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Cognitive performance is related to central sensitization in patients with chronic whiplash-associated disorders and fibromyalgia: a case-control study

Iris Coppieters (UGent) , Kelly Ickmans, Barbara Cagnie (UGent) , Jo Nijs, Robby De Pauw (UGent) and Mira Meeus (UGent)
Author
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Abstract
Background: A growing body of research has demonstrated that central sensitization (CS) is a crucial mechanism for the development of persistent pain in patients with chronic whiplash-associated disorders (WAD) and fibromyalgia (FM). Furthermore, there is increasing evidence for cognitive dysfunctions and decreased quality of life (QoL) among these patients. Yet, there is limited research concerning the interrelations between cognitive performance, indices of CS and health-related QoL in these patients. First, this study aims to examine the presence of cognitive impairment, CS, and limitations on health-related QoL in patients with chronic WAD and FM compared to healthy controls. Second, interrelations between performance-based cognitive functioning, CS, and health-related QoL will be examined in these 3 study groups. Methods: A case-control study was conducted. Fifty-nine subjects (16 chronic WAD patients, 21 FM patients and 22 pain-free volunteers) filled out the Short Form 36 item Health Survey (SF-36) to assess health-related QoL. Next, to investigate the presence of CS, 4 critical aspects of central pain modulation were assessed: local and widespread hyperalgesia by means of pressure pain thresholds (PPTs) at symptomatic and remote areas; deep-tissue hyperalgesia by cuff inflation at the arm; temporal summation (TS) of pressure pain to assess bottom-up sensitization; and the efficacy of Conditioned Pain Modulation (CPM) to evaluate endogenous pain inhibition. Finally, participants completed a battery of performance-based cognitive tests (Stroop task, psychomotor vigilance task (PVT) and operation span task (OSPAN)). Strengths and limitations: The current study is innovative because 2 chronic pain populations, characterized by CS, were compared, by using various indices of CS in relation to cognitive performance and QoL. When interpreting the results, following study limitations have to be taken into account. Firstly, the methods used to assess pain remain self-reports of induced pain. Secondly, an occlusion cuff was used as conditioning stimulus. Yet, it is not clear which conditioning stimulus is the most adequate to examine the efficacy of CPM. Results: Significant cognitive impairment, bottom-up sensitization, and decreased health-related QoL were demonstrated in patients with chronic WAD and FM compared to healthy controls (p<0.017). CPM was comparable between the 3 groups. Cognitive performance was significantly related to central pain modulation (deep-tissue hyperalgesia, TS, CPM) as well as to health-related QoL (p<0.05). Decreased cognitive performance was related to deficient CPM in healthy controls. Further, significant correlations between decreased cognitive performance and reduced health-related QoL were revealed among all study groups. Additionally, FM patients showed correlations between cognitive impairment and increased health-related QoL. Remarkably, impaired selective attention and working memory were related to less TS, whereas impaired sustained attention was correlated with dysfunctional CPM in FM patients. Discussion: These results provide preliminary evidence for the clinical importance of objectively measured cognitive deficits in patients with chronic WAD and FM. Process evaluation: Based on the current cross-sectional study no firm conclusions can be drawn on the causality of the relations. Secondly, only non-parametric statistical analyses were performed because the sample size of the current study was rather small. Consequently, further research is warranted to investigate if CS and reduced health-related QoL lead to cognitive impairment or vice versa.
Keywords
Cognition, Quality of life, Central sensitization, Whiplash, Chronic pain, Fibromyalgia

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Chicago
Coppieters, Iris, Kelly Ickmans, Barbara Cagnie, Jo Nijs, Robby De Pauw, and Mira Meeus. 2015. “Cognitive Performance Is Related to Central Sensitization in Patients with Chronic Whiplash-associated Disorders and Fibromyalgia: a Case-control Study.” In Pain Science in Motion Congress, Abstracts.
APA
Coppieters, I., Ickmans, K., Cagnie, B., Nijs, J., De Pauw, R., & Meeus, M. (2015). Cognitive performance is related to central sensitization in patients with chronic whiplash-associated disorders and fibromyalgia: a case-control study. Pain Science in Motion congress, Abstracts. Presented at the Pain Science in Motion congress.
Vancouver
1.
Coppieters I, Ickmans K, Cagnie B, Nijs J, De Pauw R, Meeus M. Cognitive performance is related to central sensitization in patients with chronic whiplash-associated disorders and fibromyalgia: a case-control study. Pain Science in Motion congress, Abstracts. 2015.
MLA
Coppieters, Iris, Kelly Ickmans, Barbara Cagnie, et al. “Cognitive Performance Is Related to Central Sensitization in Patients with Chronic Whiplash-associated Disorders and Fibromyalgia: a Case-control Study.” Pain Science in Motion Congress, Abstracts. 2015. Print.
@inproceedings{6993821,
  abstract     = {Background: A growing body of research has demonstrated that central sensitization (CS) is a crucial mechanism for the development of persistent pain in patients with chronic whiplash-associated disorders (WAD) and fibromyalgia (FM). Furthermore, there is increasing evidence for cognitive dysfunctions and decreased quality of life (QoL) among these patients. Yet, there is limited research concerning the interrelations between cognitive performance, indices of CS and health-related QoL in these patients.
First, this study aims to examine the presence of cognitive impairment, CS, and limitations on health-related QoL in patients with chronic WAD and FM compared to healthy controls. 
Second, interrelations between performance-based cognitive functioning, CS, and health-related QoL will be examined in these 3 study groups.
Methods: A case-control study was conducted. Fifty-nine subjects (16 chronic WAD patients, 21 FM patients and 22 pain-free volunteers) filled out the Short Form 36 item Health Survey (SF-36) to assess health-related QoL. Next, to investigate the presence of CS, 4 critical aspects of central pain modulation were assessed: local and widespread hyperalgesia by means of pressure pain thresholds (PPTs) at symptomatic and remote areas; deep-tissue hyperalgesia by cuff inflation at the arm; temporal summation (TS) of pressure pain to assess bottom-up sensitization; and the efficacy of Conditioned Pain Modulation (CPM) to evaluate endogenous pain inhibition. Finally, participants completed a battery of performance-based cognitive tests (Stroop task, psychomotor vigilance task (PVT) and operation span task (OSPAN)).
Strengths and limitations: The current study is innovative because 2 chronic pain populations, characterized by CS, were compared, by using various indices of CS in relation to cognitive performance and QoL. When interpreting the results, following study limitations have to be taken into account. Firstly, the methods used to assess pain remain self-reports of induced pain. Secondly, an occlusion cuff was used as conditioning stimulus. Yet, it is not clear which conditioning stimulus is the most adequate to examine the efficacy of CPM.
Results: Significant cognitive impairment, bottom-up sensitization, and decreased health-related QoL were demonstrated in patients with chronic WAD and FM compared to healthy controls (p<0.017). CPM was comparable between the 3 groups. Cognitive performance was significantly related to central pain modulation (deep-tissue hyperalgesia, TS, CPM) as well as to health-related QoL (p<0.05). Decreased cognitive performance was related to deficient CPM in healthy controls. Further, significant correlations between decreased cognitive performance and reduced health-related QoL were revealed among all study groups. Additionally, FM patients showed correlations between cognitive impairment and increased health-related QoL. Remarkably, impaired selective attention and working memory were related to less TS, whereas impaired sustained attention was correlated with dysfunctional CPM in FM patients.
Discussion: These results provide preliminary evidence for the clinical importance of objectively measured cognitive deficits in patients with chronic WAD and FM. 
Process evaluation: Based on the current cross-sectional study no firm conclusions can be drawn on the causality of the relations. Secondly, only non-parametric statistical analyses were performed because the sample size of the current study was rather small. Consequently, further research is warranted to investigate if CS and reduced health-related QoL lead to cognitive impairment or vice versa.},
  author       = {Coppieters, Iris and Ickmans, Kelly and Cagnie, Barbara and Nijs, Jo and De Pauw, Robby and Meeus, Mira},
  booktitle    = {Pain Science in Motion congress, Abstracts},
  keywords     = {Cognition,Quality of life,Central sensitization,Whiplash,Chronic pain,Fibromyalgia},
  language     = {eng},
  location     = {Brussels, Belgium},
  title        = {Cognitive performance is related to central sensitization in patients with chronic whiplash-associated disorders and fibromyalgia: a case-control study},
  year         = {2015},
}