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    How chronic pain syndromes and dry eye are correlated

    A central disorder may be the cause of high ocular pain scores


    The authors reported that in addition to worse non-ocular pain complaints and higher post-traumatic stress disorder and depression scores (p < 0.01), they found that the patients in the group with more chronic pain syndromes had more severe neuropathic-type dry eye symptoms (burning, wind- and light-evoked pain, etc.) compared with the patients with fewer chronic pain syndromes, including worse ocular pain that was assessed using the multiple pain scales (p < 0.05), with similar objective corneal dry eye signs.

    The investigators also reported that psychiatric and quality-of-life measurements indicated that there were significantly worse disease scores in the patients with high chronic pain syndromes compared with the patients with low chronic pain syndromes. Specifically, they showed that the former group had higher post-traumatic stress disorder scores (PTSD) on the PTSD checklist-Military Version, higher depression scores on the Patient Health Questionnaire 9, and lower Short Form-12 physical and mental composite scores compared with the other group.

    The authors speculated that an underlying central disorder of pain processing might explain the group of patients with dry eye and a higher number of chronic pain syndromes. Those patients consistently reported more neuropathic ocular pain and more severe symptoms than patients with the so-called traditional dry eye.

    Notably, the differences in severity occur without difference in the corneal pathologies, which suggested the presence of a non-ocular or systemic disorder.

    The mechanisms of the central disorder have not been elucidated, but numerous studies have suggested these chronic overlapping pain syndromes are “characterized by central nervous system neuroplasticity which results in increased responsiveness of nociceptive neurons and altered descending pain modulation….” such as those described in this study, as well as numerous others that include—but are not limited to—osteoarthritis, burn pain, headache, diabetic neuropathy, and muscle pain, according to the authors.

    “In these patients, whose high rate of manifestation of related [chronic pain syndromes] suggests a systemic disorder, perhaps with central sensitization as the underlying mechanism, it appears that their ocular symptoms are but another peripheral manifestation of their central disease,” the investigators concluded. “This is further supported by the greater magnitude of ocular and non-ocular pain reported by the patients in high [chronic pain syndromes] group in this study.”

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