Prevalence of Migraine and Neuropathic Pain in Rheumatic Diseases

Abstract

To investigate the physiopathology of pain in chronic inflammatory rheumatic diseases (CIRDs), we assessed the prevalence of migraine and neuropathic pain in 499 patients with CIRDs. We studied 238 patients with rheumatoid arthritis, 188 with spondyloarthritis (SpA), 72 with psoriatic arthritis (PsA), and 1 unclassified. Migraine was diagnosed according to IHS migraine diagnostic criteria. Neuropathic pain was diagnosed when patients scored at least 3 on the DN4 questionnaire. Participants completed a validated self-assessment questionnaire. Migraine prevalence was 34% (165/484), and it was highest in PsA. Risk factors for migraine were a high level of anxiety, female sex, young age, and TNF-alpha inhibitor treatment (OR = 1.90 (1.13–3.25)). Besides, high disease activity was a risk factor in SpA. Blood CRP level was not significantly associated with migraine. Of 493 patients with CIRDs, 21.5% had chronic pain with neuropathic characteristics. Compared to the French general population, these patients had significantly higher prevalences of migraine (two-fold) and neuropathic pain (three-fold). This study showed that migraine and neuropathic pain frequently occurred in patients with rheumatic diseases. Therefore, upon reporting residual pain, these patients should be checked for the presence of migraine or neuropathic pain, despite adequate clinical control of rheumatic disease.

Cellular and Molecular Machinery of Neuropathic Pain: an Emerging Insight

“…This is accompanied by the inflammation and further infiltration mediated differentiation in nerve cells [ 26.• ]. Whereas in final stage, chemotherapy-induced neuropathic pain (CINP) has been shown a negative impact on PNS via chemotherapeutic drugs as paclitaxel, and oxaliplatin has been reported with major incidences [ 27 ]. Initial chemotherapeutic treatment produces acute pain followed by repetitive treatment cycles to cause chronic neuropathic pain [ 28 ].…”

Autoimmune regulation of chronic pain

“… 114 , 115 , 162 Beyond joint pain, patients with rheumatic diseases also report higher incidences of both migraine and neuropathic pain despite clinical control of inflammation-related symptoms. 111 Identifying how pain arises in rheumatoid arthritis separate from ongoing inflammation could provide new avenues for clinically relevant pain relief.…”

Patient-Centered Care in Psoriatic Arthritis—A Perspective on Inflammation, Disease Activity, and Psychosocial Factors

“…Pain is a major complaint in a variety of rheumatic musculoskeletal conditions [ 45 ] that can impair physically and carries a negative socioeconomic and psychological burden [ 46 ]. It represents a core outcome for trial and observational studies [ 47 ].…”

“…It represents a core outcome for trial and observational studies [ 47 ]. In PsA, bodily pain is more common than in RA [ 48 ] and 20–30% of patients may experience widespread pain (without fibromyalgia) [ 49 ] or neuropathic pain [ 45 , 50 , 51 ]. Even among patients receiving biological agents, pain remains a common finding that is tied to impaired physical function, QoL, and productivity measures [ 52 ].…”