TY - JOUR
T1 - Enhanced reactivity to pain in patients with rheumatoid arthritis
AU - Edwards, Robert R.
AU - Wasan, Ajay D.
AU - Bingham, Clifton O.
AU - Bathon, Joan
AU - Haythornthwaite, Jennifer A.
AU - Smith, Michael T.
AU - Page, Gayle G.
N1 - Funding Information:
This work was supported by National Institutes of Health grant K23 AR051315 (to RRE) and by awards from the American College of Rheumatology (to RRE) and Arthritis Foundation (to RRE). These funding bodies had no direct role in study design, data analysis, or the writing of the manuscript. They provided salary support for RRE and salary for research assistants involved in data collection.
PY - 2009/5/4
Y1 - 2009/5/4
N2 - Introduction: Maladaptive physiological responses to stress appear to play a role in chronic inflammatory diseases such as rheumatoid arthritis (RA). However, relatively little stress research in RA patients has involved the study of pain, the most commonly reported and most impairing stressor in RA. In the present study, we compared psychophysical and physiological responses to standardized noxious stimulation in 19 RA patients and 21 healthy controls. Methods: Participants underwent a single psychophysical testing session in which responses to a variety of painful stimuli were recorded, and blood samples were taken at multiple time points to evaluate the reactivity of cortisol, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) to the experience of acute pain. Results: The findings suggest that RA patients display a fairly general hyperalgesia to mechanical and thermal stimuli across several body sites. In addition, while serum cortisol levels did not differ at baseline or following pain testing in patients relative to controls, the RA patients tended to show elevations in serum IL-6 and demonstrated enhanced pain-reactivity of serum levels of TNF-α compared with the healthy controls (P < 0.05). Conclusions: These findings highlight the importance of pain as a stressor in RA patients and add to a small body of literature documenting amplified responses to pain in RA. Future studies of the pathophysiology of RA would benefit from the consideration of acute pain levels when comparing RA patients with other groups, and future trials of analgesic interventions in RA patients may benefit from evaluating the effects of such interventions on inflammatory activity.
AB - Introduction: Maladaptive physiological responses to stress appear to play a role in chronic inflammatory diseases such as rheumatoid arthritis (RA). However, relatively little stress research in RA patients has involved the study of pain, the most commonly reported and most impairing stressor in RA. In the present study, we compared psychophysical and physiological responses to standardized noxious stimulation in 19 RA patients and 21 healthy controls. Methods: Participants underwent a single psychophysical testing session in which responses to a variety of painful stimuli were recorded, and blood samples were taken at multiple time points to evaluate the reactivity of cortisol, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) to the experience of acute pain. Results: The findings suggest that RA patients display a fairly general hyperalgesia to mechanical and thermal stimuli across several body sites. In addition, while serum cortisol levels did not differ at baseline or following pain testing in patients relative to controls, the RA patients tended to show elevations in serum IL-6 and demonstrated enhanced pain-reactivity of serum levels of TNF-α compared with the healthy controls (P < 0.05). Conclusions: These findings highlight the importance of pain as a stressor in RA patients and add to a small body of literature documenting amplified responses to pain in RA. Future studies of the pathophysiology of RA would benefit from the consideration of acute pain levels when comparing RA patients with other groups, and future trials of analgesic interventions in RA patients may benefit from evaluating the effects of such interventions on inflammatory activity.
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U2 - 10.1186/ar2684
DO - 10.1186/ar2684
M3 - Article
C2 - 19413909
AN - SCOPUS:66449092062
SN - 1478-6354
VL - 11
JO - Arthritis Research and Therapy
JF - Arthritis Research and Therapy
IS - 3
M1 - R61
ER -