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Rheumatoid arthritis and central sensitization

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Sometimes the central nervous system changes so that we feel more pain with less provocation (sensitization). How much does this phenomenon complicate chronic pain problems? For instance, rheumatoid arthritis (RA) is a nasty source of chronic pain, but could some of the pain be caused by central sensitization instead of the disease itself?

“Central sensitization in patients with rheumatoid arthritis: a systematic literature review”
Meeus et al. Seminars in Arthritis and Rheumatism. Volume 41, Number 4, 556–67. Feb 2012.

Meeus et al. concluded that there are signs of this, from analyzing 24 scientific papers (although “more research is needed,” of course). RA mainly attacks joints, but patients often experience pain elsewhere, and in response to a variety of stimuli, and symmetrically — all of which are a good fit for central sensitization. Also, as with many other chronic pain conditions, in RA there’s often more (or less) pain than detectable tissue trouble (e.g. see Younes), indicating that the progress of the disease is probably not the only driver of pain. Sensitization may be the best way to explain this.