Prevalence and identification of central pain features in rheumatology

Bemmel, P. van (Peter) (2017) Prevalence and identification of central pain features in rheumatology. thesis, Medicine.

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Abstract

Introduction: Central sensitization is thought to play an important role in rheumatic diseases, with fibromyalgia (FM) often being considered the prototypical central pain syndrome. Neuropathic pain (NP) questionnaires like the painDETECT (PD-Q) are increasingly used to screen for central sensitization. Objectives of this study were to determine the proportion of NP-like features in FM and rheumatoid arthritis (RA), to determine the accuracy and optimal cut-off values of the PD-Q for classifying FM, and to determine the ability of the PD-Q to independently predict FM. We also evaluated the psychometric properties of a newly developed central sensitization questionnaire (CSQ), and we determined the accuracy and optimal cut-off values of the CSQ for classifying FM. Material and methods: The PD-Q, a validated screener for NP, was used to screen for NP-like features (as indicator of central sensitization) in 94 FM and 217 RA patients. Furthermore, we evaluated the newly developed CSQ in 146 rheumatic patients (94 FM and 52 RA). Additional information was gathered on FM survey criteria and health status. Results: 73.4% of FM+ (clinically diagnosed FM + positive FM criteria) and 17.1% of RA patients reported NP. The PD-Q was very accurate in classifying FM+ (AUC: 0.90), with an optimal cut-off value of ≥17 (sensitivity 81.0%; specificity 84.4%). A PD-Q score ≥17 was the strongest predictor for FM+, stronger than quality of life and clinically relevant pain severity. The CSQ had a high reliability (Cronbach’s α:0.93), good external construct validity, and discriminant validity. The CSQ was also very accurate in classifying FM+ (AUC:0.95), with an optimal cut-off value of ≥14 (sensitivity 90.1%; specificity 89.7%). Conclusion: This study showed that almost three-quarters of FM+ and one-sixth of RA patients reported NP-like features. Both the PD-Q and the preliminary CSQ appear useful for identifying central sensitization in rheumatic patients.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty supervisor: and Vonkeman, dr. H.E. and rheumatologist, epidemiologist
Supervisor name:	Second supervisor: and Klooster. dr. P.M. ten and Medisch Spectrum Twente and Department of Rheumatology and Clinical Immunology
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:58
Last Modified:	25 Jun 2020 10:58
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1879

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