Elsevier

The Journal of Pain

Volume 17, Issue 3, March 2016, Pages 310-318
The Journal of Pain

Original Report
Neuropathic Ocular Pain due to Dry Eye Is Associated With Multiple Comorbid Chronic Pain Syndromes

https://doi.org/10.1016/j.jpain.2015.10.019Get rights and content
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Highlights

  • Dry eye (DE) exams should include an evaluation of neuropathic ocular pain (NOP).

  • DE patients with more chronic pain syndromes (high CPS group) reported NOP.

  • The high CPS group reported worse DE, depression, quality of life, and ocular and non-ocular pain.

  • NOP may share causal genetic factors with other overlapping chronic pain conditions.

  • Multidisciplinary chronic pain treatment may also benefit DE patients with NOP.

Abstract

Recent data show that dry eye (DE) susceptibility and other chronic pain syndromes (CPS) such as chronic widespread pain, irritable bowel syndrome, and pelvic pain, might share common heritable factors. Previously, we showed that DE patients described more severe symptoms and tended to report features of neuropathic ocular pain (NOP). We hypothesized that patients with a greater number of CPS would have a different DE phenotype compared with those with fewer CPS. We recruited a cohort of 154 DE patients from the Miami Veterans Affairs Hospital and defined high and low CPS groups using cluster analysis. In addition to worse nonocular pain complaints and higher post-traumatic stress disorder and depression scores (P < .01), we found that the high CPS group reported more severe neuropathic type DE symptoms compared with the low CPS group, including worse ocular pain assessed via 3 different pain scales (P < .05), with similar objective corneal DE signs. To our knowledge, this was the first study to show that DE patients who manifest a greater number of comorbid CPS reported more severe DE symptoms and features of NOP. These findings provided further evidence that NOP might represent a central pain disorder, and that shared mechanistic factors might underlie vulnerability to some forms of DE and other comorbid CPS.

Perspective

DE patients reported more frequent CPS (high CPS group) and reported worse DE symptoms and ocular and nonocular pain scores. The high CPS group reported symptoms of NOP that share causal genetic factors with comorbid CPS. These results imply that an NOP evaluation and treatment should be considered for DE patients.

Key words

Dry eye symptoms
neuropathic pain
neuropathic ocular pain
allodynia
hyperalgesia
chronic pain
chronic overlapping pain syndromes
central pain syndromes
comorbid pain syndromes

Cited by (0)

Supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences Research and Development Career Development Award CDA-2-024-10S (A.G.), NIH Center Core Grant P30EY014801, Research to Prevent Blindness Unrestricted Grant, Department of Defense (DOD-Grant#W81XWH-09-1-0675 and Grant# W81XWH-13-1-0048 ONOVA) (institutional); NIH NIDCR RO1 DE022903 (R.C.L., E.R.M.), and the Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, Florida.

The authors have no conflicts of interest to declare.