Exploring the Complex Impact of Long COVID Syndrome and the Potential Role of Massage Therapy in Treatment

Background In the aftermath of the COVID-19 pandemic caused by the Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2), a significant and troubling complication has emerged: Long COVID Syndrome. This condition, marked by persistent and often debilitating symptoms, has become a focal point of concern in the medical community. Understanding the symptomatology of Long COVID Syndrome is crucial as it could lead to novel treatment approaches, such as massage therapy, which might alleviate some of the suffering experienced by patients.

Research Approach To delve deeper into this issue, a thorough review was conducted on studies which explored the symptoms experienced by patients following a COVID-19 infection. Alongside this, an examination of literature on massage therapy dating back to 2000 was carried out to see if there might be a connection between the benefits of massage therapy and the symptoms identified in Long COVID patients.

Findings The systematic review led to the identification of 17 cohort studies from around the world, which provided a detailed look into the variety of symptoms experienced by individuals suffering from post-COVID sequelae.

The review highlighted that the pulmonary and nervous systems were most commonly affected, with patients frequently reporting symptoms such as post-traumatic stress disorder, fatigue, shortness of breath, cough, sleep disturbances, loss of smell, abdominal pain, and decreased appetite.

1. General Symptoms: Fatigue was a common complaint, reported by 32.35% of patients. Other symptoms like night sweats, chills, muscle pain, fever, and joint pain were also reported by over 10% of patients.
2. Respiratory Symptoms: A significant number of patients experienced respiratory issues, with 34.27% reporting shortness of breath (dyspnea) and 23.40% experiencing coughs. Sore throats and nasal congestion were also reported but were less common.
3. Neuropsychiatric Symptoms: The most extensive set of symptoms were neuropsychiatric. Post-Traumatic Stress Disorder (PTSD) was notably reported by 49.41% of patients in two studies. Other common symptoms included sleep disturbances, loss of smell, anxiety, depression, cognitive/memory issues, and headaches. Less frequently reported were loss of taste, blurred vision, and dizziness.
4. Gastrointestinal Symptoms: While less frequently assessed, gastrointestinal issues were still significant. Abdominal pain was reported by 31.22% of patients (in studies where it was assessed), and loss of appetite and diarrhea were also relatively common. Nausea and vomiting were less prevalent.
5. Cardiovascular Symptoms: Cardiovascular symptoms were not as widely reported, with chest pain and heart palpitations experienced by 11.3% and 7.9% of patients, respectively.
6. Dermatological Symptoms: A smaller proportion of patients reported dermatological issues, including hair loss (9%) and skin rashes (4.2%).

The study a;sp calculated the average prevalence of symptoms across various organ systems in patients with Long COVID Syndrome:

1. Pulmonary Sequelae: The most common, with 23.54% of patients experiencing symptoms related to the respiratory system.
2. General Sequelae: These were reported by an average of 18.10% of patients, indicating a significant incidence of general symptoms like fatigue, muscle pain, etc.
3. Neuropsychiatric Sequelae: Affecting an average of 17.01% of patients, this category includes symptoms such as PTSD, anxiety, and cognitive issues.
4. Gastrointestinal (GI) Sequelae: GI-related symptoms were reported by 16.71% of patients, indicating a noteworthy impact on this system.
5. Cardiovascular Sequelae: These were experienced by 9.90% of patients, highlighting a lesser but still significant effect on the cardiovascular system.
6. Dermatological Sequelae: The least common, with an average of 6.66% of patients reporting skin-related symptoms like rashes or hair loss.

Intriguingly, the review found that massage therapy has historically been beneficial for patients experiencing symptoms similar to those associated with Long COVID. In particular

1. General Sequelae: There’s no clear understanding of the pathophysiology for symptoms like fever, night sweats, and chills in the context of Long COVID. No studies in the criteria examined massage therapy’s impact on these symptoms. However, massage therapy has shown improvements in muscular and joint pain.
2. Respiratory Symptoms: Massage therapy is effective in managing respiratory symptoms like dyspnea (shortness of breath), cough, and sore throat, although its impact on nasal congestion was not studied. While some studies observed no change in dyspnea, none suggested harm from massage therapy.
3. Cardiovascular Symptoms: Massage therapy may benefit specific cardiovascular symptoms like chest pain, potentially linked to elevated levels of inflammatory markers during acute COVID-19 infection. While the relationship between massage therapy and heart palpitations was not studied, massage has been noted to decrease inflammatory markers like C-reactive protein and creatine.
4. Neuropsychiatric Sequelae: Many studies found that massage therapy significantly improved anxiety and depression, which might be linked to elevated levels of inflammatory cytokines. Massage therapy has been effective in reducing these cytokines, potentially alleviating symptoms like sleep disturbances, headaches, cognitive impairment, dizziness, and PTSD. The impact on blurred vision, loss of smell, and taste was not studied.
5. Gastrointestinal Symptoms: Massage therapy could help manage Long COVID-related gastrointestinal issues like constipation, abdominal pain, diarrhea, nausea, and vomiting. Although some studies found no significant impact, there was no evidence suggesting harm or worsened symptoms from massage therapy.

The potential role of massage therapy in modulating immune responses in Long COVID Syndrome, given the disease’s complex pathophysiology and immunological aspects, is intriguing:

1. Immunological Aspects of Long COVID: Studies have linked prolonged COVID-19 symptoms to high levels of antibodies against SARS-CoV-2, autoimmune antibodies triggering lung damage, immune hyperactivation, and altered levels of regulatory T-cells and PD-1 expression on CD4 and CD8 T-cells.
2. Immunomodulatory Effects of Massage Therapy: Historical and recent evidence points to the immunomodulatory effects of massage therapy, such as increasing T helper cell counts, decreasing cortisol levels, and reducing inflammatory signaling in various conditions.
3. Frequency and Efficacy of Massage Therapy: The frequency of massage sessions might affect their effectiveness in immunomodulation. While a single session of Swedish massage therapy showed a decrease in inflammatory cytokines, more frequent sessions resulted in a slight increase in these cytokines, indicating that moderation might be key for optimal therapeutic benefits.

Overall, massage therapy shows promise in alleviating a variety of symptoms associated with Long COVID Syndrome, particularly in neuropsychiatric and musculoskeletal areas, while being generally safe without evidence of exacerbating conditions.

While it’s unclear if massage therapy can prevent or eliminate Long COVID Syndrome, its potential to alleviate symptoms by addressing underlying proinflammatory states makes it a promising adjunct treatment option in managing Long COVID.

Conclusions Given the wide-ranging impact of Long COVID Syndrome on various organ systems and the array of symptoms that patients endure, there is a clear need for innovative treatment strategies. This study posits massage therapy as a promising option that could positively influence the most affected organ systems in Long COVID patients, particularly for those symptoms with a high incidence.

The potential for massage therapy to enhance the quality of life for these patients is an avenue worth exploring further in the quest to provide relief and support in the ongoing battle against the repercussions of COVID-19.