Central Sensitization Phenotypes in Post Acute Sequelae of SARS-CoV-2 Infection (PASC) 2021

pattismith

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Central Sensitization Phenotypes in Post Acute Sequelae of SARS-CoV-2 Infection (PASC): Defining the Post COVID Syndrome
Dennis M. Bierle, Christopher A Aakre, Stephanie L. Grach
, ...
First Published July 7, 2021 Research Article
https://doi.org/10.1177/21501327211030826

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.
 

Pyrrhus

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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).
Ooh, consensus via the DELPHI process! :rolleyes:

Ooh, an expert panel from the Mayo Clinic! :rolleyes:

Too bad that "central sensitization" is Mayo Clinic language for "psychiatric disorder". :headslap:

What a load of nonsense.
 

Pyrrhus

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Can't central sensitization also be caused by neuroinflammation? I just read a paper that said this.
The problem is that the very concept of "central sensitization" has no scientific basis in the human being.

The term "sensitization" is based on a physiological concept that only refers to the ability of a single neuron or small group of neurons located in a very small area, in laboratory animals, to fire more spontaneously in response to certain stimulation. The term "central sensitization" implies "sensitization" in the brain rather than in peripheral nervous system.

However, term "central sensitization" has nothing to do with the central nervous system of humans.

The confusion started with Yunus's illogical and pseudoscientific publications in the 1980's, which misrepresented the physiological concept that created "central sensitization". His misrepresentation was ignored by most doctors, except for psychiatrists.

The psychiatrists thought that the misrepresentation of "central sensitization" was a more acceptable way of describing psychosomatic mental illnesses, by pretending that they believed the patient. In reality, these psychiatrists used a dishonest misrepresentation of Yunus's own misrepresentation of the physiological concept of "central sensitization" to deceive patients.

Now we are seeing people borrowing ideas from the psychiatrists, and improperly using various different definitions of "central sensitization" to mean various different concepts - concepts that should be explained using scientific terminology, not pseudo-scientific terminology.
 

SWAlexander

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"His misrepresentation was ignored by most doctors, except for psychiatrists."
I agree.
Remember Dr. Arthur Janov "The Primal Scream"? He believed methylated genes can be de-methylated by intense primal therapy.
 

pattismith

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Can't central sensitization also be caused by neuroinflammation? I just read a paper that said this.
yes, you are right.

i dislike when they use the word sensitization though, and I prefer central hyperalgesia .

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
 

ljimbo423

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i dislike when they use the word sensitization though, and I prefer central hyperalgesia
When I hear the term central sensitization used, I interpret it as neuroinflammation. I think they are the same thing, in my view.

This video is Dr. Christopher Sletten. The clinical director of the pain rehabilitation center at the Mayo Clinic in Jacksonville Florida.

He explains how illness, injury, disease, etc. cause peripheral stimuli that cause central sensitization. At 7:15 he says "from what I've drawn so far on the board, how much of this is psychological"? Then he says "the answer is NONE".

 

Pyrrhus

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i dislike when they use the word sensitization though, and I prefer central hyperalgesia .
Me too. :)
"Central hyperalgesia" is a scientific term.
"Central sensitization" is pseudo-scientific nonsense.

When I hear the term central sensitization used, I interpret it as neuroinflammation. I think they are the same thing, in my view.
Except they aren't.
"Microglial sensitization" is a scientific concept.
"Central sensitization" is pseudo-scientific nonsense.
 

ljimbo423

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The other is pseudo-scientific nonsense.
Not the way I interpret it.:)

I'm not a scientist, so I do what's right for me. The authors are free to call it central sensitization (even if they're using the wrong term) and I'm free to interpret it as neuroinflammation.

I can't change the world and I'm not going to try. It takes way to much time and effort.:eek::eek:
 

pattismith

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Not the way I interpret it.:)

I'm not a scientist, so I do what's right for me. The authors are free to call it central sensitization (even if they're using the wrong term) and I'm free to interpret it as neuroinflammation.

I can't change the world and I'm not going to try. It takes way to much time and effort.:eek::eek:
we are happy to rely on people bigger than us to do the job, thank you @Pyrrhus :thumbsup:
 

Pyrrhus

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I'm not a scientist, so I do what's right for me. The authors are free to call it central sensitization (even if they're using the wrong term) and I'm free to interpret it as neuroinflammation.
Vive la différence!

My father, who studied the evolution of language, often reminded me that if enough people use a term incorrectly, it then becomes the correct term whether you like it or not. :)
 

ljimbo423

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My father, who studied the evolution of language, often reminded me that if enough people use a term incorrectly, it then becomes the correct term whether you like it or not.
Sometimes that's true.

I guess the point I was trying to make is I find some of these papers about "central sensitization" helpful, even though they are using the wrong terminology.
 
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ljimbo423

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My father, who studied the evolution of language, often reminded me that if enough people use a term incorrectly, it then becomes the correct term whether you like it or not.
I just want to be clear in what I'm saying. I'm not saying central sensitization IS the same as microglial sensitization or neuroinflammation. I know it's not.

I'm saying, I "choose" to look at central sensitization as neuroinflammation in papers like this one. It helps me to learn something from the paper, without discarding it completely because they are using the term central sensitization, instead of neuroinflammation or microglial sensitization.

Does this makes sense, or am I digging a deeper hole?
 
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Pyrrhus

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I'm saying, I "choose" to look at central sensitization as neuroinflammation in papers like this one. It helps me to learn something from the paper, without discarding it completely because they are using the term central sensitization, instead of neuroinflammation or microglial sensitization.

Does this makes sense, or am I digging a deeper hole?
It makes perfect sense. Language is only a tool that we use to communicate and understand things.

If a particular use of language helps you to communicate an idea, or helps you to understand something, then it has done its job. :thumbsup:
 

pattismith

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I just want to be clear in what I'm saying. I'm not saying central sensitization IS the same as microglial sensitization or neuroinflammation. I know it's not.

I'm saying, I "choose" to look at central sensitization as neuroinflammation in papers like this one. It helps me to learn something from the paper, without discarding it completely because they are using the term central sensitization, instead of neuroinflammation or microglial sensitization.

Does this makes sense, or am I digging a deeper hole?
It makes sense to me, even though I have a scientific background, and even though I understand @Pyrrhus own fight. :thumbsup:
I choose to read Central Hyperalgesia each time I think the paper has something to teach me,
 

SWAlexander

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I just want to be clear in what I'm saying. I'm not saying central sensitization IS the same as microglial sensitization or neuroinflammation. I know it's not.

I'm saying, I "choose" to look at central sensitization as neuroinflammation in papers like this one. It helps me to learn something from the paper, without discarding it completely because they are using the term central sensitization, instead of neuroinflammation or microglial sensitization.

Does this makes sense, or am I digging a deeper hole?
"or am I digging a deeper hole?"
Isn't this the way we learn? digging digging digging.
However not understanding the correct meaning behind the word could lead to often bad outcomes.
Example:
The difference between Neuroinflammation and Central sensitization lays also in the treatment.
Neuroinflammation treatment.
Neuroinflammation control with varying combinations of low-dose corticosteroids, anti-inflammatories, microglial suppressors, and nutritional supplements. Spinal fluid flow exercises including walking arm swings, upper body gyration, and deep breathing.
Central sensitization treatment often used drugs to treat central sensitization include: acetaminophen (paracetamol) - primarily acts centrally reinforcing descending inhibitory pathways. serotonin- and norepinephrine-reuptake inhibitors - activate noradrenergic descending pathways together with serotonergic pathways.
This has happened to me after my move from the US to Germany.
In the US, I sold my house and my animals (psych-stress), packed half of my belongings for shipment (physical stress) on top of worsening neuroinflammation and muscle weakness (Myalgia Diagnose).
2 months after arriving in Germany I went to a neurologist asking for 20mg prednisone and presented the previous diagnosis Myalgia. He sent me to a psychiatrist. The psychiatrist prescribed meds to race dopamine and norepinephrine. Being on the end of my robe, not function well, because of nearly unbearable pain and unfamiliar with German meds, I did not question their reasoning. On the third day of taking the meds, I started shaking like a person with Parkinson’s. Both doctors misunderstand the difference.
 
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Pyrrhus

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The difference between Neuroinflammation and Central sensitization lays also in the treatment.
Nice point.

While these practitioners used to say that the patient needed to simply un-learn their incorrect beliefs by, say, Graded Exercise Therapy, they now say that the patient needs to simply un-sensitize their incorrectly-sensitized nervous pathways by, say, Graded Exposure Therapy.

My sister-in-law was an in-patient in one of these non-psychiatric clinics (that happened to be run by the hospital's psychiatric faculty) in order to treat her chronic trigeminal pain.

They didn't look at her trigeminal nerve function or consider any biomedical causes of trigeminal pain. They simply told her to gradually get used to sucking on an ice-cube, which was one of the worst triggers of her trigeminal pain - in order to gradually "un-sensitize her incorrectly-sensitized trigeminal nerve."

Obviously, the Graded Exposure Therapy didn't work. But later, when she tried a biomedical treatment, her trigeminal pain seemed to clear right up.