Treatment of Post-COVID and Chronic Fatigue Syndrome with a Proprioception Based Treatment

Introduction: Post-COVID (PCS) syndrome manifests with profound fatigue, cognitive impairment, pain, myalgias, dizziness, shortness of breath and depression. Therapeutic options remain limited and the condition is often considered refractory. Case Series: We describe nine patients with severe PCS and chronic fatigue syndrome (CFS) treated with a structured, multimodal inpatient program emphasizing sophisticated pacing for a median treatment duration of 116 days. The program is based on psychosomatic treatment principles, particularly those applied in conditions affecting body image, and has been specifically adapted by incorporating pacing to address profound fatigue. Daily activity was titrated to individual tolerance, beginning with brief exertion followed by rest and gradually increasing. Medical management was individualized and included supplementation, antidepressants, antipsychotics, and in selected cases nicotine patches or low-dose naloxone. Clinically meaningful improvements were observed across nearly all domains of Health-49 and ICD-10-based symptom rating (ISR). The largest gains occurred in somatoform complaints, with median scores decreasing from 2.50 to 1.43 in Health-49 and from 1.06 to 0.55 in ISR. Additional improvements were noted in activity, self-efficacy, and anxiety. Four patients remained wheelchair-dependent at discharge. Discussion: The constellation of symptoms including chronic pain, myalgias, dizziness, and sensory hypersensitivity suggests that proprioceptive dysfunction may contribute to PCS and CFS. The selective improvement in somatoform domains following a psychosomatic, body-oriented intervention provides preliminary support for this hypothesis. Although limited by sample size, these findings indicate that post-COVID chronic fatigue syndrome may not be inherently untreatable and highlight somatosensory processing as a potential target for novel therapeutic strategies.