The role of sleep problems in central pain processing in rheumatoid arthritis

Abstract

Objective Among rheumatoid arthritis (RA) patients, pain may exist out of proportion to peripheral inflammation. This observation suggests that central nervous system pain amplification mechanisms, such as diminished conditioned pain modulation (CPM), may play a role in enhancing pain perception among some RA patients. We examined CPM, pressure pain threshold and pressure pain tolerance among RA patients compared to controls. Methods Fifty-eight female RA patients and 54 age-matched controls without chronic pain underwent quantitative sensory testing (QST) to assess CPM, pressure pain threshold and pressure pain tolerance. CPM was induced using a cold water bath, and pain threshold (when patients first felt pain) and tolerance (when pain was too much to bear) were assessed with an algometer. Associations between RA and QST measures were analyzed using linear regression. Sleep problems, mental health and inflammation were assessed as mediators of the relationship between RA and QST measures. Results Median CPM levels were 0.5 kg/cm2 (interquartile range (IQR) −0.1, 1.6) among RA patients compared to 1.5 kg/cm2 (IQR −0.1, 2.5) among controls (P = 0.04). Relative to controls, RA patients had lower pain threshold and tolerance at the wrists (P ≤ 0.05). Compared to controls, RA patients had greater problems with sleep, catastrophizing, depression and anxiety (P < 0.0001). Mediation analyses suggested that low CPM levels may be partially attributable to sleep disturbance (P = 0.04). Conclusion RA patients have impaired CPM relative to pain-free controls. Sleep problems may mediate the association between RA and attenuated CPM.

Relationship between Sleep Disorders, Pain and Quality of Life in Patients with Rheumatoid Arthritis

“…This results are consistent with Lee and et al, findings on assessing the role of sleep problems in central pain processing in rheumatoid arthritis. 33 Also a study on sleep and its relationship to pain and disease activity in juvenile idiopathic arthritis indicated meaningful correlation between sleep apnea and insomnia with pain. 34 Night sleep deprivation and pain could be playing a role in reducing the QOL as a factor with interaction effects.…”

Examining Changes in Central and Peripheral Pain as Mediates of Fatigue Improvement: Results From the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

“…The specific content of any future interventions is unknown but will likely be complex. For example, previous work has also emphasized the importance of sleep problems in mediating the link between RA and conditioned pain modulation (18), and improvements in fatigue may be observed via the targeting of sleep problems.…”

Upcoming value of gene expression analysis in rheumatology

“…При этом 47% [64] больных РА имели более низкие пороги боли на давление и повышенную чувствительность к болевым стимулам как в воспаленных суставах, так и невоспаленных тканях по сравнению со здоровыми лицами [65], тогда как обширная боль и гиперчувствительность к боли у 10-20% пациентов была ассоциирована с отрицательными результатами терапии [66]. Более того, у больных РА также отмечался относительно слабый ответ вегетативной нервной системы, гипоталамо-гипофизарно-надпочечниковой системы [67] и ослабление нисходящих анальгезирующих путей по сравнению со здоровыми лицами [68].…”