Background and aims
The abdominal pain common in Inflammatory Bowel Disease (IBD) patients is traditionally associated with inflammation but may persist during clinical remission. Central sensitisation (CS) has never been explored in these patients. This study aimed to determine the epidemiology of pain in IBD patients and to specify pain characteristics with special attention to CS.
This cross-sectional study included 200 patients; 67% had Crohn’s disease (CD). Pain was assessed using the McGill questionnaire, the Douleur Neuropathique 4 (DN4) questionnaire, and by clinical examination. Its impacts on the quality of life, depression and anxiety were also assessed.
Three-quarters of IBD patients complained of pain, including intermittent pain attacks, 62% reported abdominal pain, and 17.5% had CS. Prevalence of pain (83.6% vs. 59.1%; p < 0.001) and abdominal pain (68.7% vs. 48.5%; p = 0.006) was higher in CD patients than in ulcerative colitis (UC) patients. Multivariate analysis confirmed that age (p = 0.02), sex (female) (p = 0.004), and CD (p = 0.005) were independent risk factors for pain. Pain intensity was greater in case of CS (6 [5 - 3] vs. 3 [1.5 - 5], p < 0.003) which significantly impaired quality of life (p < 0.003) compared with pain without CS.
The prevalence of pain was high in IBD patients (≈75%) and higher in Crohn's patients. Significant impacts on quality of life were confirmed. More than 25% of patients with abdominal pain described CS responsible for more severe pain and worsened quality of life.
Rapid-onset dystonia-parkinsonism also known as DYT12-ATP1A3 is an extremely rare neurological disease. Patients develop dystonia, bradykinesia, postural instability, dysarthria, and dysphagia. Injection of botulinum toxin is the first-choice treatment for focal dystonia. We report the case of a 14-year-old patient diagnosed with rapid-onset dystonia-parkinsonism who was scheduled for injection of botulinum toxin in his upper limbs under general anesthesia. To our knowledge, there is no previous report about the anesthetic management of patients with rapid-onset dystonia-parkinsonism.
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