The role of sleep problems in central pain processing in rheumatoid arthritis
Open Access
- 1 November 2012
- journal article
- research article
- Published by Wiley in Arthritis & Rheumatism
- Vol. 65 (1), 59-68
- https://doi.org/10.1002/art.37733
Abstract
Objective Among rheumatoid arthritis (RA) patients, the intensity of pain may be out of proportion to the severity of peripheral inflammation. This observation suggests that mechanisms of central nervous system pain amplification, such as diminished conditioned pain modulation (CPM), may play a role in enhancing pain perception among some RA patients. This study was undertaken to examine the level of CPM, pressure–pain threshold, and pressure–pain tolerance among RA patients compared to healthy controls. Methods Fifty‐eight female RA patients and 54 age‐matched female control subjects without chronic pain underwent quantitative sensory testing (QST) to assess CPM levels, pressure–pain thresholds, and pressure–pain tolerance levels. CPM was induced using a cold water bath, and the pain threshold (when patients first felt pain) and pain tolerance (when pain was too much to bear) were assessed with an algometer. Associations between RA and each QST outcome were analyzed using linear regression. Sleep problems, mental health, and inflammation were assessed as mediators of the relationship between RA and QST outcomes. Results The median CPM level was 0.5 kg/cm2 (interquartile range [IQR] −0.1, 1.6) among RA patients, compared to a median of 1.5 kg/cm2 (IQR −0.1, 2.5) among controls (P = 0.04). RA patients, compared to controls, had a lower pain threshold and lower pain tolerance at the wrists (each P ≤ 0.05). In addition, RA patients had greater problems with sleep, pain catastrophizing, depression, and anxiety (P < 0.0001 versus controls). Results of mediation analyses suggested that low CPM levels might be attributed, in part, to sleep disturbance (P = 0.04). Conclusion RA patients have impaired CPM when compared to pain‐free control subjects. Sleep problems may mediate the association between RA and attenuated CPM.Keywords
This publication has 42 references indexed in Scilit:
- The contribution of pain and depression to self-reported sleep disturbance in patients with rheumatoid arthritisPain, 2012
- The role of the central nervous system in the generation and maintenance of chronic pain in rheumatoid arthritis, osteoarthritis and fibromyalgiaArthritis Research & Therapy, 2011
- Pain persists in DAS28 rheumatoid arthritis remission but not in ACR/EULAR remission: a longitudinal observational studyArthritis Research & Therapy, 2011
- Sensitization in patients with painful knee osteoarthritisPain, 2010
- Situational Versus Dispositional Measurement of Catastrophizing: Associations With Pain Responses in Multiple SamplesThe Journal of Pain, 2010
- Moderators of the Negative Effects of Catastrophizing in ArthritisPain Medicine, 2010
- Sleep continuity and architecture: Associations with pain‐inhibitory processes in patients with temporomandibular joint disorderEuropean Journal of Pain Supplements, 2009
- Enhanced reactivity to pain in patients with rheumatoid arthritisArthritis Research & Therapy, 2009
- The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis: a cross-sectional studyArthritis Research & Therapy, 2009
- Modified disease activity scores that include twenty-eight-joint counts development and validation in a prospective longitudinal study of patients with rheumatoid arthritisArthritis & Rheumatism, 1995