THU0483 ASSOCIATION OF CENTRAL SENSITIZATION AND ATTENTION DEFICIT IN MEDICAL STUDENTS WITH CHRONIC BACK PAIN

Background:Back pain is one of the most common health complaints among university students. A subset of people suffering from chronic back pain exhibit features of increased pain sensitivity and altered pain processing, suggesting central sensitization (CS) to pain1. The mechanisms behind these processes are, to date, not fully understood2. Evidence shows that in chronic pain, cognitive factors could contribute to the occurrence of central pain sensitization3,4.Objectives:To assess the association between CS and features of adult Attention Deficit Hyperactivity Disorder (ADHD) in medical students suffering from chronic back pain.Methods:Data was collected from medical students during the academic year 2018-2019 at Suez Canal University using an online survey. The survey included a section on self-reported musculoskeletal pain including back pain lasting more than 3 months in the neck, upper back and lower back, part (A) of the central sensitization inventory (CSI) and the Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS-v 1.1). Associations between CSI and ASRS-v 1.1 in students with back pain was assessed using Spearman’s correlation. Linear regression was used to estimate cross-sectional associations adjusted for age and gender.Results:Two hundred and thirty students completed the survey, 93 (40.4%) had back pain for more than 3 months. Students with back pain had significantly higher CS and attention deficit according to CSI (P<0.01), and the ASRS-v 1.1 scores (P=0.09). Correlation results showed a strong positive association between CS and ADHD in students with back pain (correlation coefficient = 0.41, P<0.001). This association remained significant after adjusting for age and gender (P<0.001).Conclusion:Results of this study suggest that in students suffering from chronic back pain, features of attention deficit are associated with elevated CS. The direction of the association requires further study and may provide novel insights into the interaction between CS and cognitive factors.References:[1]Giesecke T, Gracely RH, Grant MA, Nachemson A, Petzke F, Williams DA, Clauw DJ. Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 2004 Feb;50(2):613-23.[3]Coppieters I, Ickmans K, Cagnie B, Nijs J, De Pauw R, Noten S, Meeus M. Cognitive performance is related to central sensitization and health-related quality of life in patients with chronic whiplash-associated disorders and fibromyalgia. Pain physician. 2015;18(3):E389-401.[4]Roussel NA, Nijs J, Meeus M, Mylius V, Fayt C, Oostendorp R. Central sensitization and altered central pain processing in chronic low back pain: fact or myth?. The Clinical journal of pain. 2013 Jul 1;29(7):625-38.Disclosure of Interests: :None declared

Download Full-text

Central Sensitization and Altered Central Pain Processing in Chronic Low Back Pain

Clinical Journal of Pain ◽

10.1097/ajp.0b013e31826f9a71 ◽

2013 ◽

Vol 29 (7) ◽

pp. 625-638 ◽

Cited By ~ 136

Author(s):

Nathalie A. Roussel ◽

Jo Nijs ◽

Mira Meeus ◽

Veit Mylius ◽

Cécile Fayt ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Central Sensitization ◽

Pain Processing ◽

Central Pain ◽

Low Back ◽

Central Pain Processing

Download Full-text

Central pain processing does not differ between first episode and recurrent acute low back pain

Physiotherapy Practice and Research ◽

10.3233/ppr-190143 ◽

2020 ◽

Vol 41 (1) ◽

pp. 35-42

Author(s):

Wei-Ju Chang ◽

Valentina Buscemi ◽

Matthew B. Liston ◽

James H. McAuley ◽

Siobhan M. Schabrun

Keyword(s):

Low Back Pain ◽

Back Pain ◽

First Episode ◽

Pain Processing ◽

Central Pain ◽

Low Back ◽

Acute Low Back Pain ◽

Central Pain Processing

Download Full-text

Linking altered central pain processing and genetic polymorphism to drug efficacy in chronic low back pain

BMC Pharmacology and Toxicology ◽

10.1186/s40360-015-0023-z ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 6

Author(s):

Andreas Siegenthaler ◽

Jürg Schliessbach ◽

Pascal H. Vuilleumier ◽

Peter Juni ◽

Hanns U. Zeilhofer ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Genetic Polymorphism ◽

Chronic Low Back Pain ◽

Drug Efficacy ◽

Pain Processing ◽

Central Pain ◽

Low Back ◽

Central Pain Processing

Download Full-text

Evidence of augmented central pain processing in idiopathic chronic low back pain

Arthritis & Rheumatism ◽

10.1002/art.20063 ◽

2004 ◽

Vol 50 (2) ◽

pp. 613-623 ◽

Cited By ~ 519

Author(s):

Thorsten Giesecke ◽

Richard H. Gracely ◽

Masilo A. B. Grant ◽

Alf Nachemson ◽

Frank Petzke ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Pain Processing ◽

Central Pain ◽

Low Back ◽

Central Pain Processing

Download Full-text

0077 Objective Sleep and Neural Response to Thermal Pain Testing Following Cognitive Behavioral Treatment in Patients with Comorbid Insomnia and Fibromyalgia: A Pilot Study

SLEEP ◽

10.1093/sleep/zsaa056.075 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A31-A31

Author(s):

C McCrae ◽

J Craggs ◽

A Curtis ◽

R Staud ◽

R Berry ◽

...

Keyword(s):

Central Sensitization ◽

Nrem Sleep ◽

Cognitive Behavioral ◽

Pain Processing ◽

Central Pain ◽

Brain Response ◽

Significant Group ◽

Lentiform Nucleus ◽

Pain Ratings ◽

Central Pain Processing

Abstract Introduction Fibromyalgia (FM) is characterized by high rates of insomnia and abnormal central pain processing/heightened response to stimuli (i.e., central sensitization). This study examines whether cognitive behavioral treatments (CBTs) that target insomnia and pain improve central pain processing [indicated by decreased response to quantitative sensory testing (QST) using thermal stimuli] in patients with fibromyalgia and insomnia. Methods Before and after CBT-I, CBT-P or waitlist, adults (N=32, Mage=55.9, SD=12.2) with FM and insomnia completed QST during fMRI (Phillips Achieva 3T scanner), 14-daily pain ratings [least(0)-most(100) intense pain imaginable] and 1-night in-home polysomnography (AURA/Grass Technologies). Imaging data were processed using Brain Voyager (Brain Innovation/Netherlands). Random effects ANCOVA identified regions with significant group (3-CBT-I, CBT-P, waitlist) by time (baseline, post-treatment) interactions in brain hemodynamic response to QST. Linear regressions (using residualized change scores) were conducted for each significant region to examine how pain and sleep changes (%Stages 1–3 NREM, %REM) were related to brain response changes. Results Eleven regions exhibited significant interactions (ps&lt.00; large effects; right hemisphere: inferior frontal, superior temporal, mid-occipital, and cingulate gyri, lentiform nucleus; left hemisphere: angular, superior temporal, mid-frontal, inferior occipital, mid-temporal, and inferior frontal gyri). CBT-I decreased brain response to QST in 8 regions and CBT-P in 3 regions (CBT-I effects&gtCBT-P). Waitlist increased response in 6 regions. Pain ratings, %Stage 2 and %REM sleep were not significant for any region and were dropped from the models. Increased %Stage 1 and/or %Stage 3 predicted decreased brain response to QST in 8 of the 11 regions (ps&lt.01), accounting for 19–45% of the variance. Conclusion Compared to CBT-P, CBT-I prompted greater improvement in abnormal pain processing in patients with fibromyalgia and insomnia. Increased NREM sleep may underlie these pain processing improvements following treatment. Future research examining the potential role of NREM sleep in central sensitization and pain processing is warranted. Support National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR055160 and R01AR005160-S1; McCrae, PI). Data collected as part of clinical trial NCT02001077 Sleep and Pain Interventions (SPIN) at the University of Florida (McCrae, PI).

Download Full-text

(220) Central pain processing measures are associated with movement-evoked pain report among older adults with chronic axial low back pain

Journal of Pain ◽

10.1016/j.jpain.2015.01.135 ◽

2015 ◽

Vol 16 (4) ◽

pp. S31 ◽

Cited By ~ 1

Author(s):

C. Simon ◽

M. Bishop ◽

J. Riley ◽

R. Fillingim ◽

S. George

Keyword(s):

Older Adults ◽

Low Back Pain ◽

Back Pain ◽

Pain Processing ◽

Central Pain ◽

Low Back ◽

Pain Report ◽

Central Pain Processing

Download Full-text

Prevalence of Adult Attention Deficit Hyperactivity Disorder among medical students in Riyadh City

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc.51-1543855405 ◽

2019 ◽

pp. 246-251

Author(s):

Nader Alrahili ◽

Abdulrahman Aldakheel ◽

Abdullah AlUbied ◽

Abdulaziz Almalki ◽

Abdullah AlBarrak ◽

...

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Medical Students ◽

Attention Deficit ◽

Hyperactivity Disorder ◽

Riyadh City

Download Full-text

Treatment response and central pain processing in Anterior Cutaneous Nerve Entrapment Syndrome: An explorative study

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2016.09.014 ◽

2017 ◽

Vol 14 (1) ◽

pp. 53-59 ◽

Cited By ~ 2

Author(s):

Dagmar C. van Rijckevorsel ◽

Oliver B. Boelens ◽

Rudi M. Roumen ◽

Oliver H. Wilder-Smith ◽

Harry van Goor

Keyword(s):

Abdominal Wall ◽

Nerve Entrapment ◽

Cutaneous Nerve ◽

Diagnosis And Treatment ◽

Pain Processing ◽

Central Pain ◽

Pain Thresholds ◽

Generalized Hyperalgesia ◽

Central Pain Processing ◽

Nerve Entrapment Syndrome

AbstractBackground10–30% of chronic abdominal pain originates in the abdominal wall. A common cause for chronic abdominal wall pain is the Anterior Cutaneous Nerve Entrapment Syndrome (ACNES), in which an intercostal nerve branch is entrapped in the abdominal rectus sheath. Treatment consists of local anaesthetics and neurectomy, and is ineffective in 25% of cases for yet unknown reasons.In some conditions, chronic pain is the result of altered pain processing. This so-called sensitization can manifest as segmental or even generalized hyperalgesia, and is generally difficult to treat.ObjectiveThe aim of this study was to assess pain processing in ACNES patients responsive and refractory to treatment by using Quantitative Sensory Testing, in order to explore whether signs of altered central pain processing are present in ACNES and are a possible explanation for poor treatment outcomes.Methods50 patients treated for ACNES with locally orientated treatment were included. They were allocated to a responsive or refractory group based on their response to treatment. Patients showing an improvement of the Visual Analogue Scale (VAS) pain score combined with a current absolute VAS of <40 mm were scored as responsive.Sensation and pain thresholds to pressure and electric skin stimulation were determined in the paravertebral bilateral ACNES dermatomes and at four control areas on the non-dominant side of the body, i.e. the musculus trapezius pars medialis, musculus rectus femoris, musculus abductor hallucis and the thenar. The ACNES dermatomes were chosen to signal segmental hyperalgesia and the sum of the control areas together as a reflection of generalized hyperalgesia. Lower thresholds were interpreted as signs of sensitized pain processing. To test for alterations in endogenous pain inhibition, a conditioned pain modulation (CPM) response to a cold pressor task was determined. Also, patients filled in three pain-related questionnaires, to evaluate possible influence of psychological characteristics on the experienced pain.ResultsPatients refractory to treatment showed significantly lower pressure pain thresholds in the ACNES dermatomes and for the sum of as well as in two individual control areas. No differences were found between groups for electric thresholds or CPM response. Duration of complaints before diagnosis and treatment was significantly longer in the refractory compared to the responsive group, and refractory patients scored higher on the pain-related psychological surveys.Conclusion and ImplicationsIn this hypothesis-generating exploratory study, ACNES patients refractory to treatment showed more signs of sensitized segmental and central pain processing. A longer duration of complaints before diagnosis and treatment may be related to these alterations in pain processing, and both findings could be associated with less effective locally orientated treatment. In order to validate these hypotheses further research is needed.Registration numberNCT01920880 (Clinical Trials Register; http://www.clinicaltrials.gov).

Download Full-text