The PainDETECT questionnaire in patients with rheumatoid arthritis, osteoarthritis and fibromyalgia.

Koop, S.M.W. (2013) The PainDETECT questionnaire in patients with rheumatoid arthritis, osteoarthritis and fibromyalgia. thesis, Medicine.

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Abstract

Introduction: Chronic pain is an important problem in the field of rheumatology. Pain is divided in nociceptive and neuropathic pain. Pain in rheumatoid arthritis (RA) has been thought to be primarily nociceptive due to inflammation. However, part of the patients still experience pain even though they are clinically in remission. Pain in osteoarthritis (OA) was also thought to be mainly nociceptive. There is however a discrepancy between radiographic findings and the reported amount of pain. Also, RA and OA patients often describe their pain using descriptions which are suggestive of neuropathic pain. In fibromyalgia (FM), a nonnociceptive pain syndrome, central sensitization seems to play a part. This causes a higher responsiveness en sensitivity to pain and causes symptoms that are also seen in neuropathic pain. The painDETECT is a questionnaire that uses pain descriptors to determine whether a neuropathic pain component is present in a certain pain state. With this study we explored the applicability of the painDETECT in the screening for a neuropathic pain component in rheumatic diseases like RA, OA and FM. Methods and materials: RA, OA and FM patients were asked to complete the painDETECT questionnaire. Furthermore they completed several other questionnaires, focused on the presence of concurrent fibromyalgia, pain intensity, quality of life and disability. For RA patients the DAS28 score (a composite score measuring disease activity in RA) was also retrieved. Results: According to the painDETECT questionnaire 16.1 % of RA patients, 39.3% OA patients and 80 % FM patients suffered from a neuropathic component to their pain. Overall, these patients experienced more pain, lower quality of life and more disability. In RA patients, poorer mental health was an independent predictor of a higher painDETECT score. Measures of inflammation however, did not show a correlation with the painDETECT score. Using a cutoff value of 12 in RA, gave a sensitivity and specificity for a neuropathic component, and thus possible central sensitization, of 64.3% and 73.4%, respectively. Conclusion: The painDETECT identifies a likely neuropathic pain component in a significant part of the RA , OA and FM patients. Possibly these neuropathic symptoms are caused by central sensitization. Unfortunately the sensitivity and specificity of the painDETECT in detecting fibromyalgia in RA, are low. Future research in larger sample sizes needs to further establish whether the painDETECT can be of value for the screening of neuropathic pain in rheumatic diseases.

Item Type:	Thesis (Thesis)
Supervisor name:	Vonkeman, dr. H.E.
Supervisor name:	Klooster, dr. P.M. ten and Medisch Spectrum Twente
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:50
Last Modified:	25 Jun 2020 10:50
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1143

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