Pain: Understanding and challenges for the rheumatologist

Fitzcharles, Mary Ann; Al-Mahrezi, Abdulaziz; Shir, Yoram

doi:10.1002/art.21435

Cited by 45 publications

(31 citation statements)

References 65 publications

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“…First, it showed the correlation between the painDETECT questionnaire and clinical data, BASDAI and BASFI scores, and quality of life. This gives insight into the origin of pain in AS patients, and also the effect of NP on the daily life (42). Another strength of our study was excluding patients with comorbidities, including obesity, fibromyalgia, diabetes mellitus, smoking, and secondary osteoarthritis, which might exacerbate pain in AS (43).…”

Section: Discussionmentioning

confidence: 98%

e association of neuropathic pain and disease activity, functional level, and quality of life in patients with ankylosing spondylitis: a cross-sectional study

2018

Turk J Med Sci

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Background/aim: Increased neuropathic pain (NP) symptoms are seen in rheumatologic diseases such as fibromyalgia, osteoarthritis, and rheumatoid arthritis, but no studies have demonstrated a relationship between ankylosing spondylitis (AS) and NP except for a brain imaging study. The aim of this study was to estimate the presence of NP in patients with AS and to investigate how NP was related to disease activity, functional status, and quality of life.Materials and methods: A total of 100 AS patients (71 males and 29 females; median age: 37 years, range: 18-71 years) were included in the study. Pain (visual analog scale (VAS) and the painDETECT questionnaire), disease activity (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Patient Global Assessment of Disease Activity (PGA), and Ankylosing Spondylitis Disease Activity Score (ASDAS)), functional level (Bath Ankylosing Spondylitis Functional Index (BASFI)), and health-related quality of life (36-Item Short Form Survey (SF-36)) were evaluated. Patients were divided into two groups. Group 1 included patients with possible or likely NP symptoms (painDETECT score of ≥13) and Group 2 included patients without NP symptoms (painDETECT score of <13).Results: Low back pain-VAS, peripheral joint-VAS, BASDAI, PGA, ASDAS, and BASFI scores were significantly higher in Group 1 compared to those of Group 2 (P < 0.05). The SF-36 physical component (PC) score was significantly lower in Group 1 compared to that of Group 2 (P < 0.05). There were no significant differences between the groups regarding SF-36 mental component (MC) scores, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) values and MASES scores. Total painDETECT scores correlated positively with low back pain-VAS, peripheral joint-VAS, morning stiffness-VAS, BASDAI, ASDAS-CRP, ASDAS-ESR, PGA, BASFI, and MASES scores and ESR values, and inversely with SF-36 PC scores. Conclusion:Our results suggest that AS patients should be evaluated in terms of NP in order not to underestimate NP. If clinicians find evidence of likely NP, they should treat the patient with drugs that target NP.

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Section: Discussionmentioning

confidence: 98%

e association of neuropathic pain and disease activity, functional level, and quality of life in patients with ankylosing spondylitis: a cross-sectional study

2018

Turk J Med Sci

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“…This is caused by the activation and sensitization of nociceptive nerve fibers ("pain fibers") that supply the joint (6,7), and the ensuing activation of the central nociceptive system (8,9). Pain reduction in the course of antiinflammatory therapy might simply result from an attenuation of inflammatory processes.…”

Section: Discussionmentioning

confidence: 99%

Antinociceptive effects of tumor necrosis factor α neutralization in a rat model of antigen‐induced arthritis: Evidence of a neuronal target

Boettger¹,

Hensellek²,

Richter³

et al. 2008

Arthritis & Rheumatism

147

138

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Objective. The reduction of pain in the course of antiinflammatory therapy can result from an attenuation of the inflammatory process and/or from the neutralization of endogenous mediators of inflammation that act directly on nociceptive neurons. The purpose of this study was to investigate whether analgesic effects of the neutralization of tumor necrosis factor ␣ (TNF␣) are due to an attenuation of inflammation or whether direct neuronal effects significantly contribute to pain relief in the course of therapy.Methods. Locomotor and pain-related behavior and histology were assessed in rats with chronic antigen-induced arthritis (AIA) in the knee joint, and the rats were treated with systemic saline, etanercept, or infliximab. The expression of TNF receptors (TNFRs) in dorsal root ganglia was measured using immunohistochemical analysis and polymerase chain reaction. Action potentials were recorded from afferent A␦ fibers and C fibers of the medial knee joint nerve, and etanercept and infliximab were injected intraarticularly into normal or inflamed knee joints (AIA or kaolin/ carrageenan-induced inflammation).Results. In rats with AIA, both etanercept and infliximab significantly decreased inflammationinduced locomotor and pain-related behavior, while joint swelling was only weakly attenuated and histomorphology still revealed pronounced inflammation. A large proportion of dorsal root ganglion neurons showed TNFRI-and TNFRII-like immunoreactivity. Intraarticular injection of etanercept reduced the responses of joint afferents to mechanical stimulation of the inflamed joint starting 30 minutes after injection, but had no effect on responses to mechanical stimulation of the uninflamed joint. Conclusion. Overall, these data show the pronounced antinociceptive effects of TNF␣ neutralization, thus suggesting that reduction of the effects of TNF␣ on pain fibers themselves significantly contributes to pain relief.

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“…In an effort to cope with pain and discomfort of daily life, many patients seek complementary or alternative medications (e.g. dietary supplements) [6].…”

Section: Introductionmentioning

confidence: 99%

“…Nociceptive PGE 2 is a key pro-inflammatory modulator [3], and inhibition of this biomarker can be utilised to predict drug effects [18]. While clinical evaluation of pain remains subjective, it should not be ignored [6]. Visual analogue scale (VAS) scores together with HRQOL are widely used in this context.…”

Section: Introductionmentioning

confidence: 99%

A randomized double blind comparison of short-term duodenally administrated whale and seal blubber oils in patients with inflammatory bowel disease and joint pain

Bjørkkjær

Araujo²,

Madland

et al. 2009

Prostaglandins, Leukotrienes and Essential Fatty Acids

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Pain: Understanding and challenges for the rheumatologist

Cited by 45 publications

References 65 publications

e association of neuropathic pain and disease activity, functional level, and quality of life in patients with ankylosing spondylitis: a cross-sectional study

e association of neuropathic pain and disease activity, functional level, and quality of life in patients with ankylosing spondylitis: a cross-sectional study

Antinociceptive effects of tumor necrosis factor α neutralization in a rat model of antigen‐induced arthritis: Evidence of a neuronal target

A randomized double blind comparison of short-term duodenally administrated whale and seal blubber oils in patients with inflammatory bowel disease and joint pain

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