Central Sensitization May Worsen Musculoskeletal Pain in IBD

Central sensitization may worsen symptoms of musculoskeletal pain in individuals with inflammatory bowel disease (IBD), according to a study published in Pain Practice.

The study was conducted using a cross-sectional survey of adults in New Zealand with a previous diagnosis of IBD (ie, Crohn’s disease, ulcerative colitis, or indeterminate colitis; n=208). The survey assessed disease activity and several dimensions of musculoskeletal pain, including pain location, pain severity evaluated with a numeric rating scale, and pain interference assessed with the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference, as well as central sensitization, using a central sensitization inventory (CSI).

According to an unadjusted univariate linear regression analysis, IBD activity was found to be predictive of increased musculoskeletal pain severity (R²=0.039; P <.005) and increased musculoskeletal pain interference (R²=0.067; P <.001). IBD activity was also found to be a predictor of increased CSI scores (P <.001), and CSI scores were predictive of increased musculoskeletal pain severity (P <.001), in a mediation analysis.

After controlling for CSI scores, IBD activity was no longer a predictor of musculoskeletal pain severity. In a serial mediation analysis, IBD activity was found to be a predictor of increased CSI scores (P <.001) and CSI scores, independently (P <.001). IBD activity was no longer predictive of musculoskeletal pain interference after adjusting for CSI and MSK pain severity scores.

Study limitations include the small sample size, the use of a survey, the reliance on self-reported measures, and a high prevalence of women in the cohort (82.7%).

“Study results…implicate the possibility of central mechanisms in the development and/or maintenance of [musculoskeletal] pain states in this population,” concluded the study authors.

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Reference

Falling CL, Stebbings S, Baxter GD, Gearry RB, Mani R. Central sensitization inventory mediates the relationship between inflammatory bowel disease activity and worse musculoskeletal pain experiences [published online July 18, 2019]. Pain Pract. doi:10.1111/papr.12821