The impact of COVID-19 stress on pain and fatigue in people with and without a central sensitivity syndrome

Tim Y Koppert,Johannes W.G Jacobs,Mark A Lumley,Rinie Geenen

doi:10.1016/j.jpsychores.2021.110655

Abstract

ObjectivesStress may augment somatic symptoms in central sensitivity syndromes (CSS) such as fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome. To test this hypothesis, we examined whether the association between COVID-19 stress and somatic symptom severity would be stronger in people with than without CSS and whether psychological flexibility would buffer the impact of this stress on symptom severity. MethodsIn a 2-sample, repeated cross-sectional design, we analysed questionnaire data from Dutch people with and without CSS, collected in two independent surveys: before the COVID-19 pandemic (2018; CSS: n = 194, non-CSS: n = 337) and at the peak of the pandemic (2020; CSS: n = 428, non-CSS: n = 1101). Somatic symptom severity, worry and stress due to the pandemic, and psychological flexibility were examined in regression analyses. Two stress operationalisations were analysed: stress levels during the peak of the pandemic, and a comparison of measurements in 2020 and 2018 (assuming higher stress levels in 2020). ResultsHigher worry and stress during the pandemic (standardized β = 0.14), the presence of a CSS (β = 0.40), and lower psychological flexibility (β = −0.33) were all (p < .0001) associated with more severe somatic symptoms, but the associations of each stress operationalisation with somatic symptoms was not particularly strong in people with CSS (β = −0.026, p = .27; β = −0.037, p = .22), and psychological flexibility (β = −0.025, p = .18; β = 0.076, p = .35) did not buffer this association. ConclusionsFindings do not support the hypotheses that COVID-19 stress augments somatic symptoms, particularly in CSS, or that psychological flexibility buffers this impact. Rather, COVID-19-related stress appears to have an uncertain impact on somatic symptoms.

Highlights

Conditions such as fibromyalgia, chronic fatigue syndrome (CFS), and irritable bowel syndrome (IBS) are described with various labels, such as medically unexplained symptoms [1], persistent physical symptoms [2], functional somatic syndromes [3], bodily distress syn dromes [4], and central sensitivity syndromes (CSS) [5]
During the first peak of the COVID-19 pandemic in the Netherlands, people perceived themselves to be, on average, more stressed than normal, and these stress levels were associated with more severe somatic symptoms
Based on another operationalization of stress—comparing the peak period of the pandemic to a previous year—there was no link between stress and more severe somatic symptoms

Summary

Introduction

Conditions such as fibromyalgia, chronic fatigue syndrome (CFS), and irritable bowel syndrome (IBS) are described with various labels, such as medically unexplained symptoms [1], persistent physical symptoms [2], functional somatic syndromes [3], bodily distress syn dromes [4], and central sensitivity syndromes (CSS) [5]. The CSS nosology is based on mutual associ ations among syndromes with overlapping clinical features, and central sensitization as a presumed common pathophysiological mechanism. In this nosology, the term “sensitivity” rather than “sensitization” is used, to emphasize that it is a biopsychological rather than neuropathophysiological phenomenon [5]. Several studies suggest that a sensitive brain may augment pain and other somatic symptoms in response to stress, such as in people with fibromyalgia and widespread pain [6,7], CFS [8] or IBS [9]. The COVID-19 pandemic offers a unique context to study the impact of stress on somatic symptom severity in people with CSS

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