Pain, distress and central sensitisation in arthritis
Most forms of arthritis are associated with pain and psychological distress in the form of depression and/or anxiety. It is a viscous circle as pain and depression are mutually exacerbating; both may continue even when joint involvement appears well controlled. Now a review of the evidence has found arthritis-related stress impacts the central nervous system and together with inflammatory changes may cause central sensitisation that can lead to chronic pain and distress.
Central sensitisation is defined by the Institute of Chronic Pain as a condition of the nervous system that is associated with the development and maintenance of chronic pain:
“When central sensitisation occurs, the nervous system goes through a process called wind-up and gets regulated in a persistent state of high reactivity. This persistent state of reactivity lowers the threshold for what causes pain and subsequently comes to maintain pain even after the initial injury might have healed.”
When people have rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, gout, and in osteoarthritis of the hips and knees, central sensitisation results in long-lasting pain and psychological distress.
Cytokines and chemokines participate in both joint inflammation and central sensitisation and need to be scrutinised, the research team suggest, concluding that “chronic pain and depression are important but neglected in the clinical assessment and treatment of arthritis.”
Click here to read the original research.
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