Symptoms of central sensitization in patients with inflammatory bowel diseases: a case-control study examining the role of musculoskeletal pain and psychological factors

Scand J Pain. 2020 Oct 28;21(2):283-295. doi: 10.1515/sjpain-2020-0109. Print 2021 Apr 27.

Carrie Falling 1, Simon Stebbings 2, G David Baxter 1, Corey A Siegel 3, Richard B Gearry 4, Jo Nijs 5, Ramakrishnan Mani 1


Author information

  • 1School of Physiotherapy, University of Otago, Dunedin, 9010, New Zealand.
  • 2School of Medicine, University of Otago, Dunedin, New Zealand.
  • 3Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, USA.
  • 4Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.
  • 5Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.


Objectives: Musculoskeletal (MSK) pain is a common complaint in patients with inflammatory bowel diseases (IBD). MSK pain in IBD has previously demonstrated association with symptoms of central sensitization; however it is uncertain whether these symptoms are influenced simply by the presence of MSK pain and/or IBD. Primary aim of this study was to investigate whether symptoms of central sensitization differed across three groups: IBD patients with and without MSK pain and healthy controls. Secondary aim was to investigate between-group differences for measures of somatosensory functioning.

Methods: Cross-sectional study was performed on adults with IBD. Assessments included: central sensitization inventory (CSI), pressure pain threshold, temporal summation, conditioned pain modulation, perceived stress, affect style, anxiety, depression, and pain catastrophizing. One-way analyses of variance and covariance were used to investigate between-group differences for measures of central sensitization and potential confounding by psychological factors.

Results: Study participants (n=66) were age/gender matched across three study groups. Between-group differences were solely demonstrated for CSI scores [F(2,63)=19.835, p<0.001, r=0.62], with IBD patients with MSK pain demonstrating the highest CSI scores and healthy controls the lowest. After controlling for individual psychological features, post hoc comparisons indicated that CSI scores were significantly different between-groups (p≤0.025) after controlling for most psychological variables, with the exception of perceived stress (p=0.063) and pain catastrophizing (p=0.593).

Conclusions: IBD patients as a whole demonstrated significantly greater symptoms of central sensitization compared to healthy controls. However, IBD patients with persistent MSK pain demonstrated the greatest symptoms of central sensitization compared to patients without MSK pain and healthy controls. Between-group differences for CSI in IBD patients with MSK were not confounded by psychological features.

Implications: Study results indicate that persistent MSK pain in IBD represents patients with greater central sensitization symptomology. This increased symptomology is suggestive of underlying mechanisms related to central sensitization, highlighting patient potentially at risk for worse pain experiences.

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