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.