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

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.

 

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.

 

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.

 

Seriously, though. Mayo gonna mayo. This is supposed to be a great clinic. Pathetic.

 

But lucrative

 

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.

 

Next they will say that those who have not recovered suffer from childhood abuse…
And that CBT is necessary.

 

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.