Central Sensitization Inventory Mediates the Relationship Between Inflammatory Bowel Disease Activity and Worse Musculoskeletal Pain Experiences

Falling, Carrie; Stebbings, Simon; Baxter, David; Gearry, Richard B.; Mani, Ramakrishnan

doi:10.1111/papr.12821

Cited by 12 publications

(7 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To our knowledge, this is the first study investigating the presence of CS, as determined by a CSI score of 40 or higher, and associated conditions in patients with HS compared with age- and sex-matched controls. The mean (SD) CSI score found in patients with HS (33.7 [18.7]) is in line with previously reported CSI scores in inflammatory bowel disease, spondyloarthritis, and rheumatoid arthritis: 26.23 (12.68), 36.26 (18.51), and 38.43 (16.2), respectively . These inflammatory diseases share a frequently seen pattern in which pain symptoms cannot always be linked to underlying inflammation or peripheral mechanisms.…”

Section: Discussionsupporting

confidence: 88%

See 1 more Smart Citation

Prevalence of Central Sensitization in Patients With Hidradenitis Suppurativa

2021

View full text Add to dashboard Cite

ain is one of the most prominent and debilitating symptoms of hidradenitis suppurativa (HS) and has been incorporated as a domain in the newly developed core outcome set for HS. 1 The chronic, inflammatory, and painful nature of HS has been postulated to induce a process known as central sensitization (CS). 2 Central sensitization is an increased responsiveness of the pain perception pathway in the central nervous system to normal or subthreshold stimuli, altering and amplifying pain perception. 2 Symptoms of CS are not confined to pain and can include fatigue, memory loss, and sleep disturbances. 2 Moreover, several syndromes have been associated with CS. For example, fibromyalgia and irritable bowel syndrome are considered to share a common pathophysiological pathway, implicating neuronal hyperexcitability as the central mechanism. 2 The presence of CS in HS-associated inflammatory diseases, such as inflammatory bowel disease and rheumatic diseases, has been well established. 3,4 Therefore, the aim of this study was to assess the prevalence of central sensitization in patients with HS compared with age-and sex-matched controls. Methods Study DesignThis cross-sectional, survey-based, case-control study was performed at the Department of Dermatology of the Erasmus University Medical Center Rotterdam, in Rotterdam, the Netherlands, from February to November 2020. All consecutive, adult patients IMPORTANCE Chronic pain is one of the most prominent symptoms of hidradenitis suppurativa (HS) and an independent domain in the core outcome set for HS. Previously, the chronic, recurrent, inflammatory nature of HS was hypothesized to induce central sensitization (CS; alteration and amplification of pain perception). However, evidence for this hypothesis is currently lacking.OBJECTIVE To determine the prevalence of CS in patients with HS compared with sex-and age-matched controls. DESIGN, SETTING, AND PARTICIPANTSThis was a cross-sectional, survey-based, case-control study conducted from February to November 2020 that included all consecutive adult patients with HS attending the outpatient clinic of the Department of Dermatology of the Erasmus University Medical Center Rotterdam, in Rotterdam, the Netherlands. Age-and sex-matched controls without chronic inflammatory dermatologic diseases were recruited from the same department. MAIN OUTCOMES AND MEASURESThe main outcome was the Central Sensitization Inventory (CSI) score (ranging from 0-100) as a screening tool for presence of CS. Based on current literature, a score of 40 or higher was deemed to indicate the presence of CS. RESULTSOverall, 100 patients with HS (median [IQR] age, 34.5 [27.3-47.0] years; 71 [71%] female) and 100 controls (median [IQR] age, 33.5 [27.0-48.8] years; 71 [71%] female) were included, of which 36% and 12%, respectively, had a CSI score of 40 or higher (P < .001). Multivariate logistic regression showed that patients with HS had 4.46 (95% CI, 1.89-10.52; P = .001) times the odds of having a positive CSI compared with controls. In addition, CS ...

show abstract

Section: Discussionsupporting

confidence: 88%

“…The presence of CS in HS-associated inflammatory diseases, such as inflammatory bowel disease and rheumatic diseases, has been well established . Therefore, the aim of this study was to assess the prevalence of central sensitization in patients with HS compared with age- and sex-matched controls.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Central Sensitization in Patients With Hidradenitis Suppurativa

2021

View full text Add to dashboard Cite

show abstract

“…Further correlation analysis indicated that abdominal pain severity in the current study demonstrated a high degree of correlation with abdominal pain interference (ρ = 0.811, P < 0.001), suggesting the likely presence of collinearity between these variables. It is well documented, including a previous IBD study [4], that pain interference is in part a function of pain severity [38]. Consequently, the multiple regression model for CPM scores in the present study include investigation of contributions from negative affect, anxiety, sleep disturbance, current use of biologics, and abdominal pain severity.…”

Section: Resultsmentioning

confidence: 93%

“…Pain is reported by the majority of patients with inflammatory bowel diseases (IBD), with abdominal and musculoskeletal pain representing the most common pain complaints [1,2]. Recent investigations exploring persistent pain experiences in IBD have highlighted the relationship between worse pain experiences, active IBD, and symptoms of central sensitization [3,4]. This suggests that, like other chronic inflammatory diseases, pain experiences in IBD may be influenced by multiple factors associated with IBD and changes in pain processing within the central nervous system (CNS) [3,5].…”

Section: Introductionmentioning

confidence: 99%

Somatosensory assessments in patients with inflammatory bowel disease: a cross-sectional study examining pain processing pathways and the role of multiple patient factors

Falling

Stebbings

Baxter

et al. 2022

European Journal of Gastroenterology &Amp; Hepatology

Self Cite

View full text Add to dashboard Cite

Background Pain affects the majority of patients with inflammatory bowel disease (IBD), where pain experiences may be influenced by multiple patient factors and changes within central pain processing pathways, termed central sensitization. The current study aimed to investigate pain processing pathways in patients with IBD through somatosensory testing and associations with multiple patient factors. Methods A cross-sectional study of adults with IBD. Assessments included: somatosensory tests [i.e. pressure pain thresholds (PPT), temporal summation (TS), conditioned pain modulation (CPM)], and patient factors (i.e. demographics, comorbidity, sleep quality, psychological, pain severity and interference, and IBD features). Multiple regression analyses explored associations between somatosensory tests and multiple patient factors. Results Decreased CPM in participants (N = 51) was associated with worse abdominal pain severity and use of biologic therapies (R 2 = 0.30, F(5,44) = 5.18, P = 0.001). Increased TS was associated with biologic use (R 2 = 0.11, F(1,49) = 6.13, P = 0.017). Decreased PPT at the low back (R 2 = 0.29, F(2,48) = 11.21, P < 0.001) and Tibialis anterior (R 2 = 0.41, F(2,48) = 18.26, P < 0.001) were associated with female sex and the absence of a stoma. Conclusion Study results demonstrated associations between multiple patient factors and somatosensory tests in patients with IBD. The absence of a stoma and female sex was associated with greater sensitivity to pressure in two remote body regions, suggestive of widespread hyperalgesia. Worse abdominal pain severity and biologic use were associated with decreased pain inhibition, and biologic use was also associated with increased pain facilitation. These findings suggest the presence of altered pain processing and mechanisms of central sensitization in patients with IBD.

show abstract

“…In a proportion of patients, it is believed to be caused by inflammatory mechanisms associated with tissue damage and related to SpA, but in other patients, the chronic pain seems to be a consequence of physiological factors or central sensitization [24]. Systemic inflammation has been proposed to alter pain perception [25,26] and inflammatory activity is also associated with worse pain experience in patients with IBD [27].…”

Section: Discussionmentioning

confidence: 99%

Increased chronic pain in patients with ulcerative colitis is mostly associated to increased disease activity. A cross-sectional case-control study

Pettersson

Kragsbjerg

Hamrin

et al. 2020

Scandinavian Journal of Gastroenterology

View full text Add to dashboard Cite

Backgrounds/aims: Musculoskeletal symptoms are common in patients with ulcerative colitis (UC), but no study has compared the prevalence of chronic pain to controls from a general population. Methods: Patients with UC (n ¼ 1164) and controls (n ¼ 3867) were sent questionnaires comprising demography, history of pain, pain localization and UC patients' Patient-Simple Clinical Colitis Activity Index. Chronic regional pain (ChRP) and chronic widespread pain (ChWP) were defined as having pain for at least 3 months. Results: The response rate for the patients with UC was 49.0% and for the control persons 61.7% (p < .001). The reported prevalence of ChRP and ChWP was higher in patients with UC versus controls (33.1% vs. 24.2%; p < .001 and 19.8% vs. 12.5%; p < .001). The patients with UC reported significantly more pain in the regions 'lower back', 'hip/upper leg' and 'lower leg/foot' compared to controls. The patients with P-SCCAI 5 (n ¼ 121) reported more ChWP than patients with P-SCCAI <5 (n ¼ 426) (46.3% vs. 12.7%; p < .001) and controls (n ¼ 2425) (46.3 vs. 12.5%; p < .001) in all body regions. No significant difference in ChWP was found between patients with P-SCCAI <5 and controls (12.7% vs. 12.5%; p ¼ .917). Conclusions: Patients with UC reported more chronic pain than controls from the general population, especially from the lower back and hip region. Higher UC disease activity was associated with more pain in all body regions.

show abstract

Central Sensitization Inventory Mediates the Relationship Between Inflammatory Bowel Disease Activity and Worse Musculoskeletal Pain Experiences

Cited by 12 publications

References 48 publications

Prevalence of Central Sensitization in Patients With Hidradenitis Suppurativa

Prevalence of Central Sensitization in Patients With Hidradenitis Suppurativa

Somatosensory assessments in patients with inflammatory bowel disease: a cross-sectional study examining pain processing pathways and the role of multiple patient factors

Increased chronic pain in patients with ulcerative colitis is mostly associated to increased disease activity. A cross-sectional case-control study

Contact Info

Product

Resources

About