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Should central sensitization and neuropathic pain be considered in disease activity and treatment decision in axial ankylosing spondilitis?

Year 2019, Volume: 44 Issue: Supplement 1, 1 - 10, 29.12.2019
https://doi.org/10.17826/cumj.503652

Abstract

Purpose: The aim of this study was to evaluate the prevalence of central sensitization syndromes and the relation between severity of central sensitization and disease activity in patients with axial ankylosing spondylitis (AS). 

Materials and Methods: Study included 105 patients who were diagnosed with AS. Patients' age, sex, body mass index (BMI), disease duration, accompanying disease (diabetes, hypertension) were recorded. The severity of back pain was assessed by visual analog scale (VAS), disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS_CRP). Central sensitization inventory (CSI) was used for central sensitization. 

Results: Central sensitization was found in 45.7% of all participants and neuropathic pain was found in 34.3% of them. When we divided the group according to the central sensitization score ≥40, we found that those who were diagnosed with central sensitization were at an advanced age and have higher BMI, higher erythrocyte sedimentation rate, longer disease duration, higher disease activity, higher neuropathic pain presence and scores than others. 

Conclusion: Central sensitization syndromes and neuropathic pain are frequently associated with AS. Positive correlations of central sensitization and neuropathic pain scores with disease activity scores support that chronic pain components should be taken into consideration in the follow-up of the disease


References

  • Procházková L, Červeňák V, Souček M. [Axial spondyloarthritis].Vnitr Lek. 2018 Spring;64(2):108-116.
  • Geler-Külcü D, Batıbay S, Öztürk G, Mesci N. The association of neuropathic paIn and disease activity, functional level, and quality of life in patients with ankylosIng spondylitis: a cross-sectional study. Turk J Med Sci. 2018 Apr 30;48(2):257-265. doi: 10.3906/sag-1707-147.
  • Salaffi F, Giacobazzi G, Di Carlo M. Chronic Pain In Inflammatory Arthritis: Mechanisms, Metrology, and Emerging Targets-A Focus on the JAK-STAT Pathway.PaIn Res Manag. 2018 Feb 7;2018:8564215. doi: 10.1155/2018/8564215. eCollection 2018.
  • Kim MS, Koh IJ, Lee SY, In Y. Central sensitization is a risk factor for wound complications after primary total knee arthroplasty.Knee Surg Sports Traumatol Arthrosc. 2018 Mar 24. doi: 10.1007/s00167-018-4914-6. [Epub ahead of print]
  • Ji RR, Nackley A, Huh Y, Terrando N, Maixner W. Neuroinflammation and Central Sensitization In Chronic and Widespread Pain. Anesthesiology. 2018 Feb 19. doi: 10.1097/ALN.0000000000002130. [Epub ahead of print]
  • Nijs J, Torres-Cueco R, van Wilgen CP, Girbes EL, Struyf F, Roussel N, et al. Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization paIn.PaIn Physician. 2014 Sep-Oct;17(5):447-57.
  • Neblett R, Hartzell MM, Williams M, Bevers KR, Mayer TG, Gatchel RJ. Use of the Central Sensitization Inventory (CSI) as a treatment outcome measure for patients with chronic spinal pain disorder in a functional restoration program. Spine J. 2017 Dec;17(12):1819-1829. doi: 10.1016/j.spInee.2017.06.008. Epub 2017 Jun 12.
  • Düzce E. Turkish Validity and Reliability of Central Sensitization Inventory. Thesis. Trakya University, Department of Physical Medicine and Rehabilitation. 2018
  • Bennett MI, Smith BH, Torrance N, Potter J. The S-LANSS score for identifying pain of predominantly neuropathic origin: Validation for use In clinical and postal research. J Pain. 2005;6:149–158
  • Bennett MI, Attal N, Backonja MM; Baron R; Bouhassira D; Freynhagen R; et al. Using screening tools to identify neuropathic pain. Pain. 2017;127(3):199-203. DOI: 10.1016/j.paIn.2006.10.034
  • Koc R, Erdemoglu AK. Validity and reliability of the Turkish Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire. Pain Med. 2010 Jul;11(7):1107-14. doi: 10.1111/j.1526-4637.2010.00837.x.
  • Freynhagen R, Tölle TR, Gockel U, Baron R. The painDETECT project - far more than a screening tool on neuropathic pain. Curr Med Res OpIn. 2016 Jun;32(6):1033-57. doi: 10.1185/03007995.2016.1157460.
  • Yoshitaka M , Katsushi T, Masahiko S,Yasushi O, Juichi T, So K, et al. Validity and Reliability of the Japanese Version of the painDETECT Questionnaire: A Multicenter Observational Study. Plos One.2013; San Francisco Vol. 8, Iss. 9, (Sep 2013): e68013.https://doi.org/10.1371/journal.pone.0068013
  • Huh Y, Ji RR, Chen G. Neuroinflammation, Bone Marrow Stem Cells, and Chronic Pain.Front Immunol. 2017 Aug 21;8:1014. doi: 10.3389/fimmu.2017.01014. eCollection 2017.
  • Eller-Smith OC, Nicol AL, Christianson JA. Potential Mechanisms Underlying Centralized Pain and Emerging Therapeutic Interventions. Front Cell Neurosci. 2018 Feb 13;12:35. doi: 10.3389/fncel.2018.00035. eCollection 2018.
  • Choi JH, Lee SH, Kim HR, Lee KA. Association of neuropathic-like pain characteristics with clinical and radiographic features In patients with ankylosing spondylitis.Clin Rheumatol. 2018 Apr 30. doi: 10.1007/s10067-018-4125-z. [Epub ahead of print]
  • Gok K, Cengiz G, Erol K, Ozgocmen S. Neuropathic Pain Component In Axial Spondyloarthritis and the Influence on Disease Burden. J Clin Rheumatol. 2018 Feb 22. doi: 10.1097/RHU.0000000000000711. [Epub ahead of print]
  • Wu Q, Inman RD, Davis KD. Neuropathic pain In ankylosing spondylitis: a psychophysics and brain imaging study. Arthritis Rheum. 2013 Jun;65(6):1494-503. doi: 10.1002/art.37920.
  • Bevilaqua-Grossi D, Zanin M, Benedetti C, Florencio L, Oliveira A. Thermal and mechanical pain sensitization in patients with osteoarthritis of the knee. Physiother Theory Pract. 2018 Feb 26:1-9. doi: 10.1080/09593985.2018.1441930. [Epub ahead of print]
  • Bevilaqua-Grossi D, Zanin M, Benedetti C, Florencio L, Oliveira A. Thermal and mechanical pain sensitization in patients with osteoarthritis of the knee. Physiother Theory Pract. 2018 Feb 26:1-9. doi: 10.1080/09593985.2018.1441930. [Epub ahead of print]
  • Huysmans E, Ickmans K, Van Dyck D, Nijs J, Gidron Y, Roussel N, et al. Association Between Symptoms of Central Sensitization and Cognitive Behavioral Factors In People With Chronic Nonspecific Low Back Pain: A Cross-sectional Study. J Manipulative Physiol Ther. 2018 Feb;41(2):92-101. doi: 10.1016/j.jmpt.2017.08.007. Epub 2018 Jan 10.
  • Huysmans E, Ickmans K, Van Dyck D, Nijs J, Gidron Y, Roussel N, et al. Association Between Symptoms of Central Sensitization and Cognitive Behavioral Factors In People With Chronic Nonspecific Low Back Pain: A Cross-sectional Study. J Manipulative Physiol Ther. 2018 Feb;41(2):92-101. doi: 10.1016/j.jmpt.2017.08.007. Epub 2018 Jan 10.
  • Lluch E, Torres R, Nijs J, Van Oosterwijck J.Evidence for central sensitization in patients with osteoarthritis pain: a systematic literature review.Eur J PaIn. 2014 Nov;18(10):1367-75. doi: 10.1002/j.1532-2149.2014.499.x. Epub 2014 Apr 3.
  • De la Coba P, Bruehl S, Gálvez-Sánchez CM, Reyes Del Paso GA. Slowly repeated evoked pain (srep) as a marker of central sensıtızatıon ın fıbromyalgıa: dıagnostıc accuracy and relıabılıty ın comparıson wıth temporal summatıon of paın.Psychosom Med. 2018 May 1. Doi: 10.1097/PSY.0000000000000599. [Epub ahead of print]
  • Sanchis MN, Lluch E, Nijs J, Struyf F, Kangasperko M. The role of central sensitization in shoulder pain: A systematic literature review.Semin Arthritis Rheum. 2015 Jun;44(6):710-6. doi: 10.1016/j.semarthrit.2014.11.002. Epub 2014 Nov 13.
  • Malfliet A, Kregel J, Cagnie B, Kuipers M, Dolphens M, Roussel N, et al. Lack of evidence for central sensitization in idiopathic, non-traumatic neck pain: a systematic review. Pain Physician. 2015 May-Jun;18(3):223-36.
  • Fibromyalgia, a missed comorbidity in spondyloarthritis: prevalence and impact on assessment and treatment, Curr Opin Rheuamtol 2017;29:304-310

Santral sensitizasyon bozukluğu aksiyel ankilozan spondilitte hastalık aktivitesini değerlendirmede dikkate alınmalı mıdır?

Year 2019, Volume: 44 Issue: Supplement 1, 1 - 10, 29.12.2019
https://doi.org/10.17826/cumj.503652

Abstract

Amaç: Bu çalışmanın amacı, aksiyel ankilozan spondilit’li (AS) hastalarda santral sensitizasyon sendromlarının prevalansını ve santral sensitizasyonun şiddeti ile hastalık aktivitesi arasındaki ilişkinin değerlendirilmesidir. 

Gereç ve Yöntem: Çalışmamız, AS tanılı 105 hastayı içermektedir. Hastaların yaşı, cinsiyeti, vücut kitle indeksi (VKİ), hastalık süresi, eşlik eden hastalık (diyabet, hipertansiyon) kaydedildi. Bel ağrısının şiddeti görsel analog skala (VAS) ile, hastalık aktivitesi Bath Ankilozan Spondilit Hastalık Aktivite İndeksi (BASDAI), Bath Ankilozan Spondilit Fonksiyonel İndeks (BASFI) ve Ankilozan Spondilit Hastalık Aktivite Skoru-C-reaktif protein (ASDAS_CRP) ile değerlendirildi.  Santral sensitizasyon için santral sensitizasyon envanteri (CSI) kullanıldı.

Bulgular: Tüm katılımcıların %45.7'sinde santral sensitizasyon, (SS) % 34.3'ünde nöropatik ağrı saptandı. Grubu santral sensitizasyon skoru ≥40'a göre ayırdığımızda, santral sensitizasyon tanısı alanlarda ileri yaş, yüksek VKI, yüksek eritrosit sedimentasyon hızı (ESR), uzun hastalık süresi, yüksek hastalık aktivitesi), yüksek nöropatik ağrı varlığı ve skorları tespit ettik..

Sonuç: Santral sensitizasyon sendromları ve nöropatik ağrı sıklıkla AS ile ilişkilidir. Santral sensitizasyon ve nöropatik ağrı skorlarının hastalık aktivite skorları ile pozitif korelasyonu, hastalık takibinde kronik ağrı bileşenlerinin dikkate alınması gerektiğini desteklemektedir.


References

  • Procházková L, Červeňák V, Souček M. [Axial spondyloarthritis].Vnitr Lek. 2018 Spring;64(2):108-116.
  • Geler-Külcü D, Batıbay S, Öztürk G, Mesci N. The association of neuropathic paIn and disease activity, functional level, and quality of life in patients with ankylosIng spondylitis: a cross-sectional study. Turk J Med Sci. 2018 Apr 30;48(2):257-265. doi: 10.3906/sag-1707-147.
  • Salaffi F, Giacobazzi G, Di Carlo M. Chronic Pain In Inflammatory Arthritis: Mechanisms, Metrology, and Emerging Targets-A Focus on the JAK-STAT Pathway.PaIn Res Manag. 2018 Feb 7;2018:8564215. doi: 10.1155/2018/8564215. eCollection 2018.
  • Kim MS, Koh IJ, Lee SY, In Y. Central sensitization is a risk factor for wound complications after primary total knee arthroplasty.Knee Surg Sports Traumatol Arthrosc. 2018 Mar 24. doi: 10.1007/s00167-018-4914-6. [Epub ahead of print]
  • Ji RR, Nackley A, Huh Y, Terrando N, Maixner W. Neuroinflammation and Central Sensitization In Chronic and Widespread Pain. Anesthesiology. 2018 Feb 19. doi: 10.1097/ALN.0000000000002130. [Epub ahead of print]
  • Nijs J, Torres-Cueco R, van Wilgen CP, Girbes EL, Struyf F, Roussel N, et al. Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization paIn.PaIn Physician. 2014 Sep-Oct;17(5):447-57.
  • Neblett R, Hartzell MM, Williams M, Bevers KR, Mayer TG, Gatchel RJ. Use of the Central Sensitization Inventory (CSI) as a treatment outcome measure for patients with chronic spinal pain disorder in a functional restoration program. Spine J. 2017 Dec;17(12):1819-1829. doi: 10.1016/j.spInee.2017.06.008. Epub 2017 Jun 12.
  • Düzce E. Turkish Validity and Reliability of Central Sensitization Inventory. Thesis. Trakya University, Department of Physical Medicine and Rehabilitation. 2018
  • Bennett MI, Smith BH, Torrance N, Potter J. The S-LANSS score for identifying pain of predominantly neuropathic origin: Validation for use In clinical and postal research. J Pain. 2005;6:149–158
  • Bennett MI, Attal N, Backonja MM; Baron R; Bouhassira D; Freynhagen R; et al. Using screening tools to identify neuropathic pain. Pain. 2017;127(3):199-203. DOI: 10.1016/j.paIn.2006.10.034
  • Koc R, Erdemoglu AK. Validity and reliability of the Turkish Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire. Pain Med. 2010 Jul;11(7):1107-14. doi: 10.1111/j.1526-4637.2010.00837.x.
  • Freynhagen R, Tölle TR, Gockel U, Baron R. The painDETECT project - far more than a screening tool on neuropathic pain. Curr Med Res OpIn. 2016 Jun;32(6):1033-57. doi: 10.1185/03007995.2016.1157460.
  • Yoshitaka M , Katsushi T, Masahiko S,Yasushi O, Juichi T, So K, et al. Validity and Reliability of the Japanese Version of the painDETECT Questionnaire: A Multicenter Observational Study. Plos One.2013; San Francisco Vol. 8, Iss. 9, (Sep 2013): e68013.https://doi.org/10.1371/journal.pone.0068013
  • Huh Y, Ji RR, Chen G. Neuroinflammation, Bone Marrow Stem Cells, and Chronic Pain.Front Immunol. 2017 Aug 21;8:1014. doi: 10.3389/fimmu.2017.01014. eCollection 2017.
  • Eller-Smith OC, Nicol AL, Christianson JA. Potential Mechanisms Underlying Centralized Pain and Emerging Therapeutic Interventions. Front Cell Neurosci. 2018 Feb 13;12:35. doi: 10.3389/fncel.2018.00035. eCollection 2018.
  • Choi JH, Lee SH, Kim HR, Lee KA. Association of neuropathic-like pain characteristics with clinical and radiographic features In patients with ankylosing spondylitis.Clin Rheumatol. 2018 Apr 30. doi: 10.1007/s10067-018-4125-z. [Epub ahead of print]
  • Gok K, Cengiz G, Erol K, Ozgocmen S. Neuropathic Pain Component In Axial Spondyloarthritis and the Influence on Disease Burden. J Clin Rheumatol. 2018 Feb 22. doi: 10.1097/RHU.0000000000000711. [Epub ahead of print]
  • Wu Q, Inman RD, Davis KD. Neuropathic pain In ankylosing spondylitis: a psychophysics and brain imaging study. Arthritis Rheum. 2013 Jun;65(6):1494-503. doi: 10.1002/art.37920.
  • Bevilaqua-Grossi D, Zanin M, Benedetti C, Florencio L, Oliveira A. Thermal and mechanical pain sensitization in patients with osteoarthritis of the knee. Physiother Theory Pract. 2018 Feb 26:1-9. doi: 10.1080/09593985.2018.1441930. [Epub ahead of print]
  • Bevilaqua-Grossi D, Zanin M, Benedetti C, Florencio L, Oliveira A. Thermal and mechanical pain sensitization in patients with osteoarthritis of the knee. Physiother Theory Pract. 2018 Feb 26:1-9. doi: 10.1080/09593985.2018.1441930. [Epub ahead of print]
  • Huysmans E, Ickmans K, Van Dyck D, Nijs J, Gidron Y, Roussel N, et al. Association Between Symptoms of Central Sensitization and Cognitive Behavioral Factors In People With Chronic Nonspecific Low Back Pain: A Cross-sectional Study. J Manipulative Physiol Ther. 2018 Feb;41(2):92-101. doi: 10.1016/j.jmpt.2017.08.007. Epub 2018 Jan 10.
  • Huysmans E, Ickmans K, Van Dyck D, Nijs J, Gidron Y, Roussel N, et al. Association Between Symptoms of Central Sensitization and Cognitive Behavioral Factors In People With Chronic Nonspecific Low Back Pain: A Cross-sectional Study. J Manipulative Physiol Ther. 2018 Feb;41(2):92-101. doi: 10.1016/j.jmpt.2017.08.007. Epub 2018 Jan 10.
  • Lluch E, Torres R, Nijs J, Van Oosterwijck J.Evidence for central sensitization in patients with osteoarthritis pain: a systematic literature review.Eur J PaIn. 2014 Nov;18(10):1367-75. doi: 10.1002/j.1532-2149.2014.499.x. Epub 2014 Apr 3.
  • De la Coba P, Bruehl S, Gálvez-Sánchez CM, Reyes Del Paso GA. Slowly repeated evoked pain (srep) as a marker of central sensıtızatıon ın fıbromyalgıa: dıagnostıc accuracy and relıabılıty ın comparıson wıth temporal summatıon of paın.Psychosom Med. 2018 May 1. Doi: 10.1097/PSY.0000000000000599. [Epub ahead of print]
  • Sanchis MN, Lluch E, Nijs J, Struyf F, Kangasperko M. The role of central sensitization in shoulder pain: A systematic literature review.Semin Arthritis Rheum. 2015 Jun;44(6):710-6. doi: 10.1016/j.semarthrit.2014.11.002. Epub 2014 Nov 13.
  • Malfliet A, Kregel J, Cagnie B, Kuipers M, Dolphens M, Roussel N, et al. Lack of evidence for central sensitization in idiopathic, non-traumatic neck pain: a systematic review. Pain Physician. 2015 May-Jun;18(3):223-36.
  • Fibromyalgia, a missed comorbidity in spondyloarthritis: prevalence and impact on assessment and treatment, Curr Opin Rheuamtol 2017;29:304-310
There are 27 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research
Authors

Tuba Koca 0000-0002-4596-858X

Hasan Göğebakan This is me 0000-0002-3448-4838

Gözde Çetin This is me 0000-0001-9680-7535

Publication Date December 29, 2019
Acceptance Date May 4, 2019
Published in Issue Year 2019 Volume: 44 Issue: Supplement 1

Cite

MLA Koca, Tuba et al. “Should Central Sensitization and Neuropathic Pain Be Considered in Disease Activity and Treatment Decision in Axial Ankylosing Spondilitis?”. Cukurova Medical Journal, vol. 44, 2019, pp. 1-10, doi:10.17826/cumj.503652.

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