Central Sensitization and Chronic Pain Personality Profile: Is There New Evidence? A Case-Control Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
- Radiological and clinical diagnosis of knee OA based on the American College of Rheumatology (ACR) criteria, affecting at least one knee with a minimum of 3 months of symptom duration prior to screening.
- Male or female (nonchildbearing potential) at least 45 years old.
- A minimum of 4 out of 10 on the numerical rating scale (item 5 of Brief Pain Inventory) at screening and/or a requirement for the use of an analgesic for the knee pain.
- Clinical evidence of pain or altered sensations spread beyond the knee joint by manual palpation in the baseline rheumatologist assessment.
- At least 3 tender points in the extended version of the Arendt–Nielsen peripatellar map (excluding points 3, 7, and 8, which are part of the joint itself). A tender point is defined as a point showing a pressure pain threshold below 4 kg/cm2 [34].
- A pain score of 4 points or more in an 11-point verbal scale during a 2 s, 4 kg/cm2 pressure stimulation on the anterior surface of the tibial bone.
- Presence of temporal summation (increase of more than 1 point in an 11-point verbal scale after 10 repeated pressure stimulation at 1 s interstimulus intervals) on the most sensitive site of the peripatellar region [11].
- Diagnosis of FM following the ACR criteria [34].
- History of widespread nonarticular pain with insidious onset primary over 3 months.
- One year minimum of disease evolution.
- Absence of comorbid chronic fatigue syndrome.
- No history of rheumatic disorder, no history of functional pain or physical widespread pain.
- No history of Axis I or II psychiatric illness and no history of neurological disease.
2.2. Procedure
2.3. Assessment
- Novelty-seeking (NS), defined as the inclination to respond impulsively to novel stimuli with active avoidance of frustration.
- Harm-avoidance (HA) as the tendency to inhibit responses to aversive stimuli leading to avoidance of punishment.
- Reward dependence (RD) as the predisposition to answer to signals of reward.
- Persistence (PS) as the tendency to perseverance despite frustration and fatigue.
- Self-directedness (SD), which refers to the ability to control, regulate, and adapt behavior to fit the situation.
- Cooperativeness (CO), which is related to acceptance of other people.
- Self-transcendence (ST), which is viewed as the identification with everything conceived as essential and consequential parts of a unified whole.
- Exploratory excitability (NS1), impulsiveness (NS2), extravagance (NS3), and disorderliness (NS4).
- HA: Anticipatory worry (HA1), fear of uncertainty (HA2), shyness with strangers (HA3), and fatigability (HA4).
- RD: Sentimentality (RD1), openness to warm (RD2), attachment (RD3), and dependence (RD4).
- PS: Eagerness of effort (PS1), work-hardened (PS2), ambitious (PS3), and perfectionist (PS4).
- Responsibility (SD1), purposefulness (SD2), resourcefulness (SD3), self-acceptance (SD4), and enlightened second nature (SD5).
- CO: Social acceptance (C1), empathy (C2), helpfulness (C3), compassion (C4), pure-hearted conscience (C5).
- ST: Self-forgetful (ST1), transpersonal identification (ST2), and spiritual acceptance (ST3).
2.4. Data Analysis
3. Results
OA Patients versus Controls and FM Patients versus OA-noCS Patients
4. Discussion
- The sample size is small, especially for the OA-CS group. Given the size of the sample, we were not able to carry out an analysis that differentiates between gender and age.
- External validity is limited by the sample size, even though the sample is very specific and restrictive, with the inclusion/exclusion criteria. For example, FM patients showed no chronic fatigue, which is a very common characteristic.
- The FM group was not divided into potential subgroups of patients according to severity; for example, there are few studies that show evidence in this field. Thus, it is complicated to find previous studies to compare our results with others.
- The effects of other symptoms of central sensitization that may be present in these patients, such as migraine, irritable bowel syndrome, or low back pain, have not been studied in OA groups due to the small sample size.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Groups | |||||
---|---|---|---|---|---|
Factors | OA | OA-CS | OA-noCS | FM | Control |
N | 46 | 15 | 31 | 47 | 22 |
Gender (women %) | 71.7 | 84.2 | 65.9 | 100 | 59.3 |
Age ((SD)) | 66.67 (7.78) | 66.37 (8.77) | 66.8 (7.39) | 46.47 (7.92) | 62.92 (7.39) |
Months after diagnosis ( ± SD) | 55.28 (63.34) | 50.58 (54.09) | 57.46 (67.71) | 84.38 (54.14) | - |
Educational level (%) | |||||
Uneducated | 6.7 | 10.5 | 4.9 | 0 | 0 |
Primary education | 21.7 | 26.3 | 19.5 | 10.6 | 26.9 |
Secondary education | 15 | 10.6 | 17.1 | 21.3 | 12.1 |
General education | 5 | 10.5 | 2.4 | 12.8 | 7.4 |
Vocational education and training and/or Higher education | 31.7 | 36.8 | 29.3 | 17 | 30.6 |
Bachelor and/or University Degree | 20 | 5.3 | 26.8 | 38.3 | 23 |
Drug use (%) | |||||
Painkiller | 50 | 16 | 34 | 16 | 0 |
Non-steroidal Anti-inflammatory drugs (NSAIDs) | 51 | 16 | 35 | 17 | 2 |
Antiepileptic drugs | 2 | 0 | 2 | 4 | 3 |
Antidepressant drugs | 14.9 | 15.8 | 19.5 | 85.7 | 7.4 |
Questionnaires | |||||
FIQ | - | - | 65.99 (14.01) | - | |
Mini-Mental: 27.61 (2.68) | 26.82 (3.17) | 28 (2.36) | - | 27.5 (2.45) |
Group | ||||||
---|---|---|---|---|---|---|
TCI-R Dimensions | OA-noCS (n = 15) Mean (SD) | OA-CS (n = 31) Mean (SD) | FM (n = 47) Mean (SD) | C (n = 22) Mean (SD) | K–W Test p | Cronbach’s Alpha |
Novelty-seeking | 45.58 (27.53) | 39.00 (29.25) | 36.21 (22.33) | 43.68 (24.25) | 0.379 | 0.43 |
Harm-avoidance * | 53.61 (30.30) | 43.80 (30.44) | 85.85 (15.17) | 43.27 (30.29) | <0.001 * | 0.77 |
Reward dependence | 57.94 (22.80) | 51.13 (24.62) | 55.15 (27.89) | 42.09 (32.94) | 0.227 | 0.64 |
Persistence | 39.03 (28.15) | 50.8 (32.94) | 41.13 (30.58) | 42.05 (26.07) | 0.675 | 0.77 |
Self-directedness | 55.71 (28.03) | 63.67 (31.40) | 45.98 (30.27) | 55.36 (29.63) | 0.178 | 0.74 |
Cooperativeness | 58.55 (30.84) | 52.87 (32.39) | 53.74 (27.88) | 52.95 (29.05) | 0.817 | 0.71 |
Self-transcendence | 60.71 (30.03) | 54.87 (35.32) | 49.26 (30.07) | 62.91 (32.82) | 0.275 | 0.78 |
Group | |||||
---|---|---|---|---|---|
TCI-R Temperamental Profile | OA (n = 46) n (%) | OA-CS (n = 15) n (%) | OA-noCS (n = 31) n (%) | FM (n = 47) n (%) | C (n = 22) n (%) |
Methodical | 8 (17.4) | 4 (26.7) | 4 (12.9) | 14 (29.8) | 3 (13.6) |
Cautious | 8 (17.4) | 2 (13.3) | 6 (19.4) | 17 (36.2) | 3 (13.6) |
Explosive | 6 (13) | 0 | 6 (19.4) | 8 (17.0) | 2 (9.1) |
Sensitive | 2 (4.3) | 0 | 2 (6.5) | 7 (14.9) | 1 (4.5) |
Passionate | 8 (17.4) | 3 (20) | 5 (16.1) | 1 (2.1) | 4 (18.2) |
Independent | 3 (6.5) | 1 (6.7) | 2 (6.5) | 0 | 8 (36.4) |
Adventurous | 3 (6.5) | 2 (13.3) | 1 (3.2) | 0 | 0 |
Reliable | 8 (17.4) | 3 (20) | 5 (16.1) | 0 | 1 (4.5) |
Chi-square = 61.116, p < 0.001. | |||||
TCI-R Personality Disorders | OA (n = 46) n(%) | OA-CS (n = 15) n(%) | OA-noCS (n = 31) n(%) | FM (n = 47) n(%) | C (n = 22) n(%) |
Absent | 30 (66.7) | 12 (80) | 18 (60) | 28 (63.6) | 16 (72.7) |
Obsessive | 5 (11.1) | 3 (20) | 2 (6.7) | 7 (15.9) | 1 (4.5) |
Avoidant | 3 (6.7) | 0 | 3 (10) | 4 (9.1) | 0 |
Borderline | 3 (6.7) | 0 | 3 (10) | 3 (6.8) | 2 (9.1) |
Passive–aggressive | 1 (2.2) | 0 | 1 (3.3) | 2 (4.5) | 0 |
Histrionic | 2 (4.4) | 0 | 2 (6.7) | 0 | 0 |
Antisocial | 1 (2.2) | 0 | 1 (3.3) | 0 | 3 (13.6) |
Chi-square = 24.261, p = 0.147 |
OA vs. C | |||
---|---|---|---|
ORadj (95% CI) | (ORadj − 1) × 100 | p | |
Reward Dependence (RD) | 1.079 (1.079–1.153) | 7.9% (7.9–15.3%) | 0.024 |
FM vs. OA-noCS | |||
ORadj (95% CI) | (ORadj − 1) × 100 | p | |
Harm Avoidance (HA) | 1.332 (1.042–1.702) | 33.2% (4.2–70.2%) | 0.022 |
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Lopez-Ruiz, M.; Doreste Soler, A.; Pujol, J.; Losilla, J.-M.; Ojeda, F.; Blanco-Hinojo, L.; Martínez-Vilavella, G.; Gutiérrez-Rosado, T.; Monfort, J.; Deus, J. Central Sensitization and Chronic Pain Personality Profile: Is There New Evidence? A Case-Control Study. Int. J. Environ. Res. Public Health 2023, 20, 2935. https://doi.org/10.3390/ijerph20042935
Lopez-Ruiz M, Doreste Soler A, Pujol J, Losilla J-M, Ojeda F, Blanco-Hinojo L, Martínez-Vilavella G, Gutiérrez-Rosado T, Monfort J, Deus J. Central Sensitization and Chronic Pain Personality Profile: Is There New Evidence? A Case-Control Study. International Journal of Environmental Research and Public Health. 2023; 20(4):2935. https://doi.org/10.3390/ijerph20042935
Chicago/Turabian StyleLopez-Ruiz, Marina, Andrea Doreste Soler, Jesus Pujol, Josep-Maria Losilla, Fabiola Ojeda, Laura Blanco-Hinojo, Gerard Martínez-Vilavella, Teresa Gutiérrez-Rosado, Jordi Monfort, and Joan Deus. 2023. "Central Sensitization and Chronic Pain Personality Profile: Is There New Evidence? A Case-Control Study" International Journal of Environmental Research and Public Health 20, no. 4: 2935. https://doi.org/10.3390/ijerph20042935