COVID-19 Miniseries Episode 69: Post-Acute COVID-19 and Central Sensitization

Central sensitization (CS) describes pathophysiologic changes in the central nervous system, including alterations in neurochemistry, CNS receptors, endogenous opioid system hyperactivity, cytokine and HPA axis dysregulation, and sympathetic hyperactivity. Collectively, these changes result in amplification of pain and sensory signals, leading to widespread pain, fatigue and other sensory sensitivities. Fibromyalgia and Chronic Fatigue Syndrome are established diagnoses/manifestations of central sensitization. In the era of the COVID-19 pandemic, we continue to learn about Post-Acute COVID-19 Syndrome, a manifestation of central sensitization similar to other post-infectious forms of CS, which underlies the persistent symptoms that many people experience after initial recovery from COVID-19. Elizabeth C. Wight, M.D. joins us to talk about Mayo Clinic’s treatment approach to central sensitization, which is rooted in empowering patients with education and a framework for a self-management program. This includes stress management, moderation, positive thinking, decreasing focus on symptoms, sleep hygiene, and Cognitive Behavioral Therapy among others.

Additional resources:

• Post-COVID Recovery on Mayo Clinic Connect: https://connect.mayoclinic.org/page/post-covid-recovery/

• Mayo Clinic’s “A Systematic Approach to Medically Unexplained Symptoms 2021” course can be found at https://ce.mayo.edu/internal-medicine/content/systematic-approach-medically-unexplained-symptoms-2021#group-tabs-node-course-default1
• Clauw DJ. Fibromyalgia: A clinical review. JAMA. 2014;311(15):1547-1555. doi:1001/jama.2014.3266
• Clauw DJ. Fibromyalgia and related conditions. Mayo Clin Proc. 2015 May;90(5):680-92. https://doi.org/10.1016/j.mayocp.2015.03.014
• Harte, SE, Harris, RE, Clauw, DJ. The neurobiology of central sensitization. J Appl Behav Res. 2018; 23(2): e12137. https://doi.org/10.1111/jabr.12137

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