Aim:
Aims: This study aims to compare the intensity of the pain, medication requirements and the evolution of symptoms of neuropathic pain patients with or without COVID‑19 infection and to determine whether the severity of the infection influenced these variables.

Material and methods:
Materials and methods: In all, 400 adults with chronic neuropathic pain (≥3months duration) were included-200 positive and 200 negative for SARS‑CoV‑2. Baseline demographic and clinical characteristics were comparable between groups (age, sex, BMI, comorbidities, pain duration; all p>0.22) to meaningful outcome comparison. Pain severity, analgesic consumption, pain course and symptom deterioration were assessed pre-/post-COVID‑19 or similar follow-up for the controls.

Results:
Results: In COVID‑positive group score values raised from 4.6 ± 1.1 to 7.7 ± 1.4 (p<0.05), at a more significant extent in women (4.7-8.2, p<0.01) as in diabetic patients (4.6-8.1, p<0.001). The COVID-negative group had no significant change (4.2-4.3, p =0.42). Post-COVID, 72% of infected patients needed more analgesics and 65% of them other drugs, vs. 15% and 12%, respectively, in the negative group p<0.001. Pain curves trajectories evidenced steeper increments in COVID‑positive (85% vs. 25% in severe vs. mild COVID-19 worsening, p<0.001, revealing a directly related pain severity to the infection.

Conclusions:
Conclusion: SARS‑CoV‑2 infection is an aetiologic factor that independently leads to a substantial worsening of chronic neuropathic pain, an increase in analgesic needs, and a more severe symptom burden. The impact is most pronounced among women, diabetic patients and those with severe COVID‑19. These results emphasize the importance of proactive pain management approaches and longitudinal tracking in this population.