Journal
JOURNAL OF PAIN
Volume 23, Issue 5, Pages 784-795Publisher
CHURCHILL LIVINGSTONE
DOI: 10.1016/j.jpain.2021.11.010
Keywords
Dry eye disease; ocular pain; central sensitization; quantitative sensory testing; aftersensations; photophobia; photoallodynia
Categories
Funding
- Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences RD (CSRD) [I01 CX002015]
- Department of Defense Vision Research Program (VRP) [W81XWH-20-1-0820]
- National Eye Institute [R01EY026174, R61EY032468]
- Research to Prevent Blindness [GR004596]
- NIH Center Core Grant [P30EY014801]
- Department of Defense Gulf War Illness Research Program (GWIRP) [W81XWH-20-1-0579]
- Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Biomedical Laboratory R&D (BLRD) Service [I01 BX004893]
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This study found that combining ratings of ocular pain intensity, response to topical anesthetic eye drops, and corneal mechanical pain thresholds produced the best predictive model for central sensitization in individuals with DED. The study also revealed that self-reported rating of pain sensitivity to light can serve as a quick screening tool.
Dry eye disease (DED) is a diagnosis given to individuals with a heterogeneous combination of symptoms and/or signs, including spontaneous and evoked ocular pain. Our current study evaluated whether and which ocular pain assessments could serve as screening tools for central sensitization in individuals with DED. A cohort of individuals with DED symptoms (n = 235) were evaluated for ocular pain, DED signs (tear production, evaporation), evoked sensitivity to mechanical stimulation at the cornea, and evidence of central sensitization. Central sensitization was defined for this study as the presence of pain 30 seconds after termination of a thermal noxious temporal summation protocol (ie, aftersensations) presented at a site remote from the eye (ventral forearm). We found that combining ratings of average intensity of ocular pain, ratings of average intensity of pain due to light, response to topical anesthetic eye drops, and corneal mechanical pain thresholds produced the best predictive model for central sensitization (area under the curve of .73). When examining ratings of intensity of ocular pain due to light alone (0-10 numerical rating), a cutoff score of 2 maximized sensitivity (85%) and specificity (48%) for the presence of painful aftersensations at the forearm. Self-reported rating of pain sensitivity to light may serve as a quick screening tool indicating the involvement of central nociceptive system dysfunction in individuals with DED. Perspective: This study reveals that clinically-relevant variables, including a simple 0 to 10 rating of ocular pain due to light, can be used to predict the contribution of central sensitization mechanisms in a subgroup of individuals with DED symptoms. These findings can potentially improve patient stratification and management for this complex and painful disease. (C) Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc.
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