Central Sensitization Phenotypes in Post Acute Sequelae of SARS-CoV-2 Infection (PASC): Defining the Post COVID Syndrome, 2021, Bierle et al

Andy

Andy

Retired committee member
Abstract

Objective
To develop and implement criteria for description of post COVID syndrome based on analysis of patients presenting for evaluation at Mayo Clinic Rochester between November 2019 and August 2020.

Methods
A total of 465 patients with a history of testing positive for COVID-19 were identified and their medical records reviewed. After a thorough review, utilizing the DELPHI methods by an expert panel, 42 (9%) cases were identified with persistent central sensitization (CS) symptoms persisting after the resolution of acute COVID-19, herein referred to as Post COVID syndrome (PoCoS). In this report we describe the baseline characteristics of these PoCoS patients.

Results
Among these 42 PoCoS patients, the mean age was 46.2 years (median age was 46.5 years). Pain (90%), fatigue (74%), dyspnea (43%), and orthostatic intolerance (38%) were the most common symptoms. The characteristics of an initial 14 patients were utilized for the development of clinical criteria via a modified Delphi Method by a panel of experts in central sensitization disorders. These criteria were subsequently applied in the identification of 28 additional cases of suspected PoCoS. A 2-reviewer system was used to analyze agreement with using the criteria, with all 28 cases determined to be either probable or possible cases by the reviewers. Inter-reviewer agreement using these proposed defining criteria was high with a Cohen’s alpha of .88.

Conclusions
Here we present what we believe to be the first definitional criteria for Post COVID syndrome. These may be useful in clinical phenotyping of these patients for targeted treatment and future research.

Open access, https://journals.sagepub.com/doi/10.1177/21501327211030826
 
It's funny how patients are never included as part of the Delphi method review group.

No long-covid patients want this to be called "Post COVID Syndrome".

One key problem with their criteria is that it poorly discriminates between individuals who have pulmonary damage and those who have other typical post-viral symptoms.

For all the talk of "central sensitization", they didn't actually provide any evidence, nor serious hypotheses as to the presence of such phenomena, nor why it could be triggered by a viral infection.
 
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We define certain symptoms as ‘persistent central sensitization (CS) symptoms’ without any objective evidence or verifiable theoretical justification, then look for those specific symptoms and conclude because we found them Long Covid is a unitary condition involving central sensitisation.

Don’t you just love circular logic? I propose that nasty demons jumping up and down inside people’s brains is the cause of horrid headache syndrome.

In our hypothetical ‘horrid headache’ clinic we see only people with horrid headaches, which proves horrid headache syndrome and the causal nasty demons exist. Does it matter that we ignore the distinctions between acute viral infections, migraine, brain tumour or raised intra cranial pressure? Our preferred treatment is to give people lots of cod liver oil, internally and externally, which makes them very slippy resulting the demons falling over when they try to jump up and down.
 
Andy said:
Here we present what we believe to be the first definitional criteria for Post COVID syndrome. These may be useful in clinical phenotyping of these patients for targeted treatment and future research.
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Uhhh... well I guess this answers the question of "how delusional are people pushing this stuff?" and it's all of it. The first? Holy narcissism Batman, can't even check for yourself before making such a ridiculous assertion?

And as always, mislabeling something then looking back at the things you mislabeled and finding they were mislabeled this way only means you don't know what you're doing. The modern concepts of psychosomatics were built on chronically ill people and so of course when they look at chronically ill people with their magical lenses they see the invalid concept they wrongly applied.

Clearly there is no process in medicine to address self-serving circlejerking. It just passes through unhindered by thought or reason. This is exactly like the proces of defining "demonic possession" on epileptic seizures then "positively identifying demonic possession" by this definition. There's absolutely nothing smart or ethical about this.
 
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Andy said:
patients with a history of testing positive for COVID-19 were identified and their medical records reviewed. After a thorough review, utilizing the DELPHI methods by an expert panel, 42 (9%) cases were identified with persistent central sensitization (CS) symptoms persisting
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Interesting that they didn’t talk to any of the patients or collect data systematically. Instead, they reviewed their medical records and decided if, in their opinion, the patients symptoms supported the researchers’ opinions of the illness.
I believe a similar approach was used in assessing the Royal Free outbreak.
 
Abstract said:
were identified with persistent central sensitization (CS) symptoms persisting after the resolution of acute COVID-19, herein referred to as Post COVID syndrome (PoCoS)
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:rofl:
Oh, that's the best name yet. First you get Covid-19, with or without a history of prior emotional trauma, and then you get a bit concerned about not recovering immediately, or the lure of wall-to-wall Netflix gets too strong, and then..... Hocus Pocos.... by magic.... you have PoCoS.
 
It's basically an advertisement wrapped around baseless speculation:
The Mayo Clinic General Internal Medicine (GIM) division offers evaluation and treatment programs for individuals experiencing central sensitization, including those of post-infectious etiologies. Patients may directly request or be referred for evaluation at Mayo Clinic in Rochester for these concerns. Patient-reported symptoms are collected prior to appointment scheduling to facilitate consolidated appointment itineraries. Not surprisingly, GIM has seen an increase in requests for consultation from patients with unexplained symptoms following acute infection with COVID-19.
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This is the basis of deciding that PoCoS is a central sensitisation syndrome:
The phenomenon of patients developing persistent symptoms after infectious illnesses is well-established. Prolonged post-infectious syndromes have been reported following infections by highly inflammatory agents such as Epstein-Barr virus, West Nile virus, Zika, Chikununga, Severe Acute Respiratory Syndrome (SARS), and Borrelia spp. These syndromes may involve persistent fatigue, unrefreshing sleep, nausea, headaches, and cognitive dysfunction, among other symptoms that may differ from the presentation of the original acute illness.10-21 These symptoms persist far beyond 6 months in many cases, and patients eventually meet criteria for chronic fatigue syndrome (CFS) or another central sensitization syndrome (CSS), wherein perception of severity of sensory stimuli are enhanced. One consistent finding noted on neuroimaging in this patient population is persistent central nervous system (CNS) inflammation, particularly of the thalamus and midbrain.22,23 Laboratory abnormalities include increased proinflammatory cytokines such as TNF-α and IL-6, suppressed ACTH, and T cell dysregulation.14,20,24-30 Based upon our current knowledge, SARS-CoV-2 appears to be highly immunogenic, and indeed the putative mechanisms of many of the cardiovascular and pulmonary complications have also been determined to be immune-mediated.31 It therefore stands to reason that SARS-CoV-2 has the potential to incite a significant post-viral syndrome with central sensitization, which we refer to as Post COVID syndrome (PoCoS), which is one of the clinical phenotypes seen in PASC.
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They are saying no more than: other infectious diseases produce prolonged post-infectious syndromes, and PoCos looks like those. And we eventually label patients with those prolonged post-infectious syndromes with a central sensitisation syndrome. 'SARS-CoV-2 seems to be highly immunogenic', so it stands to reason that it can produce a central sensitisation syndrome .... And we treat it with 'graded rehabilitation'.
 
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These syndromes may involve persistent fatigue, unrefreshing sleep, nausea, headaches, and cognitive dysfunction, among other symptoms that may differ from the presentation of the original acute illness
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The use of those words, "may", "could", "can" leads to very silly stuff. Of course those are all symptoms of the acute illness, but they would only know that by checking. Of course not everyone has those symptoms, but they "may" do, which is their own standard for raising a correlation, which they try to argue as a difference here.

The thing about paying attention is that you have to pay attention to the things that matter, not just the things you think should matter. There is very little of that whenever medicine looks at chronic illness and there is exactly none of that here. The circular logic here is appalling. They can actually look at confirming evidence and conclude it does the opposite. Which is fitting for people who flip reality in their heads.
 
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