Validity and contributions to pain from the central aspects of pain questionnaire in rheumatoid arthritis

Abstract. Introduction:. The central nervous system (CNS) contributes to pain perception across musculoskeletal conditions. The central aspects of pain (CAP) questionnaire captures a single score associated with quantitative sensory testing (QST) evidence of CNS dysfunction validated in knee osteoar...

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Main Authors: Stephanie Louise Smith, Vasileios Georgopoulos, Onosi Sylvia Ifesemen, Richard James, Eamonn Ferguson, Richard J. Wakefield, Deborah Wilson, Philip Buckley, Dorothy Platts, Susan Ledbury, Ernest Choy, Tim Pickles, Zoe Rutter-Locher, Bruce Kirkham, David Andrew Walsh, Daniel F. McWilliams
Format: Article
Language:English
Published: Wolters Kluwer 2025-08-01
Series:PAIN Reports
Online Access:http://journals.lww.com/painrpts/fulltext/10.1097/PR9.0000000000001295
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Summary:Abstract. Introduction:. The central nervous system (CNS) contributes to pain perception across musculoskeletal conditions. The central aspects of pain (CAP) questionnaire captures a single score associated with quantitative sensory testing (QST) evidence of CNS dysfunction validated in knee osteoarthritis. Objectives:. Given the different pathophysiology of rheumatoid arthritis (RA), an inflammatory polyarthritis, this cross-sectional study assessed CAP's psychometric properties and its association with pain in RA. Methods:. Adults with RA were recruited from Nottinghamshire, London, and Cardiff. Participants completed CAP and reported pain using a numerical rating scale. A subgroup underwent additional assessments, including quantitative sensory testing (QST; Pressure Pain detection Threshold, Temporal Summation, Conditioned Pain Modulation), Disease Activity Score-28, C-reactive protein, questionnaires addressing pain and related characteristics, and Central Sensitization Inventory short form (CSI-9). Cronbach alpha, confirmatory factor (CFA), and Rasch measurement theory assessed CAP's reliability and validity. Multivariable linear regression modelled contributions to pain by inflammation indices and CAP or CSI-9. Results:. The 380 participants (73% female, median 63 years) reported average pain over the past 4 weeks of 6/10 and a CAP score of 9/16. Central aspects of pain demonstrated acceptable reliability (ICC(2,1) = 0.71), CFA fit (comparative fit index = 0.99, Tucker–Lewis index = 0.99, root mean square error of approximation = 0.034, standardized root mean residuals = 0.03), and internal consistency (α = 0.82). Central aspects of pain was significantly associated with pain (0.50 ≤ β ≤ 0.57) but not QST. Central aspects of pain explained 33% of pain variance, rising to 42% with inflammation, age, sex, and body mass index. Central Sensitization Inventory-9 correlated with pain, not QST and explained less pain variance than CAP. Conclusion:. Central aspects of pain is reliable and valid for use with people with RA and explains RA pain variance better than inflammation or CSI-9.
ISSN:2471-2531