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Central SensitisationNCT05021783

The Relationship Between Magnetic Resonance Imaging (MRI) Scores and Sensory Testing in Axial Spondyloarthritis

An observational study of Central Sensitisation and Axial Spondyloarthritis, run by Marmara University at 1 site in Turkey (Türkiye).

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Axial spondyloarthritis is one of the most common rheumatic diseases and chronic pain and morning stiffness are the main complaints of these patients. Central sensitization is defined as increased response to normal or sub-threshold stimuli of central nervous system and its close relationship with many rheumatological… Read more about this study

Who is it for?
Ages 18 to 65 years
What is being tested?
Pressure pain threshold, Central Sensitization Inventory and Spondyloarthritis Research Consortium of Canada scoring system
How many people
24 participants
Where
1 siteTurkey (Türkiye)
Study dates
1 Feb 2021to 15 Aug 2021
How long will I take part?
30 Days
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: AxSpA patientsThe patients aged 18-65 years diagnosed with axSpA according to the ASAS criteria will be recruited from a Rheumatology outpatient clinic of a single tertiary care hospital

Who may be able to join

  • Diagnosed with axSpA according to the Assessment of SpondyloArthritis International Society (ASAS) criteria
  • Aged between 18-65 years

Who cannot join

  • Had an other rheumatic diseases, peripheral vascular disease, peripheral neuropathy and spine disease (e.g., symptomatic herniated disc, spinal stenosis),
  • Using centrally acting pain medications (e.g., pregabaline, duloxetine, opioids) or glucocorticoids (>10 mg prednisone or its equivalent) within 3 months of study enrollment

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site
  • Marmara University

    Istanbul, 34100

Other trials in Turkey (Türkiye)

About this study

Official title: Investigation of the Relationship Between Sacroiliac Magnetic Resonance Imaging (MRI) Scores and Quantitative Sensory Testing in Patients With Axial Spondyloarthritis

Axial spondyloarthritis is one of the most common rheumatic diseases and chronic pain and morning stiffness are the main complaints of these patients. Central sensitization is defined as increased response to normal or sub-threshold stimuli of central nervous system and its close relationship with many rheumatological diseases has been demonstrated in several studies. There is no method for the diagnosis of central sensitization is accepted as a gold standard. The clinical scales and quantitative sensory testing (QST) widely is used for this purpose widely. The most commonly used QST types include pressure pain threshold (PPT), temporal summation (TS) and conditioned pain modulation (CPM). The well-known scale used for the evaluation of central sensitization is the Central Sensitization Inventory (CSI) , developed in 2011 for detect central sensitization in chronic pain patients. In this study, it was aimed to investigate the relationship between QST and CSI and sacroiliac MRI changes.

Read the detailed description

Central sensitization is hypersensitivity and increased response to normal/painless stimuli due to dysfunction in endogenous pain pathways. Quantitative sensory testing is frequently used to detect pain sensitization, and pressure pain threshold (PPT) and temporal summation (TS) are often preferred for this purpose. Recently, in addition to these methods, conditional pain modulation (CPM), in which descending pain pathways are tested, is also preferred. With PPT and TS measurement, local/generalized sensitivity increase can be detected in patients who develop pain sensitization. Observation of increased nociceptor response and decrease in pressure pain threshold in the tissue damaged area is interpreted in favor of peripheral sensitization, while obtaining a similar response in adjacent or distant areas is defined as generalized increased sensitivity. Although it is known that local hyperalgesia is one of the main findings of inflammation, studies that have shown this quantitatively are limited. Inflammatory lesions are observed in patients with axial spondyloarthritis, especially in the active stages of the disease, and the relationship of these lesions with PPT, TS and CPM values and pain sensitization is unknown. Therefore, in this study, it was planned to investigate the relationship of inflammatory and structural lesions detected by sacroiliac MRI with regional PPT,TS, CPM and pain sensitization in patients diagnosed with axSpA.

Being tested
Pressure pain threshold, Central Sensitization Inventory, Spondyloarthritis Research Consortium of Canada scoring system, Temporal Summation, Conditioned pain modulation
Medical subject headings
Axial Spondyloarthritis, Inflammation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Pressure pain thresholdDiagnostic test

    Also called PPT

    The sacroiliac PPT scores will be obtained bilaterally from four measurement points; the first point is located 1 cm medially and caudally from spina iliaca posterior superior (SIPS) and 3 more laterally, medially and cranially.The left trapezius muscle will be used to evaluate distant control point .The 1 cm2 algometer probe will be placed vertically in the each selected point and pressure will be increased with 0.1 kg/sc until the participant reporting pressure became painful. The pressure value at which the pain is first felt will be accepted as the PPT of that point.

  • Central Sensitization InventoryDiagnostic test

    Also called CSI

    Standardized questionnaire to determine the level of central sensitization

  • Spondyloarthritis Research Consortium of Canada scoring systemOther

    Also called SPARCC

    SPARCC scoring consists of two subcomponents to detect sacroiliitis activation and structural damage. In the short tau inversion recovery (STIR) sequence, 6 consecutive coronal sections will be examined and the signal increase will be scored as 0 = normal signal and 1 = increased signal. In this way, the maximum score can be 12 in a single coronal section. Evaluations Total maximum score of 72 in 6 consecutive coronal sections. In structural scoring, similar to sacroiliitis scoring, the SI joint is divided into four quadrants to evaluate whether there is fatty change, erosion, backfill and ankylosis. Each lesion is scored as 0=absent or 1=present. In this way, fatty change and erosion can be scored between 0-40 and backfill and ankylosis can be scored between 0-20 in 5 consecutive sections in total scoring.

  • Temporal SummationDiagnostic test

    Also called TS

    TS will be evaluated over the trapezius muscle and sacroiliac joints with manuel algometer. In the evaluation of TS, a pressure as much the PPT value of each point will be applied with pain pressure algometer ten times with a 1-second interstimulus interval. Patients will be asked to rate their pain using on a 0 to 10 visual analogue scale (VAS) at 0, 5, and 10 seconds. TS will be calculated by subtracting the rating at 0 seconds from the rating at 10 seconds. The point that is located 1 cm medially and caudally from SIPS was used for SI joint TS measurement on both sides.

  • Conditioned pain modulationDiagnostic test

    Also called CPM

    First stimulus will be applied to trapezius with the pressure that induced a pain intensity of 4 point on a 10 point VAS as called a test stimulus. After that the right hand of the patient will be immersed in 7 Celsius water for 20 seconds to create a conditioning stimulus. Second test stimulus with the same intensity of first one will be applied to trapezius after the conditioning stimulus and patients will be asked to rate their pain. If the patients cannot hold their hand in the water for 20 seconds, the test stimulus will be applied immediately after the patients removed their hands out of water. The ratio between the first and second VAS values multiplied by 100 will be defined as CPM score

Study groups in NCT05021783
Study groupRoleWhat they receive
PatientsPatients with Axial SpondyloArthritis
Receives: Diagnostic Test: Pressure pain threshold; Diagnostic Test: Central Sensitization Inventory; Other: Spondyloarthritis Research Consortium of Canada scoring system; Diagnostic Test: Temporal Summation; Diagnostic Test: Conditioned pain modulation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Central Sensitization Inventory (CSI)

    25 somatic and psychosocial symptoms, which are frequently found in patients with central sensitization in part A, are questioned. In part B, the presence of diseases whose relationship with central sensitization is well defined is questioned in the patient without participating in scoring. Central sensitization is assumed in patients who score 40 or more over 100 points. As the score increases, the severity of sensitization is considered to increase.

    Measured: 1 months

  2. Pressure pain threshold (PPT)

    The sacroiliac PPT scores were obtained from four measurement points; the first point was located 1 cm medially and caudally from spina iliaca posterior superior (SIPS) and 3 more laterally, medially, and cranially. Lower scores are interpreted in favor of increased pain sensitization.

    Measured: 1 months

  3. Temporal summation (TS)

    TS will be evaluated over the trapezius muscle and sacroiliac joints with manuel algometer. In the evaluation of TS, a pressure as much the PPT value of each point will be applied with pain pressure algometer ten times with a 1-second interstimulus interval. Patients will be asked to rate their pain using on a 0 to 10 visual analogue scale (VAS) at 0, 5, and 10 seconds. TS will be calculated by subtracting the rating at 0 seconds from the rating at 10 seconds. The point that is located 1 cm medially and caudally from SIPS was used for SI joint TS measurement on both sides. As the score increases, the severity of sensitization is considered to increase.

    Measured: 1 months

  4. Conditioned pain modulation (CPM)

    First stimulus will be applied to trapezius with the pressure that induced a pain intensity of 4 point on a 10 point VAS as called a test stimulus. After that the right hand of the patient will be immersed in 7 Celsius water for 20 seconds to create a conditioning stimulus. Second test stimulus with the same intensity of first one will be applied to trapezius after the conditioning stimulus and patients will be asked to rate their pain. If the patients cannot hold their hand in the water for 20 seconds, the test stimulus will be applied immediately after the patients removed their hands out of water. The ratio between the first and second VAS values multiplied by 100 will be defined as CPM score. Higher scores indicate better descending pain inhibition.

    Measured: 1 months

Secondary outcomes (1)
  1. Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system

    SPARCC scoring consists of two subcomponents to detect sacroiliitis activation and structural damage.

    Measured: 1 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Aug 2021
  2. Study start1 Feb 2021
  3. Primary completion1 Aug 2021
  4. Study completion15 Aug 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Case only
Time perspective
Cross-sectional
Enrolment
24 participants (actual)
Target duration
30 Days
IDs, dates and publications
ClinicalTrials.gov ID
NCT05021783
Sponsor's protocol ID
09.2021.64
Status last verified
Aug 2021
First submitted
16 Aug 2021
Last updated
26 Aug 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Kiltz U, Baraliakos X, Regel A, Buhring B, Braun J. Causes of pain in patients with axial spondyloarthritis. Clin Exp Rheumatol. 2017 Sep-Oct;35 Suppl 107(5):102-107. Epub 2017 Sep 29.

    PubMed 28967358
  • Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl. 1986;3:S1-226. No abstract available.

    PubMed 3461421
  • Rolke R, Baron R, Maier C, Tolle TR, Treede -DR, Beyer A, Binder A, Birbaumer N, Birklein F, Botefur IC, Braune S, Flor H, Huge V, Klug R, Landwehrmeyer GB, Magerl W, Maihofner C, Rolko C, Schaub C, Scherens A, Sprenger T, Valet M, Wasserka B. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain. 2006 Aug;123(3):231-243. doi: 10.1016/j.pain.2006.01.041. Epub 2006 May 11.

    PubMed 16697110
  • Maksymowych WP, Inman RD, Salonen D, Dhillon SS, Williams M, Stone M, Conner-Spady B, Palsat J, Lambert RG. Spondyloarthritis research Consortium of Canada magnetic resonance imaging index for assessment of sacroiliac joint inflammation in ankylosing spondylitis. Arthritis Rheum. 2005 Oct 15;53(5):703-9. doi: 10.1002/art.21445.

    PubMed 16208659
  • Maksymowych WP, Wichuk S, Chiowchanwisawakit P, Lambert RG, Pedersen SJ. Development and preliminary validation of the spondyloarthritis research consortium of Canada magnetic resonance imaging sacroiliac joint structural score. J Rheumatol. 2015 Jan;42(1):79-86. doi: 10.3899/jrheum.140519. Epub 2014 Oct 15.

    PubMed 25320219
  • Mayer TG, Neblett R, Cohen H, Howard KJ, Choi YH, Williams MJ, Perez Y, Gatchel RJ. The development and psychometric validation of the central sensitization inventory. Pain Pract. 2012 Apr;12(4):276-85. doi: 10.1111/j.1533-2500.2011.00493.x. Epub 2011 Sep 27.

    PubMed 21951710
  • van Leeuwen RJ, Szadek K, de Vet H, Zuurmond W, Perez R. Pain Pressure Threshold in the Region of the Sacroiliac Joint in Patients Diagnosed with Sacroiliac Joint Pain. Pain Physician. 2016 Mar;19(3):147-54.

    PubMed 27008288
  • de Goeij M, van Eijk LT, Vanelderen P, Wilder-Smith OH, Vissers KC, van der Hoeven JG, Kox M, Scheffer GJ, Pickkers P. Systemic inflammation decreases pain threshold in humans in vivo. PLoS One. 2013 Dec 17;8(12):e84159. doi: 10.1371/journal.pone.0084159. eCollection 2013.

    PubMed 24358337

Questions about this trial

What is this clinical trial studying?

An observational study of Central Sensitisation and Axial Spondyloarthritis, run by Marmara University at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 26 Aug 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Central Sensitization Inventory (CSI) (time frame: 1 months). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05021783, which also lists 8 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Aug 2021.

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