of psychological manifestations of COVID-19 and prolonged hospitalization. This study highlights the pathogenicity of COVID-19-induced AIDP, its potential severity, and the importance of a multidisciplinary approach to managing it.

Therapeutic role of columbianadin in human disorders: Medicinal importance, biological properties and analytical aspects

Introduction: Herbal medicines have been used for the treatment of human disorders and associated secondary complications since a very early age. Herbal medicines are composed with a variety of medicinal plants and their derived products. Coumarin class phytochemicals have an important role in medicine due to its anti-coagulant, anti-cancer, anti-HIV and anti-inflammatory activity. Herbal medicines have been gaining popularity in the modern system of medicine mainly due to its safety and efficacy. Columbianadin is an active phytochemical of Angelica pubescens and Heracleum candolleanum. Columbianadin have analgesic, anti-inflammatory, calcium-channel blocking properties and platelet aggregation inhibitory potential. Method(s): Present work described the medicinal importance and pharmacological activities of columbianadin in medicine supported by their traditional medicinal application and pharmacological activities. Scientific data of columbianadin has been collected from PubMed, Google Scholar, Google, Scopus, and Science Direct. However, scientific data of columbianadin published in Journals, books and scientific report have also been collected in the present paper. Analytical data of columbianadin have also been described to know the significance of analytical techniques for the isolation, and identification of columbianadin. Result(s): Scientific data of columbianadin signified the biological importance and therapeutic potential of columbianadin in medicine. Scientific data of columbianadin revealed their biological potential against inflammation, neuropathic pain, cancer, hepatic complications, and immune system disorders. However, biological effectiveness of columbianadin on blood-brain barrier permeability, body tissue, channels and platelet has also been discussed in the present work. Moreover, its therapeutic effectiveness against nematodes has been also summarized in this work. Analytical data for the isolation and identification of columbianadin in different samples has also been presented in this work. Discussion(s): Present work signified the biological importance and therapeutic potential of columbianadin in medicine, which could be used for the treatment of human disorders and associated secondary complications.Copyright © 2022 The Author(s)

Top 20 Research Studies of 2021 for Primary Care Physicians

This article summarizes the top 20 research studies of 2021 identified as POEMs (patient-oriented evidence that matters) that did not address the COVID-19 pandemic. Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists prevent adverse cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and also reduce all-cause and cardiovascular mortality. Most older adults (mean age, 75 years) with prediabetes do not progress to diabetes. Among patients in this age group with type 2 diabetes treated with medication, an A1C level of less than 7% is associated with increased risk of hospitalization for hypoglycemia, especially when using a sulfonylurea or insulin. For patients with chronic low back pain, exercise, nonsteroidal anti-inflammatory drugs, duloxetine, and opioids were shown to be more effective than control in achieving a 30% reduction in pain, but self-discontinuation of duloxetine and opioids was common. There is no clinically important difference between muscle relaxants and placebo in the treatment of nonspecific low back pain. In patients with chronic pain, low- to moderate-quality evidence supports exercise, yoga, massage, and mindfulness-based stress reduction. For acute musculoskeletal pain, acetaminophen, 1,000 mg, plus ibuprofen, 400 mg, without an opioid is a good option. Regarding screening for colorectal cancer, trial evidence supports performing fecal immunochemical testing every other year. For chronic constipation, evidence supports polyethylene glycol, senna, fiber supplements, magnesium-based products, and fruit-based products. The following abdominal symptoms carry a greater than 3% risk of cancer or inflammatory bowel disease: dysphagia or change in bowel habits in men;rectal bleeding in women;and abdominal pain, change in bowel habits, or dyspepsia in men and women older than 60 years. For secondary prevention in those with established arteriosclerotic cardiovascular disease, 81 mg of aspirin daily appears to be effective. The Framingham Risk Score and the Pooled Cohort Equations both overestimate the risk of cardiovascular events. Over 12 years, no association between egg consumption and cardiovascular events was demonstrated. Gabapentin, pregabalin, duloxetine, and venlafaxine provide clinically meaningful improvements in chronic neuropathic pain. In patients with moderate to severe depression, initial titration above the minimum starting dose of antidepressants in the first eight weeks of treatment is not more likely to increase response. In adults with iron deficiency anemia, adding vitamin C to oral iron has no effect. In children with pharyngitis, rhinosinusitis, acute bronchitis, or acute otitis media, providing education combined with a take-and-hold antibiotic prescription results in 1 in 4 of those children eventually taking an antibiotic.Copyright © 2022 American Academy of Family Physicians.

Evaluation of the pain in COVID-19 patients with musculoskeletal pain: A cross-sectional study

Aim: There is no study that have assessed face-to-face using the multidimensional pain scale in COVID-19 patients with musculoskeletal pain. This study aimed to reveal the pain region, character and severity in COVID-19 patients with musculoskeletal pain. Material(s) and Method(s): This cross-sectional study was carried out in 214 patients who had a positive result of the polymerase chain reaction test within the last five days and at least one musculoskeletal pain symptom, such as fatigue, myalgia, and arthralgia/polyarthralgia. The cases were divided into groups as clinically severe and non-severe. Evaluations were made on the first day of admission. Myalgia symptoms were classified as diffuse and local. The McGill Pain Questionnaire was used for pain regions and caharacters while the Visual Analog Scale (VAS) was for pain intensity. Result(s): The frequency of involvement was myalgia (96.3%), fatigue (77.6%) and polyarthralgia (62.6%), respectively. The diffuse myalgia was (53.3%) in all patients. The mean myalgia VAS score in the non-severe group was 5.88+/-1.83 and 6.25+/-1.24 in the severe group (p=0.192). The most common pain areas were the back, feet, and knees respectively, and throbbing (40.7%), aching (30.8%), and pricking (26.1%) were the most common characteristics. The suffocating character of the pain was significantly higher in the severe group (p<0.05). Discussion(s): Defining disease-specific pain regions, character and severity in COVID-19 patients with musculoskeletal pain is important in managing possible chronic pain.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Two Cases of COVID-19 With Concomitant Unexplained Dental Pain: Coincidence or Related?

As the rapidly evolving Covid-19 pandemic spread and became a global concern and the study of the disease's features became possible, its signs and symptoms were elucidated in many studies around the world. In addition to other fairly typical symptoms including fever, cough, sore throat, and shortness of breath, the Covid-19 pandemic has several neurological symptoms that have been noted and documented, including headaches, muscle, and joint discomfort, loss of taste and smell, as well as generalized body aches. However, there were a few unusual symptoms that were noted, one of which we will focus on in this report, namely, tooth pain. The Covid-19 virus has caused tooth pain and discomfort in two Lebanese patients. The reported pain is not related to any local aggression; therefore, it is likely a neurological consequence of the viral infection by the SARS-Cov-2 virus.

Pain Management in the Post-COVID Era-An Update: A Narrative Review.

An extensive computer search (from January 2020 to January 2023) was conducted including literature from the PubMed, Scopus, MEDLINE, Web of Science, and EMBASE databases. According to preset criteria, a total of 58 articles were included in this review article. Generally, any patient who becomes infected with COVID-19 can develop post-COVID-19 conditions. The course of COVID-19 is divided into three main stages: acute COVID-19 (up to 4 weeks), post-acute COVID-19 (from 4 to 12 weeks), and post-COVID (from 12 weeks to 6 months). If a more protracted course of COVID (over 6 months) is demonstrated, the term "long-COVID" is used. Although the acute stage of COVID-19 infection most commonly manifests with acute respiratory symptoms, one very common symptom of the disease is pain, while the most common symptoms of post-COVID syndrome are shortness of breath, dry cough, fatigue, loss of olfactory and gustatory function, tightness and chest pain, sleep and mood disturbances, body aches, muscle and joint pain, sore throat, fever, and persistent headaches. All observations demonstrated a high incidence of chronic pain syndromes of various localization in the post- and long-COVID period. Post-COVID chronic pain might include a newly developed chronic pain as a part of post-viral syndrome; worsening of preexisting chronic pain due to the associated changes in the medical services, or a de novo chronic pain in healthy individuals who are not infected with COVID. Chronic pain during and post-COVID-19 pandemic is an important health issue due to the significant impacts of pain on the patients, health care systems, and society as well. Therefore, it is important that patients with chronic pain receive effective treatment according to their specific needs. Accordingly, the main goal of this review article is to provide a broad description about the post-COVID pain and to explore the impact of long COVID-19 on chronic pain patients, and also to give brief reports about the prevalence, risk factors, possible mechanisms, different presentations, and the management tools through a systematic approach.

COVID-19-Related Neuropathic Pain: A Systematic Review and Meta-Analysis.

INTRODUCTION: SARS-CoV-2, responsible for the coronavirus disease (COVID-19) pandemic, may impact other systems apart from the respiratory system, including the nervous system. In this systematic review, we aimed to establish the prevalence and determinants of neuropathic pain amongst COVID-19-infected individuals. METHODOLOGY: A literature search in the PubMed database was performed and 11 papers were eligible for inclusion in this systematic review and meta-analysis. RESULTS: The pooled prevalence of COVID-19-related neuropathic pain was 6.7% (95% CI: 4.7-9.5%) for hospitalised patients during the acute phase and 34.3% (95% CI: 14.3-62%) for long COVID patients. The identified risk factors for COVID-19-related neuropathic pain development included depression, COVID-19 severity and azithromycin use. CONCLUSIONS: Neuropathic pain is a very common symptom in long COVID, indicating the urgency for further research in this direction.

A review of nutrition in neuropathic pain of leprosy.

Leprosy is a neglected tropical disease (NTD) that continues to burden low- and middle-income countries (LMICs), despite being eliminated as a public health concern by the World Health Organization (WHO) in 2000. The causative agents, Mycobacterium leprae and Mycobacterium lepromatosis, affect nearly 200,000 individuals globally each year, with over 19,000 new cases detected in the Americas in 2020 alone. Canada has experienced an increasing incidence of leprosy, due to rising levels of travel and migration from endemic areas, reaching over 37,000 individuals with leprosy by the end of 2020. Patients experience a spectrum of signs and symptoms including hypopigmented cutaneous macules alongside peripheral neuropathy including peripheral neuropathic pain (PNP) and disabling sensory neuropathies. Despite the development of effective and curative therapeutics via multidrug therapy (MDT), many barriers to treatment adherence and effective immunological control of the pathogen challenge the care of patients with leprosy. Socioeconomic barriers, such as disability-related social stigma and often undiagnosed nutritional deficiencies, have resulted in heightened disease severity. PNP therapeutics are associated with significant side effects and remain ineffective as the majority of individuals will not experience a greater than 30% reduction of symptoms. Nutrient supplementation is known to be instrumental in reducing host oxidative stress, strengthening the immune system and mitigating comorbidities. Likewise, dietary lifestyle interventions known to be physiologically beneficial have recently emerged as powerful tools conferring neuroprotective effects, potentially mitigating PNP severity. However, a significant knowledge gap concerning the effect of adequate nutrition on host immunological control of leprosy and PNP severity exists. Further evaluation of this relationship will provide key insight into the pathogenesis of leprosy, strengthening the current body of literature.

COVID-19 infection and pain in adolescents with sickle cell disease: A case series.

Adolescents with sickle cell disease (SCD) have been shown to have pain-related sequelae following COVID-19 infection. In this case series, we discuss five adolescents with SCD and SARS-CoV-2 infection who subsequently developed complex pain circumstances manifested as: (1) increased frequency of acute care visits or admissions for pain; (2) new onset chronic pain; (3) new onset neuropathic pain; (4) escalation in the complexity of pharmacologic therapies; (5) increased use of nonpharmacologic interventions. While more research is needed to fully understand the implications of COVID-19 infection on pain in adolescents with SCD, these cases suggest the presence of a complex relationship.

Pain in critically ill COVID-19 patients: An Italian retrospective study.

We retrospectively analyzed the data from patients admitted to the intensive care unit (ICU) of the Hospital of L'Aquila during the first and second waves of pandemic to identify pain related to COVID-19. Pain was evaluated by using the Numerical Rating Scale, and the assessment for neuropathic disturbances of pain was performed with von Frey's hair and Lindblom tests. Pain increased significantly during hospitalization (from 48% at hospital admission to 94.3% at ICU discharge). Female patients were affected by somatic pain in 32.8% of the cases and by somatic pain and pain with neuropathic features (NFs) in 23.5% of the cases, during the ICU stay. Somatic pain and pain with NFs affected more frequently patients with cardiological and respiratory comorbidities. Patients treated with continuous positive airway pressure via helmet had a higher frequency of somatic pain and pain with neuropathic disturbances (84 and 74%, respectively). The frequency of somatic pain and pain with neuropathic disturbances was lower in patients sedated with propofol combined with ketamine. Females have been associated with a higher risk of somatic pain and pain with NFs. Patients with cardiological and respiratory comorbidities undergoing noninvasive ventilation had higher levels of pain. As conclusion, ketamine may reduce the promotion or the worsening of pain in COVID-19 patients.

Phenotyping Post-COVID Pain as a Nociceptive, Neuropathic, or Nociplastic Pain Condition.

Pain after an acute Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) condition (post-COVID pain) is becoming a new healthcare emergency. Precision medicine refers to an evidence-based method of grouping patients based on their diagnostic/symptom presentation and then tailoring specific treatments accordingly. Evidence suggests that post-COVID pain can be categorized as nociceptive (i.e., pain attributable to the activation of the peripheral receptive terminals of primary afferent neurons in response to noxious chemical, mechanical, or thermal stimuli), neuropathic (i.e., pain associated with a lesion or disease of the somatosensory nervous system and limited to a "neuroanatomically plausible" distribution of the system), nociplastic (i.e., pain arising from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain), or mixed type (when two pain phenotypes co-exist). Each of these pain phenotypes may require a different treatment approach to maximize treatment effectiveness. Accordingly, the ability to classify post-COVID pain patients into one of these phenotypes would likely be critical for producing successful treatment outcomes. The 2021 International Association for the Study of Pain (IASP) clinical criteria and grading system provide a framework for classifying pain within a precision pain medicine approach. Here we present data supporting the possibility of grouping patients with post-COVID pain into pain phenotypes, using the 2021 IASP classification criteria, with a specific focus on nociplastic pain, which is probably the primary mechanism involved in post-COVID pain. Nociplastic pain, which is usually associated with comorbid symptomology (e.g., poor sleep quality, fatigue, cognitive-emotional disturbances, etc.) and is considered to be more difficult to treat than other pain types, may require a more nuanced multimodal treatment approach to achieve better treatment outcomes.