Widespread Pressure Pain Hypersensitivity in Patients With Multiple Sclerosis With and Without Pain as Sign of Central Sensitization

Fernández‐de‐las‐Peñas, César; Ortega‐Santiago, Ricardo; Ortiz-Gutiérrez, Rosa María; Caminero, Ana B.; Salom‐Moreno, Jaime; Arendt-Nielsen, Lars

doi:10.1097/ajp.0000000000000084

Cited by 20 publications

(15 citation statements)

References 31 publications

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“…This theory was previously supported by our group, who used an algometer to measure the thermal and discomfort thresholds and demonstrated significantly lower values in MS patients than healthy controls, irrespectively of the presence of pain [5]. These data have also been recently confirmed by Fernández et al, who demonstrated widespread pressure pain hypersensitivity even in MS patients without pain [6]. The broad categories of MS-related pain are the central neuropathic pain, which include the most common dysesthetic extremity pain, musculoskeletal pain, including back pain, painful tonic spasms and headache; pain in MS can be paroxystic, acute or chronic [7].…”

Section: Introductionsupporting

confidence: 72%

Chronic Pain in Multiple Sclerosis Patients: Utility of Sensory Quantitative Testing in Patients with Fibromyalgia Comorbidity

et al. 2015

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Background: Lower thermal and discomfort thresholds may predispose multiple sclerosis (MS) patients to chronic pain, but a possible effect of fibromyalgia (FM) comorbidity has never been investigated. Aims were to investigate the thermal and discomfort thresholds in the evaluation of pain intensity between MS patients with FM (PFM+) and MS patients with pain not associated to FM (PFM−). Methods: One hundred thirty three MS patients were investigated for chronic pain. FM was assessed according to the 1990 ACR diagnostic criteria. An algometer was used to measure the thresholds in the patients and 60 matched healthy subjects. Results: Chronic pain was present in 88 (66.2%) patients; 12 (13.6%) had neuropathic pain, 22 (17.3%) were PFM+ and 65 (48.9%) PFM−. PFM+ were predominantly female (p = 0.03) and had a greater EDSS (p = 0.01) than NoP; no other significant differences emerged than PFM−. The thresholds were lower in MS patients than controls (p < 0.01), mainly in the PFM+. FM severity influenced the thermal threshold (p < 0.001), while the female gender influenced the discomfort threshold (p < 0.001). Conclusion: Thermal and discomfort thresholds were lower in patients than controls and were the lowest in PFM+. Their more severely impaired thermal threshold supports a neurophysiological basis of such association.

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Section: Introductionsupporting

confidence: 72%

Chronic Pain in Multiple Sclerosis Patients: Utility of Sensory Quantitative Testing in Patients with Fibromyalgia Comorbidity

et al. 2015

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“…These results show that overactive endogenous pain facilitation is characteristic of pain symptoms in CFS, but not in MS. This is consistent The presence of widespread hyperalgesia in people with CFS is not a novel finding (10,26,27), but this aspect of pain has only recently been reported in people with MS (12). The exact mechanisms underlying pain and widespread hyperalgesia in MS have not been elucidated.…”

Section: Discussionsupporting

confidence: 62%

“…Similarities and differences in pain experienced by patients with CFS or MS have yet to be explored as a potential means of gaining insight into the causal background of pain symptoms. In particular, central sensitization, i.e., increased excitability of the central nervous system, has been demonstrated in CFS (10,11), and has been posited to play a role in MS, albeit on the basis of one study which reported widespread hyperalgesia in patients with MS (12). Central sensitization is characterized by impaired endogenous pain inhibition (13) and overactive endogenous pain facilitation (14).…”

mentioning

confidence: 99%

Endogenous Pain Facilitation Rather Than Inhibition Differs Between People with Chronic Fatigue Syndrome, Multiple Sclerosis, and Controls: An Observational Study

Collin

Nijs²,

Meeus³

et al. 2017

Pain Phys

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Background: Commonalities in the core symptoms of fatigue and cognitive dysfunction experienced by chronic fatigue syndrome (CFS, also known as ME) and multiple sclerosis (MS) patients have been described. Many CFS and MS patients also experience chronic pain, which has been attributed to central sensitization in both groups of patients. However, the characteristics of pain in CFS and MS patients have not been compared. Objectives: To compare experimental pain measurements in patients with CFS or MS and healthy controls. Study design: Observational study. Setting: This study took place in Belgium at Vrije Universiteit Brussel and the University of Antwerp. Methods: Pressure pain thresholds, temporal summation, conditioned pain modulation, and occlusion cuff pressure thresholds rated as painful (1st cuff pressure threshold) and as 3/10 on a verbal numerical scale (2nd cuff pressure threshold) were measured in patients with CFS (n = 48), MS (n = 19) and healthy pain-free controls (n = 30). Adjusted between-group differences were estimated using linear regression models. Results: Finger pain pressure thresholds of patients with CFS, compared with patients with MS, were 25% lower (difference ratio 0.75 [95% CI 0.59, 0.95], P = 0.02) and shoulder pain pressure thresholds were 26% lower (difference ratio 0.74 [0.52, 1.04], P = 0.08). Compared with patients with MS, patients with CFS had 29% lower first cuff pressure threshold (difference ratio 0.71 [0.53, 0.94], P = 0.02) and 41% lower 2nd cuff pressure threshold (0.59 [0.41, 0.86], P = 0.006). Finger temporal summation was higher in patients with CFS than in patients with MS (mean difference 1.15 [0.33, 1.97], P = 0.006), but there were no differences in shoulder temporal summation or conditioned pain modulation at either site. Differences between patients with CFS and MS tended to be greater than between either patient group and healthy controls. Pain pressure thresholds and cuff pressure thresholds tended to be positively correlated, and temporal summation negatively correlated, with higher physical function and lower fatigue in both groups of patients. Subjective pain in patients with CFS but not in patients with MS was strongly negatively correlated with pain pressure thresholds and cuff pressure thresholds, and positively correlated with temporal summation. Limitations: The main limitations of our study are the relatively small sample sizes, its crosssectional design, and its exploratory nature. Conclusions: We found differences in the characteristics of pain symptoms reported by patients with CFS and patients with MS, which suggest different underlying mechanisms. Specifically, overactive endogenous pain facilitation was characteristic of pain in patients with CFS but not in patients with MS, suggesting a greater role for central sensitization in CFS. Keywords: Chronic fatigue syndrome, CFS/ME, multiple sclerosis, experimental pain, central sensitization

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“…Central Sensitization has been most often identified with fibromyalgia, and associated chronic widespread pain and sensitivity, with no observable pathology or nociceptive etiology. However, CS has also been identified in subsets of patients with clear evidence of tissue trauma, pathology, and/or nociceptive components, including multiple sclerosis (Fernández‐de‐las‐Peñas et al., ), osteoarthritis (Akinci et al., ; Lluch, Torres, Nijs, & Van Oosterwijck, ), rheumatoid arthritis (Meeus et al., ), and post‐surgical breast cancer (Fernández‐Lao et al., ). Interestingly CS has also been tied to various other conditions in which pain is not a primary symptom, including post‐traumatic stress disorder, multiple chemical sensitivity, restless leg syndrome (Yunus, , ) over‐active bladder (Reynolds, Dmochowski, Wein, & Bruehl, ), and chronic hives (Torresani, Bellafiore, & De Panfilis, ), suggesting that CS may not only be associated with pain hypersensitivity but can also involve hypersensitivity to other stimuli, including lights, sounds, fragrances, skin irritants, bodily sensations, and stress‐evoking life events (Nijs, Goubert, & Ickmans, ; Yunus, , ).…”

Section: Central Sensitizationmentioning

confidence: 99%

The central sensitization inventory: A user’s manual

Neblett

2018

J Appl Biobehavioral Res

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The Central Sensitization (CSI) Inventory was introduced in 2012. It was initially intended as a screener to help identify when presenting symptoms may be related to central sensitization or indicate the presence of a central sensitivity syndrome. It has now been translated and validated in a number of European, Asian, and South American languages. This article provides an overview of CSI rationale, development, recommended uses, and research results, including evidence of validity and reliability, in clinical and non‐clinical subject samples.

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Widespread Pressure Pain Hypersensitivity in Patients With Multiple Sclerosis With and Without Pain as Sign of Central Sensitization

Cited by 20 publications

References 31 publications

Chronic Pain in Multiple Sclerosis Patients: Utility of Sensory Quantitative Testing in Patients with Fibromyalgia Comorbidity

Chronic Pain in Multiple Sclerosis Patients: Utility of Sensory Quantitative Testing in Patients with Fibromyalgia Comorbidity

Endogenous Pain Facilitation Rather Than Inhibition Differs Between People with Chronic Fatigue Syndrome, Multiple Sclerosis, and Controls: An Observational Study

The central sensitization inventory: A user’s manual

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