【原】COVID后疼痛综合征（四）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Fiala K, Martens J, Abd-Elsayed A. Post-COVID Pain Syndromes. Curr Pain Headache Rep. 2022 May;26(5):379-383. 本次学习由阎芳副主任医师主讲。

One case study assessing the treatment of refractory headache in the setting of COVID-19 pneumonia found that a patient who had controlled migraines did not respond to their usual effective acute therapy. The study also mentioned that anti-convulsants may offer benefits with the lowest risk of side-effects and medication interactions. This case however was when the patient acutely was affected with the coronavirus. One physician, Dr. Brain Plato, was quoted saying that “for those who have persistent symptoms, probably the thing we are finding to be most effective might be to put them on a course of steroids…” and mentions there being a use of other preventative and as needed medications . Other physicians online mention the potential benefit of breathing exercises. While there are many proposed modalities for the treatment of long-term headaches associated with COVID-19, there are no official guidelines for doctors to follow. It is important for there to be further research into the treatment of headaches that are long-term consequences to COVID-19 to help these patients. 

一项评估新冠肺炎肺炎背景下顽固性头痛治疗的个案研究发现，一些偏头痛的患者在新冠肺炎后，对其头痛常规有效的急性治疗方法变得不再有效了。这项研究还提到，抗惊厥药在控制头痛的同时，可以将药物副作用和药物相互作用风险降到最低。然而，该病例处于新冠肺炎感染急性期。引用一位名叫Brain Plato的医生的话说，“对于那些有持续症状的人，我们发现最有效的方法可能是给他们服用类固醇……”并提到了其他预防性药物和必要的药物。其他医生在网上提到了呼吸练习的潜在益处。虽然有许多新冠肺炎相关长期头痛的治疗方法，但医生没有可遵循的官方指南。对新冠肺炎后长期头痛的治疗进行进一步研究是重要的，以帮助这些患者。

Chest Pain

A major concern in patients who present with long-term pain following infection with SARS-CoV-2 is chest pain, as there is evidence to suggest that persistent cardiac symptoms like chest pain, palpitations, and tachycardia for up to 6 months indicate underlying cardiac sequelae. Previous radiologic investigation of patients who recovered from coronavirus found persistent cardiac abnormalities in 78% of patients and myocardial inflammation in 60% of patients. This investigation also found no association between the incidence of cardiac sequela and severity of acute coronavirus illness. A separate investigation of athletes who recovered from COVID-19 found similar instances of myocardial inflammation in 46% of patients, providing additional evidence for both the risk of long-term cardiac sequela and the independence of cardiac damage from illness severity and overall patient health. While not all instances of post-COVID chest pain may be indicative of underlying cardiac abnormalities, it is important for clinicians to investigate all instances of post-COVID chest pain as it is both a prevalent and potentially concerning finding for patient cardiac health.

胸痛

胸痛是新冠病毒感染后长期疼痛的一个值得关注的疼痛类型，因为有证据表明，持续6个月的持续心脏症状（如胸痛、心悸和心动过速）表明存在潜在的心脏后遗症。此前对冠状病毒康复患者的放射学调查发现，78%的患者存在持续性心肌异常，60%的患者存在心肌炎症。这项调查还发现，心脏后遗症的发生率与急性冠状病毒病的严重程度之间没有关联。针对新冠肺炎康复后运动员进行的另一项调查发现，46%的患者存在类似的心肌炎症情况，本研究也再次证明了发生新冠后长期心脏后遗症的风险，且心脏损害与新冠肺炎严重程度和患者整体健康状况并无关系。虽然并非所有新冠肺炎后胸痛都表明潜在的心脏异常，但临床医生对所有新冠肺炎后胸痛病例进行研究很重要，因为新冠后胸痛很常见且可能影响到患者的心脏健康。

Persistent chest pain is one of the most common long-term symptoms in patients who have recovered from SARS-CoV-2. A clinical follow-up of 130 patients recovering from SARS-CoV-2 found that 13% of patients reported persistent chest pain at least 60 days after initial infection. Additionally, a separate, retrospective study of 274 patients in Nigeria noted similar results, finding that 10% of patients enrolled in the study self-reported symptoms of chest pain following coronavirus infection. There are a variety of proposed mechanisms for post-COVID chest pain, each of which should be investigated by clinicians in patients presenting with correlated symptoms. Chest pain may be secondary to cardiac damage, as previously discussed. The ACE2 receptor, which SARS-CoV-2 displays a high affinity for, is highly expressed in myocardial cells, which offers a possible route of entry for the virus to cause long-term cardiac damage. ACE2 receptors are also highly expressed in type II alveolar epithelial cells, which accounts for the lungs being the primary target of SARS-CoV-2 infection. Underlying pulmonary embolism has also been proposed as a potential mechanism for post-COVID chest pain, particularly when accompanied by shortness of breath in patients. Patients who present with long-term chest pain following coronavirus infection should be thoroughly investigated for pulmonary emboli, as this could present a life-threatening complication in high-risk patients. While post-COVID chest pain can be acutely managed with pain medication, it is critical for clinicians to investigate these patients for pulmonary emboli as well as underlying cardiac conditions such as pericarditis, myocarditis, and other cardiac abnormalities.

持续性胸痛是新冠肺炎康复患者最常见的长期症状之一。对130名新冠肺炎康复患者的临床随访发现，13%的患者在初次感染后60天后报告存在持续胸痛。此外，针对尼日利亚274名患者进行的一项回顾性研究也发现了类似的结果，研究中10%的患者报告了感染冠状病毒后的胸痛症状。新冠后胸痛的机制很多，临床医生应在出现相关症状的患者中针对每一种机制进行研究。如前所述，胸痛可能继发于心脏损害。ACE2受体在心肌细胞中高表达，由于新冠病毒对ACE2具有高亲和力，这为病毒造成长期心脏损伤提供了可能的途径。ACE2受体也在II型肺泡上皮细胞中高表达，这说明肺是新冠病毒感染的主要目标。潜在的肺栓塞也被认为是新冠后胸痛的潜在机制，特别是当患者伴有呼吸短促的症状时。冠状病毒感染后出现长期胸痛的患者应仔细检查以排除肺栓塞，因为这可能会导致高危患者出现危及生命的并发症。尽管新冠肺炎后胸痛可以通过止痛药物进行紧急止痛治疗，但临床医生必须仔细检查以排除这些患者可能存在的肺栓塞以及潜在的心脏疾病，如心包炎、心肌炎和其他心脏异常。

Summary

COVID-19 has taken the world by storm and there is a growing body of literature on how it can acutely manifest in patients. Now that COVID-19 has been affecting patients for approximately 2 years, we are discovering the potential long-term effects possible after contracting the virus. There appears to be an increase in the number of cases of long-term headaches, chest pain, testicular pain, and chronic pain being reported after COVID-19 infection. It has been postulated that secondary to the COVID-19 pandemic, chronic pain may be expected to rise in both the immediate and long-term. Further analysis of the literature should be conducted in the future to continue to analyze the chronic effects of COVID-19.

总结

新冠肺炎席卷全球，关于其急性期症状的文献越来越多。现在，新冠肺炎已经影响患者约2年了，我们正不断发现感染新冠病毒后可能产生的潜在长期影响。新冠肺炎感染后，长期头痛、胸痛、睾丸疼痛和慢性疼痛的病例似乎有所增加。据推测，继新冠肺炎疫情之后，慢性疼痛患者可能会在近期和长期内越来越多。未来应对相关文献进行进一步分析，以继续分析新冠肺炎的慢性影响。