Introduction: Post-COVID-19 fatigue is common after recovery from COVID-19. Excess formation of reactive oxygen species (ROS) leading to oxidative stress-related mitochondrial dysfunction is referred to as a cause of these chronic fatigue-like symptoms. The present observational pilot study aimed to investigate a possible relationship between the course of ROS formation, subsequent oxidative stress, and post-COVID-19 fatigue.Method: A total of 21 post-COVID-19 employees of the General Hospital Nuremberg suffering from fatigue-like symptoms were studied during their first consultation (T1: on average 3 months after recovery from COVID-19), which comprised an educational talk on post-COVID-19 symptomatology and individualized outpatient strategies to resume normal activity, and 8 weeks thereafter (T2). Fatigue severity was quantified using the Chalder Fatigue Scale together with a health survey (Patient Health Questionnaire) and self-report on wellbeing (12-Item Short-Form Health Survey). We measured whole blood superoxide anion () production rate (electron spin resonance, as a surrogate for ROS production) and oxidative stress-induced DNA strand breaks (single cell gel electrophoresis: “tail moment” in the “comet assay”).Results: Data are presented as mean ± SD or median (interquartile range) depending on the data distribution. Differences between T1 and T2 were tested using a paired Wilcoxon rank sign or t-test. Fatigue intensity decreased from 24 ± 5 at T1 to 18 ± 8 at T2 (p < 0.05), which coincided with reduced formation (from 239 ± 55 to 195 ± 59 nmol/s; p < 0.05) and attenuated DNA damage [tail moment from 0.67 (0.36–1.28) to 0.32 (0.23–0.71); p = 0.05].Discussion: Our pilot study shows that post-COVID-19 fatigue coincides with (i) enhanced formation and oxidative stress, which are (ii) reduced with attenuation of fatigue symptoms.
19 December 2024 in Journal of Psychosomatic Research
Clinical experiences using a psychosomatic-oriented multimodal treatment approach in patients with post-COVID are promising. We established a half-day multimodal treatment program for post-COVID patients at the Department of Psychosomatic Medicine at General Hospital Nuremberg, Paracelsus Medical University, Germany. This observational study between January 2022 and March 2023 comprised baseline documentation of Patient Health Questionnaire (PHQD), ICD-10 Symptom Rating (ISR), Fatigue Scale (FS) and Health Status Questionnaire (SF-12) at admission and discharge of 65 patients suffering from post-COVID. Multimodal psychosomatic treatment was scheduled for 3-4 weeks. At admission, PHQ and FS showed a high level of somatic symptom burden (PHQ-15: M = 16.0, SD = 5.6) and fatigue symptoms (FS: M = 27.1, SD = 4.4). Depressive (PHQ-9: M = 14.0, SD = 5.3) and anxiety symptoms (GAD-7: M = 9.6, SD = 5.6) were moderately and mildly pronounced, respectively. Compared to patients from our standard clinical settings post-COVID patients had a comparably high or even higher mental symptom burden (e.g. PHQ-15: p < .001, d = 0.79; PHQ-9: p = .009, d = 0.39). Compared to admission, symptomatology of post-COVID patients at discharge was improved (e.g. PHQ-15: p = .004, d = 0.26; FS: p = .009, d = 0.32). Despite the short duration of treatment, the patients showed a significant reduction in symptoms between admission and discharge. Further data including a control group and extending the duration of treatment will show whether the changes in symptoms are of the multimodal psychosomatic treatment.
Introduction: Cancer-related fatigue (CRF) is a common symptom of cancer and/or its treatment. Most cancer patients are affected during treatment, as well as years thereafter. Around a third of survivors report suffering from CRF. Those affected are often restricted in their everyday life. Acute and chronic stress are factors that increase a person’s vulnerability to develop CRF. In previous studies different instruments measuring acute and chronic stress related to CRF were used. However, a global instrument to determine individual stress load is lacking.Methods: Therefore, a developed global stress index (GSI) combining specific measuring instruments for acute and chronic stress is validated on an oncological sample and its influence on fatigue is examined. It is hypothesized that individuals with a high global stress load measured by the GSI report higher levels of CRF. The data will be collected using questionnaires in participants suffering from breast cancer with a curative treatment approach. Participants will be surveyed during tumor-specific therapy and six months later. They receive a consultation if fatigue symptoms are strongly pronounced. The study is registered at Deutsches Register Klinischer Studien, no. DRKS DRKS00027864.Discussion: This will be the first study using the GSI as a valid measure for surveying longitudinally acute and chronic stress load in an oncological sample in relation to CRF symptom development. The GSI may help to identify tumor patients with high levels of stress in good time and thus prevent chronic fatigue.