Investigation of Central Sensitization Frequency and Related Factors in Axial Spondyloarthritis Patients

Summary

The term axial spondyloarthritis (axSpA) describes a group of chronic inflammatory diseases that characterized with spinal involvement. AxSpA is one of the most common rheumatic diseases and chronic pain and morning stiffness are the main complaints of these patients. Central sensitization is defined as increased response to normal or sub-threshold stimuli of central nervous system and its close relationship with many rheumatological diseases has been demonstrated in several studies. Pain in axSpA patients is generally considered as a result of increased inflammatory burden and structural changes, However, failure to adequate analgesia in every patient whose inflammation is suppressed with anti-inflammatory treatment suggests new pain mechanisms. Central sensitization (CS) is one of these mechanisms and its recognition is only possible by detailed evaluation of the patient. There is no method for the diagnosis of central sensitization is accepted as a gold standard. clinical scales and quantitative sensory testing (QST) widely is used for this purpose widely. The most commonly used QST types include pressure pain threshold (PPT), temporal summation (TS) and conditioned pain modulation (CPM). The well-known scale used for the evaluation of central sensitization is the Central Sensitization Inventory , developed by Mayer et.al in 2011 for detect central sensitization in chronic pain patients. The aim of this study is to evaluate the frequency of central sensitization (CS) in patients with axSpA by means of clinical scales and quantitative sensory testing (QST), to examine related comorbidities and the parameters associated with the development of sensitization in these patients.

Conditions

• Axial Spondyloarthritis
• Central Sensitisation

Interventions

DIAGNOSTIC_TEST

Pressure pain threshold

The PPT assessments of spine will be performed over the spinous process and 2 cm right and left side of the corresponding spinous process. The regional PPT scores will be composed from sum of all PPT values for related segments at spine. The sacroiliac PPT scores will be obtained bilaterally from four measurement points; the first point is located 1 cm medially and caudally from spina iliaca posterior superior (SIPS) and 3 more laterally, medially and cranially.The left trapezius muscle will be used to evaluate distant control point .The 1 cm2 algometer probe will be placed vertically in the each selected point and pressure will be increased with 0.1 kg/sc until the participant reporting pressure became painful. The pressure value at which the pain is first felt will be accepted as the PPT of that point.

DIAGNOSTIC_TEST

Temporal summation

TS will be evaluated over the trapezius muscle, sacroiliac joints, C7, T6, and L3 levels at spine with manuel algometer. TS scores will be calculated for each spine level as the sum of three values which measured over the spinous process and 2 cm right and left side of corresponding level. In the evaluation of TS, a pressure as much the PPT value of each point will be applied with pain pressure algometer ten times with a 1-second interstimulus interval. Patients will be asked to rate their pain using on a 0 to 10 visual analogue scale (VAS) at 0, 5, and 10 seconds. TS will be calculated by subtracting the rating at 0 seconds from the rating at 10 seconds. The point that is located 1 cm medially and caudally from SIPS was used for SI joint TS measurement on both sides.

DIAGNOSTIC_TEST

Conditioned pain modulation

First stimulus will be applied to trapezius with the pressure that induced a pain intensity of 4 point on a 10 point VAS as called a test stimulus. After that the right hand of the patient will be immersed in 70C water for 20 seconds to create a conditioning stimulus. Second test stimulus with the same intensity of first one will be applied to trapezius after the conditioning stimulus and patients will be asked to rate their pain. If the patients cannot hold their hand in the water for 20 seconds, the test stimulus will be applied immediately after the patients removed their hands out of water. The ratio between the first and second VAS values multiplied by 100 will be defined as CPM score

DIAGNOSTIC_TEST

Central Sensitization Inventory

Standardized questionnaire to determine the level of central sensitization

OTHER

Bath Ankylosing Spondylitis Disease Activity Index

Standardized questionnaire to determine the level of disease activity in AxSpa patients

OTHER

Ankylosing Spondylitis Quality of Life

Standardized questionnaire to investigate the quality of life in AxSpa patients

OTHER

Istanbul Low Back Pain Disability Index

Standardized questionnaire to investigate the disability

OTHER

Beck Depression Inventory

Standardized questionnaire to investigate the depression

OTHER

Fatigue Severity Scale

Standardized questionnaire to investigate the fatigue

OTHER

Pittsburgh Sleep Quality Index

Standardized questionnaire to investigate the sleep quality and disturbance

OTHER

Fibromyalgia Rapid Screening Tool

Standardized questionnaire to detect fibromyalgia

OTHER

Visual analogue scale

global pain score on a 0 to 10

Sponsors & Collaborators

• Marmara University

  lead OTHER

Principal Investigators

• Mehmet T DURUOZ, Professor · Marmara University

Eligibility

Min Age

18 Years

Max Age

65 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2019-10-20

Primary Completion

2020-02-14

Completion

2020-04-18

Countries

• Turkey (Türkiye)

Study Locations