Sensory & Symptom Severity May Show Pain Concentration in COPCs


What are COPCs?

Chronic Overlapping Pain Conditions (COPCs) are distinguishable by the atypical pain processing by the central nervous system. A new study published in the Pain journal, illustrates this ‘centralized pain’ characteristic by using a diverse and large collection of symptom spheres — the spatial spread of pain, the intensity of pain, mood imbalances, over sensitivity to external stimuli, changed somatic feelings, exhaustion, and cognitive dysfunction.

Study Cohorts

To study the factor structure of centralized pain symptoms, the study used data of three cohorts —healthy control participants, patients with other mixed-pain COPCs, and patients suffering from Urologic Chronic Pelvic Pain Syndrome (UCPPS) gathered from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. The cohort with mixed pain included people diagnosed with temporomandibular disorder or fibromyalgia, in addition to chronic fatigue syndrome, migraine, and irritable bowel syndrome.

The UCPPS subsection was evaluated at baseline and again at six and twelve months, while those in the additional two groups were just assessed at baseline. All participants were valued for the severity of the urinary symptom, disability, the extent of spatial pain, depression, pain severity, fatigue and sleep, and cognitive dysfunction. The CMI (Complex Medical Symptom Inventory — a diagnostic tool that helps in recognizing the presence of disorders that frequently go with Fibromyalgia — gave insight into patients’ full symptom affliction and the occurrence of COPCs.


Study Findings

Two overall factors in all three cohorts were identified. The first, termed Generalized Sensory Sensitivity (GSS), is distinguishable by a wide-ranging rise in sensitivity to diffuse pain as well as environmental stimuli and internal somatic sensations; the other factors are identifiable by constitutional indicators – Pain, Sleep, Cognition, Energy (SPACE), and Affect.

Analyses of the UCPPS cohort found the identical 2-factor structure at month six and one year. This association with each other suggests that the 2-factor arrangement can be reproduced over time. Secondary analyses revealed that GSS is particularly related to the existence of comorbid COPCs, whereas SPACE shows moderate links with assessments of disability and urinary symptoms. These factors may signify a significant and distinct variety of symptoms which point to the centralized pain phenotype at high levels. The investigators note that these factors could signify important and dissimilar range of symptoms that suggest that the centralized phenotype of high levels of pain.

Basically, the processing of pain in a disordered way within the central nervous system, often results in a varied combination of symptoms generally referred to as “centralized pain” felt by those with COPC.

These clusters of symptoms are widely predominant and infamously hard to treat in disorders such as chronic pelvic pain, fibromyalgia, and TMJ (temporomandibular) disorder. The researchers sought out commonalities between a range of conditions that would allow for a more accurate description and classification of the clusters and thereby the separation between them and other sources of peripheral pain.

Study limitations comprised the lack of enduring clinical effects, the possibility for progress in concept definitions, as well as the likelihood that the UCPSS could include distinct and dissimilar conditions.

Study Conclusion

The authors concluded for that empirical and analysis of the confirmatory aspect sustain a 2-factor prototype of centralized pain, using solid links between both factors. This elementary two-factor arrangement was evident in all cohorts. They endorse further longitudinal trials that investigate COPC symptom paths and therapeutic reactions and should allow for the measurement of each factor.