The important role of central sensitization in chronic musculoskeletal pain seen in different rheumatic diseases

Güler, Mehmet Akif; Çelik, Ömer; Ayhan, Figen

doi:10.1007/s10067-019-04749-1

Cited by 57 publications

(44 citation statements)

References 37 publications

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“…The wide distribution of hyperalgesia suggests that persistent pain may be caused by central pain regulation mechanisms rather than peripheral stimulation of nociceptors [ 30 ]. According to the central sensitization inventory (CSI), 41% of RA patients had central sensitization syndrome [ 31 ]. Before the clinical characteristics of arthritis become obvious, the central pain processing has changed [ 32 , 33 ].…”

Section: Cns Regulation Mechanismsmentioning

confidence: 99%

Pain Mechanism in Rheumatoid Arthritis: From Cytokines to Central Sensitization

Cao

Fan

Yin

2020

Mediators of Inflammation

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Pain is the most common symptom in patients with rheumatoid arthritis (RA). Although in recent years, through the implementation of targeted treatment and the introduction of disease-modifying antirheumatic drugs (DMARDs), the treatment of RA patients has made a significant progress, a large proportion of patients still feel pain. Finding appropriate treatment to alleviate the pain is very important for RA patients. Current research showed that, in addition to inflammation, RA pain involves peripheral sensitization and abnormalities in the central nervous system (CNS) pain regulatory mechanisms. This review summarized the literature on pain mechanisms of RA published in recent years. A better understanding of pain mechanisms will help to develop new analgesic targets and deploy new and existing therapies.

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Section: Cns Regulation Mechanismsmentioning

confidence: 99%

Pain Mechanism in Rheumatoid Arthritis: From Cytokines to Central Sensitization

Cao

Fan

Yin

2020

Mediators of Inflammation

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“…Identification of CS is seen as particularly important, as patients with this mechanism typically present with increased pain sensitivity and maladaptive psychosocial factors which are often associated with poorer treatment outcomes 9–11 . CS may play a part in a multitude of chronic musculoskeletal conditions, including rheumatic diseases (rheumatoid and osteoarthritis, spondyloarthropathies, and fibromyalgia), temporomandibular disorder, myofascial pain syndrome, tendinopathy, spinal pain, and headache 12–15 …”

Section: Introductionmentioning

confidence: 99%

Quantitative Sensory Testing Discriminates Central Sensitization Inventory Scores in Participants with Chronic Musculoskeletal Pain: An Exploratory Study

2021

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Background The Central Sensitization Inventory (CSI) is often used in clinical settings to screen for the presence of central sensitization. However, various cutoff scores have been reported for this tool, and scores have not been consistently associated with widespread pain sensitivity as measured with quantitative sensory testing (QST). The purpose of this study was to compare QST profiles among asymptomatic controls and participants with chronic musculoskeletal pain (CMP), and to determine the association between self‐report questionnaires and QST in participants with CMP. Methods Twenty asymptomatic controls and 46 participants with CMP completed the CSI, PROMIS‐29, and QST assessments of mechanical and thermal pain thresholds remote to the area of pain. Receiver Operating Characteristic analysis revealed a cutoff score of 33.5 for the CSI. PROMIS‐29 Quality of Life (QOL) inventory and QST measures were compared between low and high CSI groups. Results The high CSI group (n = 19) had significantly lower mechanical and thermal pain thresholds, and larger impairments in QOL measures, compared to the low CSI group (n = 27) and asymptomatic controls. Participants with CSI scores < 33.5 presented similarly to asymptomatic controls. Anxiety, pain interference, and CSI scores demonstrated the highest number of significant associations to QST measures. Conclusion A cutoff score of 33.5 on the CSI may be useful for discriminating widespread pain sensitivity and quality of life impairments in participants with CMP. Future studies should consider how the presence of high or low CSI may impact differential diagnosis, prognosis, and treatment responsiveness for patients with primary or secondary CMP.

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“…The chronic pain caused by OA sometimes is not correlated with the severity of the peripheral injury. Neuroplastic changes in pain-related circuits, resulting in maladaptive neuroplasticity, lead to a perpetuation of pain 3 , 4 . This process has been shown in other chronic pain conditions such as phantom limb pain, fibromyalgia, and low back pain, supporting the idea of a central nervous system modulation of chronic pain 5 , 6 .…”

Section: Introductionmentioning

confidence: 99%

Increased motor cortex inhibition as a marker of compensation to chronic pain in knee osteoarthritis

Simis

Imamura

Melo

et al. 2021

Sci Rep

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This study aims to investigate the associative and multivariate relationship between different sociodemographic and clinical variables with cortical excitability as indexed by transcranial magnetic stimulation (TMS) markers in subjects with chronic pain caused by knee osteoarthritis (OA). This was a cross-sectional study. Sociodemographic and clinical data were extracted from 107 knee OA subjects. To identify associated factors, we performed independent univariate and multivariate regression models per TMS markers: motor threshold (MT), motor evoked potential (MEP), short intracortical inhibition (SICI), intracortical facilitation (ICF), and cortical silent period (CSP). In our multivariate models, the two markers of intracortical inhibition, SICI and CSP, had a similar signature. SICI was associated with age (β: 0.01), WOMAC pain (β: 0.023), OA severity (as indexed by Kellgren–Lawrence Classification) (β: − 0.07), and anxiety (β: − 0.015). Similarly, CSP was associated with age (β: − 0.929), OA severity (β: 6.755), and cognition (as indexed by the Montreal Cognitive Assessment) (β: − 2.106). ICF and MT showed distinct signatures from SICI and CSP. ICF was associated with pain measured through the Visual Analogue Scale (β: − 0.094) and WOMAC (β: 0.062), and anxiety (β: − 0.039). Likewise, MT was associated with WOMAC (β: 1.029) and VAS (β: − 2.003) pain scales, anxiety (β: − 0.813), and age (β: − 0.306). These associations showed the fundamental role of intracortical inhibition as a marker of adaptation to chronic pain. Subjects with higher intracortical inhibition (likely subjects with more compensation) are younger, have greater cartilage degeneration (as seen by radiographic severity), and have less pain in WOMAC scale. While it does seem that ICF and MT may indicate a more acute marker of adaptation, such as that higher ICF and MT in the motor cortex is associated with lesser pain and anxiety.

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The important role of central sensitization in chronic musculoskeletal pain seen in different rheumatic diseases

Cited by 57 publications

References 37 publications

Pain Mechanism in Rheumatoid Arthritis: From Cytokines to Central Sensitization

Pain Mechanism in Rheumatoid Arthritis: From Cytokines to Central Sensitization

Quantitative Sensory Testing Discriminates Central Sensitization Inventory Scores in Participants with Chronic Musculoskeletal Pain: An Exploratory Study

Increased motor cortex inhibition as a marker of compensation to chronic pain in knee osteoarthritis

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