Pain threshold and intensity in rheumatic patients: correlations with the Hamilton Depression Rating scale

Abstract

Individuals suffering from chronic pain are frequently affected by depression, which in turn increases the risk of developing chronic pain over time. This study aims to investigate the relationship between depression and pain intensity and threshold in a group of rheumatic patients compared to healthy subjects. One hundred twenty-four individuals of whom 50 were affected by rheumatoid arthritis (RA), 23 by psoriatic arthritis (PsA), 23 by ankylosing spondylitis (AS), and 28 age-matched controls without chronic pain underwent quantitative sensory testing to assess pressure pain threshold with pressure algometry. Pain intensity was evaluated through the visual analogue scale (VAS) and depression through the Hamilton Depression Rating scale (HAMD). A significant inverse correlation between HAMD values and pressure pain thresholds was found in the entire group of patients (p < 0.0001), in controls (p = 0.02), and also in RA (p = 0.002), PsA (p < 0.0002), and AS (p = 0.02) patients when analyzed separately, while no significant correlation was found between HAMD and VAS values or pressure pain thresholds and VAS. We found lower pain thresholds in RA and PsA patients while no difference has been evidenced in AS patients compared to healthy controls. HAMD scores were also significantly higher in rheumatic patients than in controls. The use of pressure algometry in the evaluation of chronic pain in patients affected by rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis that display comorbid depression could represent an additional and integrative method to improve pain/depression overlap management or research.

Pain Mechanisms and Ultrasonic Inflammatory Activity as Prognostic Factors in Patients With Psoriatic Arthritis: A Prospective Cohort Study

“…Contributions from central sensitization to generalized pain in RA and OA are well documented (6,7,14,41). Previous studies of pain mechanisms in PsA are scarce and include a few studies that have demonstrated lowered pain pressure thresholds in PsA versus healthy controls (42) and high frequencies of mixed/neuropathic pain features in PsA according to the PDQ score, similar to our findings (3). Other studies have mainly focused on the worst-end spectrum of central sensitization, i.e., fibromyalgia.…”

Explanatory factors and predictors of fatigue in persons with rheumatoid arthritis: A longitudinal study

“…BRAF-MDQ Physical and Living) suggesting that pain intensity may influence the energy and the ability to cope, physically and socially. Previous studies show a weak association between pain threshold and VAS pain in persons with rheumatic diseases and chronic pain (29,30), while stronger association has been observed between pain threshold and depression (30), both of which relate to the central nervous system. This highlights the multifaceted nature of pain in RA, which can be influenced by peripheral and central pain sensitization beyond inflammation (10,26).…”

Association of Exercise Therapy and Reduction of Pain Sensitivity in Patients With Knee Osteoarthritis: A Randomized Controlled Trial

“…However, as we neither tested pain sensitivity locally on the knee or at more remote areas (e.g., upper extremity), it is not possible to determine if exercise therapy reduces the peripheral input from the knee to provide local desensitization, or if more universal adaptations in the central nervous system have occurred yielding a general desensitization. Exercise is also likely to cause changes in psychological variables, such as depression and quality of life (), that are associated with pain sensitivity (). In the present study these factors were unfortunately not assessed, and it is possible that the reduced pain sensitivity after exercise may also be mediated through improvements in psychological well‐being.…”