A systematic review and meta-analysis of questionnaires to screen for pain sensitisation and neuropathic like pain in inflammatory arthritis

Rutter-Locher, Zoe; Arumalla, Nikita; Norton, Sam; Taams, Leonie; Kirkham, Bruce; Bannister, Kirsty

doi:10.1016/j.semarthrit.2023.152207

Cited by 6 publications

(2 citation statements)

References 52 publications

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“… 9 There is a growing acknowledgement that a significant proportion—up to 40%—of chronic pain in RA stems not from ongoing inflammation but from a dysregulated nervous system. 10 , 11 This dysregulation can be due to peripheral sensitisation or abnormalities in central processing within the spinal cord or brain, leading to increased pain sensitivity (hyperalgesia) and pain triggered by external stimuli that do not usually provoke pain (allodynia). 11 , 12 The degree to which pain is caused by dysregulation of the nervous system will vary between patients, with some experiencing predominantly inflammatory pain, some more centralised, but also many that have varying degrees of both.…”

Section: Introductionmentioning

confidence: 99%

“…Pain in rheumatoid arthritis (RA), arising from joint inflammation, has been characterised as a diffuse, burning ache that can range from moderate to severe intensity, typically fluctuating between flare‐ups and periods of remission 9 . There is a growing acknowledgement that a significant proportion—up to 40%—of chronic pain in RA stems not from ongoing inflammation but from a dysregulated nervous system 10,11 . This dysregulation can be due to peripheral sensitisation or abnormalities in central processing within the spinal cord or brain, leading to increased pain sensitivity (hyperalgesia) and pain triggered by external stimuli that do not usually provoke pain (allodynia) 11,12 .…”

Section: Introductionmentioning

confidence: 99%

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Comparative analysis of centrally mediated and inflammatory pain experiences amongst patients diagnosed with rheumatoid arthritis: A multimethods study

Rutter‐Locher,

Esterine,

Williams

et al. 2024

Health Expectations

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BackgroundThe identification of pain originating from distinct biological processes may lead to individualised pain treatment. In this study, we aimed to explore the pain experiences of patients with rheumatoid arthritis (RA), differentiating between those predominantly exhibiting features of peripheral inflammatory versus centrally mediated pain.MethodsThrough a multimethods approach we (i) quantitatively analysed the differences in pain descriptors between patients diagnosed with RA experiencing peripheral inflammatory and centrally mediated pain, utilising the Short Form‐McGill Pain Questionnaire which includes the pain visual analogue scale (VAS) and (ii) qualitatively explored their subjective pain experiences grounded in the biopsychosocial model, commonly applied in chronic pain.ResultsParticipants with centrally mediated pain reported higher pain scores on the VAS, used a wider range of pain descriptors, and a higher proportion selected each descriptor compared to those with inflammatory pain (p < .001). The qualitative analysis revealed the centrally mediated pain group's experiences were overwhelming and relentless, struggling to precisely articulate the nature of their pain. In contrast, individuals with inflammatory pain expressed their pain in more tangible terms and shared their adaptive and coping strategies. Importantly, both groups revealed the substantial psychological, functional and social impacts of their pain, highlighting the often ‘invisible’ and misunderstood nature of their symptoms.ConclusionThis study has gained a deeper insight into the pain experiences of patients living with RA, particularly in differentiating between centrally mediated and inflammatory types of pain, potentially facilitating a more individualised approach to pain treatment.Patient ContributionPatients actively participated in the study conception and design. This engagement includes collaboration with key stakeholders, such as members of the National Rheumatoid Arthritis Society and Patient Research Partners (PRPs), who provided continuous feedback and guidance throughout the research process. Specifically, the qualitative element was coproduced with two PRPs, who were involved in co‐leading the focus groups and data analysis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparative analysis of centrally mediated and inflammatory pain experiences amongst patients diagnosed with rheumatoid arthritis: A multimethods study

Rutter‐Locher,

Esterine,

Williams

et al. 2024

Health Expectations

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Psychological distress over 12 months post-diagnosis in an early inflammatory arthritis cohort

Zhao,

Galloway,

Ledingham

et al. 2024

Rheumatology

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Objectives People with inflammatory arthritis (IA) experience worsened mental wellbeing alongside disease progression. Using the National Early Inflammatory Arthritis Audit (NEIAA), we assessed trends in psychological distress during 12-months following IA diagnosis, mapping these against clinical outcomes to identify associations. Methods This is a prospective study of people recruited to NEIAA receiving an IA diagnosis and completing the baseline patient survey. Patient reported outcomes (PROs) at baseline, 3-months and 12-months were collected, including psychological distress (assessed using Patient Health Questionnaire Anxiety and Depression Screener (PHQ4ADS)). Mixed effects linear regression models estimated associations between predictor variables with psychological distress at baseline and over time. Results Of 6,873 eligible patients, 3,451 (50.2%) showed psychological distress at baseline. Of those completing follow-ups, 30.0% and 24.1% were distressed at 3-months and 12-months, respectively. Higher psychological distress at diagnosis was more commonly reported by younger, female, and non-white patients. Clinical factors, including higher counts of comorbidities, prior depression, and higher disease activity at diagnosis were associated with higher distress. Higher distress at baseline was associated with poorer outcomes over time in quality of life, disability, work performance, disease activity, as well as reduced likelihood of achieving good treatment response by EULAR criteria. Conclusion Half of patients with IA show significant mental health comorbidity at presentation, which associated with worse disease outcomes and quality of life. Screening for anxiety and depression should be a universal standard, and access to effective mood therapies alongside arthritis treatments is essential. Strategies should be culturally valid and consider multi-morbidities.

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A randomised controlled trial of the effect of intra-articular lidocaine on pain scores in inflammatory arthritis

Rutter-Locher,

Norton,

Denk

et al. 2024

Pain

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Chronic pain in inflammatory arthritis (IA) reflects a complex interplay between active disease in a peripheral joint and central pronociceptive mechanisms. Because intra-articular lidocaine may be used to abolish joint-specific peripheral input to the central nervous system, we aimed to validate its use as a clinical tool to identify those patients with IA whose pain likely incorporates centrally mediated mechanisms. We began by investigating whether there was a placebo response of intra-articular injection in patients with IA 1:1 randomised to receive intra-articular lidocaine or control (0.9% saline). After, in a larger patient cohort not randomized to placebo vs lidocaine groups, we tested whether patients with IA could be stratified into 2 cohorts based on their response to intra-articular lidocaine according to markers of centrally mediated pain. To this end, we evaluated postlidocaine pain numerical rating scale (NRS) scores alongside baseline painDETECT, fibromyalgia criteria fulfillment, and quantitative sensory testing outcomes. Numerical rating scale scores were collected at baseline and 3-, 5-, and 10-minutes postinjection. Firstly, the placebo effect of intra-articular injection was low: compared to baseline, the mean pain NRS score 5-minutes postinjection was reduced by 3.5 points in the lidocaine group vs 1.2 points in the control group. Secondly, postlidocaine NRS scores were significantly higher in those with a high (>18) baseline painDETECT score, fibromyalgia, and low-pressure pain threshold at the trapezius (P = 0.002, P = 0.001, P = 0.005, respectively). Persistent high pain after intra-articular lidocaine injection could be used as an indicator of pronociceptive mechanisms that are centrally mediated, informing centrally targeted analgesic strategies.

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A systematic review and meta-analysis of questionnaires to screen for pain sensitisation and neuropathic like pain in inflammatory arthritis

Cited by 6 publications

References 52 publications

Comparative analysis of centrally mediated and inflammatory pain experiences amongst patients diagnosed with rheumatoid arthritis: A multimethods study

Comparative analysis of centrally mediated and inflammatory pain experiences amongst patients diagnosed with rheumatoid arthritis: A multimethods study

Psychological distress over 12 months post-diagnosis in an early inflammatory arthritis cohort

A randomised controlled trial of the effect of intra-articular lidocaine on pain scores in inflammatory arthritis

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