Prevalence of Central Sensitization in Patients With Hidradenitis Suppurativa

Abstract

ain is one of the most prominent and debilitating symptoms of hidradenitis suppurativa (HS) and has been incorporated as a domain in the newly developed core outcome set for HS. 1 The chronic, inflammatory, and painful nature of HS has been postulated to induce a process known as central sensitization (CS). 2 Central sensitization is an increased responsiveness of the pain perception pathway in the central nervous system to normal or subthreshold stimuli, altering and amplifying pain perception. 2 Symptoms of CS are not confined to pain and can include fatigue, memory loss, and sleep disturbances. 2 Moreover, several syndromes have been associated with CS. For example, fibromyalgia and irritable bowel syndrome are considered to share a common pathophysiological pathway, implicating neuronal hyperexcitability as the central mechanism. 2 The presence of CS in HS-associated inflammatory diseases, such as inflammatory bowel disease and rheumatic diseases, has been well established. 3,4 Therefore, the aim of this study was to assess the prevalence of central sensitization in patients with HS compared with age-and sex-matched controls. Methods Study DesignThis cross-sectional, survey-based, case-control study was performed at the Department of Dermatology of the Erasmus University Medical Center Rotterdam, in Rotterdam, the Netherlands, from February to November 2020. All consecutive, adult patients IMPORTANCE Chronic pain is one of the most prominent symptoms of hidradenitis suppurativa (HS) and an independent domain in the core outcome set for HS. Previously, the chronic, recurrent, inflammatory nature of HS was hypothesized to induce central sensitization (CS; alteration and amplification of pain perception). However, evidence for this hypothesis is currently lacking.OBJECTIVE To determine the prevalence of CS in patients with HS compared with sex-and age-matched controls. DESIGN, SETTING, AND PARTICIPANTSThis was a cross-sectional, survey-based, case-control study conducted from February to November 2020 that included all consecutive adult patients with HS attending the outpatient clinic of the Department of Dermatology of the Erasmus University Medical Center Rotterdam, in Rotterdam, the Netherlands. Age-and sex-matched controls without chronic inflammatory dermatologic diseases were recruited from the same department. MAIN OUTCOMES AND MEASURESThe main outcome was the Central Sensitization Inventory (CSI) score (ranging from 0-100) as a screening tool for presence of CS. Based on current literature, a score of 40 or higher was deemed to indicate the presence of CS. RESULTSOverall, 100 patients with HS (median [IQR] age, 34.5 [27.3-47.0] years; 71 [71%] female) and 100 controls (median [IQR] age, 33.5 [27.0-48.8] years; 71 [71%] female) were included, of which 36% and 12%, respectively, had a CSI score of 40 or higher (P < .001). Multivariate logistic regression showed that patients with HS had 4.46 (95% CI, 1.89-10.52; P = .001) times the odds of having a positive CSI compared with controls. In addition, CS ...

Elucidation of Pain Mechanisms in Hidradenitis Suppurativa

“…However, surveybased studies have suggested that central sensitization and neuropathic pain also contribute to the pain experience of patients with HS. 1,5,11,12 Strategies for HS Pain Management…”

A practical, comprehensive guide to pain management hidradenitis suppurativa

“…Pain associated with HS can be categorized into nociceptive, neuropathic, and nociplastic pain, each of which may require distinct treatment strategies 15,24–26 . HS pain has traditionally been considered to be nociceptive.…”

“…Neuropathic 24,25 and nociplastic 26 pain may also play an important role in HS pain. Neuropathic pain arises from sensory nerve dysfunction and often follows a segmental or peripheral distribution pattern as pain radiates along the course of the nerve.…”

Scientific Knowledge Graph and Trend Analysis of Central Sensitization: A Bibliometric Analysis

“…CS can be present in many conditions with chronic pain, including fibromyalgia, 6 endometriosis, 7 chronic low back pain, 8 , 9 hidradenitis suppurativa, 10 osteoarthritis, 6 , 11 rheumatoid arthritis and chronic migraine. 12 Besides, complex regional pain syndrome (CRPS), also known as Sudeck’s atrophy, is also highly associated with CS and is characterized by significant autonomic and inflammatory features.…”