Project details

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Central Sensitization - an unexplored aetiology of pain in Epidermolysis Bullosa

Keywords:
epidermolysis bullosa Pain (Chronic) Central Sensitization (nociplasticity)

Researchers:
prof. dr. A.P. Wolff
dr. M.C. Bolling
dhr NHB (Nic) Schräder

Type of project:
Stage Wetenschap / Research project

Nature of the research:
An explorative cross-sectional survey study for an enthusiastic student with an interest in dermatology and/or pain medicine.

Fields of study:
anesthesiology dermatology

Background / introduction
The Center for Blistering Diseases, Department of Dermatology, UMC Groningen is the Dutch reference center for patients with the Genetic Skin condition Epidermolysis Bullosa (EB).

EB is an inherited blistering skin condition with heterogenous clinical phenotypes. Most patients with EB suffer from pain which is often recalcitrant. The impact of pain on quality-of-life outcomes is significant, and pain treatment therefore is central to clinical care in EB.

Pain aetiologies in EB that have been identified at present, relate to nociceptive pain the physical damage or injury to the skin and mucous membranes (blistering, wounds, scarring and cancer), and neuropathic pain (small fibre neuropathies). It is however well known that the resulting subjective perception and experience of pain in EB is a result of bio-psycho-social factors. The concept of nociplastic pain in EB has not yet been assessed. Nociplastic pain is proposed as a third category of pain and is mechanistically distinct from nociceptive and neuropathic pain aetiologies. It may be characterized by hyperalgesia, allodynia and widespread pain that is significantly more variable in the anatomical localization, intensity, and chronology. Furthermore, nociplastic pain does not respond to conventional peripheral or central acting analgesics aimed at treating either nociceptive pain types. Lastly, nociplastic pain can exist in parallel to other pain aetiologies, thus resulting in a mixed-pain state, and emphasizing the importance of assessing this in clinical practice, when conventional treatment provides inadequate alleviation.

The limited effectiveness of centrally or peripherally acting allopathic analgesic or anti-neuropathic pain treatments in EB may be explained by the presence of nociplastic pain in this population. In order to provide insight that can attune clinical pain care in EB, it is first important to assess the prevalence of nociplasticity using validated questionnaires.
Research question / problem definition
Primary outcome:
To determine the proportion of patients, per EB type, achieving scores within the Central Sensitization Inventory (CSI) above the cut-off for a clinical diagnosis of central sensitization.

Secondary outcomes:
To explore any correlations between CSI scores and I) Pain scores (McGill Pain questionnaire) II) self-reported severity, III) Self-reported BSA%, IV) demographic data (age, gender and EB type).
Workplan
See attached image (flowchart of study timeline)

The student researcher, under supervision of the research team (physician researcher and dermatologist), will be responsible for the inclusion of patients, dissemination of surveys and analysis of the collected data.
They will incorporate their own clinical and scientific perspectives into the discussion and eventual manuscript for publication.

The study timeline from inclusion to writing of the manuscript is 24 weeks.
We expect to include 40 participants.
The research program REDCap is set up for the easy dissemination of surveys.
References
1. Schräder NHB, Korte EWH, Duipmans JC, Stewart RE, Bolling MC, Wolff AP. Identifying Epidermolysis Bullosa Patient Needs and Perceived Treatment Benefits: An Explorative Study Using the Patient Benefit Index. J Clin Med. 2021 Dec 13;10(24):5836. doi: 10.3390/jcm10245836. PMID: 34945131; PMCID: PMC8709493.

2. Schräder NHB, Yuen WY, Jonkman MF. Pain Quality Assessment Scale for Epidermolysis Bullosa. Acta Derm Venereol. 2018 Mar 13;98(3):346-349. doi: 10.2340/00015555-2827. PMID: 29057428.
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