Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20200010
Brazilian Journal of Pain
Original Article

Central sensitization and beliefs among patients with chronic pain in a primary health care unit

Sensibilização central e crenças entre pacientes com dores crônicas em uma unidade de atenção primária de saúde

Gustavo Henrique Dionísio; Victor Yoshioka Salermo; Alexandre Padilha

Downloads: 0
Views: 430

Abstract

BACKGROUND AND OBJECTIVES: The pain that persists for more than three months is classified as chronic pain. Current studies suggest the existence of a dynamic relationship between biological changes, psychological state, and social context within the pain phenomenon and its chronicity. Central sensitization can be defined as the amplification of the neural signaling within the central nervous system that causes pain hypersensitivity, characterized by overlapping symptoms. The objective of this study was to evaluate the central sensitization, dysfunctional beliefs and other variables such as self-perception about sleep quality in a group of patients with chronic pain.

METHODS: The patients answered sociodemographic questions, questions about pain-related habits and beliefs, and completed the central sensitization questionnaire.

RESULTS: The 30 participants involved in the study had a mean value of 49.86±16.14 for central sensitization, as well as a high presence of dysfunctional beliefs and poor sleep self-perception.

CONCLUSION: The need for a biopsychosocial look aiming to investigate the beliefs and level of central sensitization of patients with chronic pain is becoming increasingly necessary, as it is essential to understand the socioeconomic conditions of each individual for better evaluation and management. An initial educational approach in an easy language that stimulated the reflection and participation of patients to understand their symptoms was well accepted by these patients.

Keywords

Chronic pain, Health education, Pain management, Primary health care

Resumo

JUSTIFICATIVA E OBJETIVOS: É classificada como dor crônica a dor que persiste por um período superior a três meses. Estudos atuais sugerem a existência de uma relação dinâmica entre mudanças biológicas, estado psicológico e contexto social dentro do fenômeno da dor e de sua cronificação. A sensibilização central pode ser definida como a amplificação da sinalização neural dentro do sistema nervoso central que provoca hipersensibilidade à dor, caracterizada pela sobreposição de sintomas. O objetivo deste estudo foi avaliar a sensibilização central, crenças disfuncionais e outras variáveis como autopercepção sobre qualidade do sono em um grupo de pacientes com dores crônicas de uma unidade de atenção primária de saúde.

MÉTODOS: Os pacientes responderam a questões sociodemográficas, questões sobre hábitos e crenças relacionadas à dor e preencheram o questionário de sensibilização central.

RESULTADOS: Os 30 participantes incluídos no estudo apresentaram o valor médio de 49,86±16,14 para sensibilização central, além de elevada presença de crenças disfuncionais e autopercepção ruim do sono.

CONCLUSÃO: A necessidade de um olhar biopsicossocial, que se proponha a investigar as crenças e o nível de sensibilização central de pacientes com dores crônicas se mostra cada vez mais necessário, assim como é fundamental compreender as condições socioeconômicas de cada indivíduo para melhor avaliação e cuidado. Abordagem inicial educativa, com linguagem acessiva, que estimula a reflexão e participação dos pacientes para a compreensão dos seus sintomas foi bem aceita pelos pacientes.

Palavras-chave

Atenção primária à saúde, Dor crônica, Educação em saúde, Manejo da dor

References

Blyth FM, March LM, Brnabic AJ, Jorm LR, Williamson M, Cousins MJ. Chronic pain in Australia: a prevalence study. Pain. 2001;89(2-3):127-34.

Keefe FJ, Rumble ME, Scipio CD, Giordano LA, Perri LM. Psychological aspects of persistent pain: current state of the science. J Pain. 2004;5(4):195-211.

Pincus T, Burton AK, Vogel S, Field AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine. 2002;27(5):E109-20.

Trivedi MH. The link between depression and physical symptoms. Prim Care Companion J Clin Psychiatry. 2004;6(Suppl 1):12-6.

Means-Christensen AJ, Roy-Byrne PP, Sherbourne CD, Craske MG, Stein MB. Relationships among pain, anxiety, and depression in primary care. Depress Anxiety. 2008;25(7):593-600.

Stahl S, Briley M. Understanding pain in depression. Human Psychopharmacol. 2004;19(Suppl 1):S9-13.

Asmundson GJG, Katz J. Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art. Depress Anxiety. 2009;26(10):888-901.

Gameroff MJ, Olfson M. Major depressive disorder, somatic pain, and health care costs in an urban primary care practice. J Clin Psychiatry. 2006;67(8):1232-9.

Turk DC, Okifuji A. Psychological factors in chronic pain: evolution and revolution. J Consult Clin Psychol. 2002;70(3):678-90.

Sardá Júnior JJ, Nicholas MK, Pimenta CA, Asghari A. Psychosocial predictors of pain, incapacity and depression in Brazilian chronic pain patients. Rev Dor. 2012;13(2):111-8.

Smith MT, Haythornthwaite JA. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev. 2004;8(2):119-32.

Kundermann B, Krieg JC, Schreiber W, Lautenbacher S. The effects of sleep deprivation on pain. Pain Res Manag. 2004;9(1):25-32.

Lautenbacher S, Kundermann B, Krieg JC. Sleep deprivation and pain perception. Sleep Med Rev. 2006;10(5):357-69.

Smith MT, Edwards RR, McCann UD, Haythornthwaite JA. The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep. 2007;30(4):494-505.

Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581-624.

Meeus M, Nijs J, Van Wilgen P, Noten S, Goubert D, Huljnen I. Moving on to movement in patients with chronic joint pain. 2016.

Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015;350:h444.

Schur EA, Afari N, Furberg H, Olarte M, Goldberg J, Sullivan PF. Feeling bad in more ways than one: comorbidity patterns of medically unexplained and psychiatric conditions. J Gen Intern Med. 2007;22(6):818-21.

Yunus MB. Central sensitivity syndromes: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness. Semin Arthritis Rheum. 2008;37(6):339-52.

Deitos A, Dussán-Sarria JA, Souza AD, Medeiros L, Tarragô Mda G, Sehn F. Clinical value of serum neuroplasticity mediators in identifying the central sensitivity syndrome in patients with chronic pain with and without structural pathology. Clin J Pain. 2015;31(11):959-67.

Gatchel RJ, Okifuji A. Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic nonmalignant pain. J Pain. 2006;7(11):779-93.

Smeets RJ, Vlaeyen JW, Hidding A, Kester AD, van der Heijden GJ, van Geel AC. Active rehabilitation for chronic low back pain: cognitive-behavioral, physical, or both? First direct post-treatment results from a randomized controlled trial [ISRCTN22714229]. BMC Musculoskel Disord. 2006;7(5).

Bertolazi AN, Fagondes SC, Hoff LS, Dartora EG, Miozzo IC, de Barba ME. Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med. 2011;12(1):70-5.

Caumo W, Antunes LC, Elkfury JL, Herbstrith EG, Busanello Sipmann R, Souza A. The Central Sensitization Inventory validated and adapted for a Brazilian population: psychometric properties and its relationship with brain-derived neurotrophic factor. J Pain Res. 2017;10:2109-22.

Moseley GL, Butler DS. Fifteen years of explaining pain: the past, present, and future. J Pain. 2015;16(9):807-13.

Vasconcelos FH, Araújo GC. Prevalence of chronic pain in Brazil: a descriptive study. BrJP. 2018;1(2):176-9.

dos Santos FA, de Souza JB, Antes DL, d'Orsi E. Prevalence of chronic pain and its association with the sociodemographic situation and physical activity in leisure of elderly in Florianópolis, Santa Catarina: population-based study. Rev Bras Epidemiol. 2015;18(1):234-47.

Grol-Prokopczyk H. Sociodemographic disparities in chronic pain, based on 12-year longitudinal data. Pain. 2017;158(2):313-22.

Orhurhu VJ, Pittelkow TP, Hooten WM. Prevalence of smoking in adults with chronic pain. Tob Induc Dis. 2015;13(1):17.

Malta DC, Oliveira MM, Andrade SSCA, Caiaffa WT, Souza MFM, Bernal RTI. Factors associated with chronic back pain in adults in Brazil. Rev Saude Publica. 2017;51(Suppl 1):9s.

Hodges PW. Hybrid approach to treatment tailoring for low back pain: a proposed model of care. J Orthop Sports Phys Ther. 2019;49(6):453-63.

Petersen T, Olsen S, Laslett M, Thorsen H, Manniche C, Ekdahl C. Inter-tester reliability of a new diagnostic classification system for patients with non-specific low back pain. Aust J Physiother. 2004;50(2):85-94.

Scholtes SA, Gombatto SP, Van Dillen LR. Differences in lumbopelvic motion between people with and people without low back pain during two lower limb movement tests. Clin Biomech. 2009;24(1):7-12.

Marcuzzi A, Dean CM, Wrigley PJ, Chakiath RJ, Hush JM. Prognostic value of quantitative sensory testing in low back pain: a systematic review of the literature. J Pain Res. 2016;9:599-607.

Mallen CD, Peat G, Thomas E, Dunn KM, Croft PR. Prognostic factors for musculoskeletal pain in primary care: a systematic review. Br J Gen Pract. 2007;57(541):655-61.

Costa Lda CM, Maherl CG, McAuleyl JH, Hancockl MJ, Smeets RJ. Self-efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain. Eur J Pain. 2011;15(2):213-9.

Picavet HS, Vlaeyen JW, Schouten JS. Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. Am J Epidemiol. 2002;156(11):1028-34.

Hoogendoorn WE, van Poppel MN, Bongers PM, Koes BW, Bouter LM. Systematic review of psychosocial factors at work and private life as risk factors for back pain. Spine. 2000;25(16):2114-25.

Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(Suppl):S2-15.

Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10(9):895-926.

Williams DA. Phenotypic features of central sensitization. J Appl Biobehav Res. 2018;23(2).

Neblett R, Cohen H, Choi Y, Hartzell MM, Williams M, Mayer TG. The Central Sensitization Inventory (CSI): establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. J Pain. 2013;14(5):438-45.

Barbosa FM, Vieira EB, Garcia JB. Beliefs and attitudes in patients with chronic low back pain. BrJP. 2018;1(2):116-21.

Tang NKY, Salkovskis PM, Hodges A, Wright KJ, Hanna M, Hester J. Effects of mood on pain responses and pain tolerance: an experimental study in chronic back pain patients. Pain. 2008;138(2):392-401.

van Middendorp H, Lumley MA, Jacobs JW, Bijlsma JW, Geenen R. The effects of anger and sadness on clinical pain reports and experimentally-induced pain thresholds in women with and without fibromyalgia. Arthritis Care Res. 2010;62(10):1370-6.

Wagner G, Koschke M, Leuf T, Schlösser R, Bär KJ. Reduced heat pain thresholds after sad-mood induction are associated with changes in thalamic activity. Neuropsychologia. 2009;47(4):980-7.

Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychol Bull. 2007;133(4):581-624.

Crombez G, Vlaeyen JW, Heuts PHT, Lysens R. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain. 1999;80(1):329-39.

Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine. 2015;40(6):392-8.

Girish G, Lobo LG, Jacobson JA, Morag Y, Miller B, Jamadar DA. Ultrasound of the shoulder: asymptomatic findings in men. AJR Am J Roentgenol. 2011;197(4):W713-9.

Culvenor AG, Øiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2019;53(20):1268-78.

Dolphens M, Nijs J, Cagnie B, Meeus M, Roussel N, Kregel J. Efficacy of a modern neuroscience approach versus usual care evidence-based physiotherapy on pain, disability and brain characteristics in chronic spinal pain patients: protocol of a randomized clinical trial. BMC Musculoskelet Disord. 2014;15:149.

Ryan CG, Gray HG, Newton M, Granat MH. Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: a pilot randomised controlled trial. Man Ther. 2010;15(4):382-7.

Van Oosterwijck J, Nijs J, Meeus M, Truijen S, Craps J, Van den Keybus N. Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study. J Rehabil Res Dev. 2011;48(1):43-58.

Nijs J, Van Houdenhove B. From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: Application of pain neurophysiology in manual therapy practice. Man Ther. 2009;14(1):3-12.

Castro CES, Parizotto NA, Barboza HFG. Programa mínimo sobre mecanismos de dor e analgesia para cursos de graduação em fisioterapia. Rev Bras Fisioter. 2003;7(1):85-92.

Smart K, Doody C. Mechanisms-based clinical reasoning of pain by experienced musculoskeletal physiotherapists. Physiotherapy. 2006;92(3):171-8.

Moseley L. Unraveling the barriers to reconceptualization of the problem in chronic pain: the actual and perceived ability of patients and health professionals to understand the neurophysiology. J Pain. 2003;4(4):184-9.


Submitted date:
07/30/2019

Accepted date:
12/10/2019

5ef1357a0e8825c95ec092e1 brjp Articles

BrJP

Share this page
Page Sections