Preprint Peak alpha frequency is associated with pain severity in Long COVID patients with new-onset chronic pain, 2026, Silva-Passadouro+

[SNT Gatchaman]

Peak alpha frequency is associated with pain severity in Long COVID patients with new-onset chronic pain

Spoiler: Authors

Bárbara Silva-Passadouro; Omar Khoja; Alexander J Casson; Ioannis Delis; Christopher Brown; Manoj Sivan

New-onset chronic pain is a common and debilitating symptom of Long COVID (LC) that remains not fully understood in terms of pathophysiology and therapeutic targets. A growing body of evidence in chronic pain syndromes similar to LC demonstrates an association between EEG alpha oscillatory activity and the experience of pain, with clinical studies showing maladaptive changes in oscillatory activity, particularly a slowing of alpha activity. This study aims to investigate the association between EEG alpha oscillatory activity and pain perception in new-onset LC-chronic pain.

We recruited 31 individuals (20 females) with a clinical diagnosis of LC reporting new-onset chronic pain and 31 healthy pain-free age- and sex-matched controls. Participants completed questionnaires regarding symptoms and psychological functioning prior to recording eyes-open resting-state EEG. Peak alpha frequency (PAF) and spectral power within the alpha band (8-13 Hz) were extracted from EEG signals.

Lower PAF over the posterior scalp region was significantly associated with higher LC-chronic pain severity when controlling for age and depression. This observation was consistent across PAF estimation methods. PAF was significantly increased, particularly in the posterior region, in the moderate pain LC subgroup compared to both severe pain subgroup and controls, while alpha power did not differ between the three groups and was not associated with pain severity.

Our findings highlight associations between PAF and pain symptoms in a new post-infection chronic pain syndrome. PAF can thus be explored as a potential biomarker and therapeutic target for EEG-based neuromodulation interventions in LC-chronic pain. These results may have implications for other similar chronic pain syndromes.


Web | DOI | PDF | Preprint: MedRxiv | Open Access

 

[SNT Gatchaman]

Noting that the senior author is Manoj Sivan, who this week replied in response to Jo, Michelle and Joan's An Open Letter to BACME re ME/CFS Guide to Therapy. See link, link and link.

This paper concludes with —

Overall, our findings, while early, suggest non-invasive targeted neuromodulation could be explored as a potential therapeutic avenue for new-onset LC chronic pain. Tailored neuromodulation strategies show promise within an integrated multidisciplinary management framework for LC-chronic pain, and could be relevant to other similar post-infectious syndromes manifesting with chronic pain symptomology.

 

[SNT Gatchaman]

BMI, mean (SD)

Long COVID patient group (n = 31)
31.4 (9.5) (missing: 6)

Healthy pain-free control group (n = 31)
24.4 (4.0) (missing: 1)

I didn't see this discussed in limitations or elsewhere, but it looks like EEG alpha waves can be affected by BMI, at least in terms of amplitude. Eg Resting state cortical electroencephalographic rhythms in subjects with normal and abnormal body weight (2011) —

As original results of the present study, parietal and temporal low-frequency alpha sources (8–10.5 Hz) fitted the pattern underweight > normal-weight > overweight/obese, whereas the occipital low-frequency alpha sources fitted the pattern normal-weight > underweight > overweight/obese. Furthermore, the amplitude of the parietal, occipital and temporal high-frequency alpha (10.5–13 Hz) sources was stronger in the normal-weight subjects than in the underweight and overweight/obese subjects. Noteworthy, here the subdivision among underweight, normal-weight and overweight/obese subjects were merely based on BMI value, with no evidence in favor of psychiatric correlates. Indeed, none of the enrolled subjects had a current psychiatric disorder as evaluated by DSM-IV-R and SCID I and II.

Noted in limitations is —

eyes-open resting-state EEG was selected to reduce drowsiness and maintain attention, which is particularly important in the LC population where fatigue and sleep disturbances may influence alertness. While this approach is methodologically valid, it should be noted that alpha power is typically higher in the eyes-closed condition and PAF shifts can occur, limiting direct comparison with eyes-closed resting-state EEG studies.

 

[Sean]

Tailored neuromodulation strategies show promise within an integrated multidisciplinary management framework​

And always will.