title: Neuropathic Ocular Pain due to Dry Eye is Associated with Multiple Comorbid Chronic Pain Syndromes.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Miami Veterans Administration Medical Center, Miami, Florida; Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
authors.forename: Anat
authors.initials: A
authors.lastname: Galor
authors.affiliation: Miami Veterans Administration Medical Center, Miami, Florida; Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Derek
authors.initials: D
authors.lastname: Covington
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Levitt
authors.affiliation: Miami Veterans Administration Medical Center, Miami, Florida; Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
authors.forename: Katherine T
authors.initials: KT
authors.lastname: McManus
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Seiden
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida; Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Felix
authors.affiliation: Miami Veterans Administration Medical Center, Miami, Florida; Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Jerry
authors.initials: J
authors.lastname: Kalangara
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
authors.forename: William
authors.initials: W
authors.lastname: Feuer
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Patin
authors.affiliation: John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida; John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Eden R
authors.initials: ER
authors.lastname: Martin
authors.affiliation: Miami Veterans Administration Medical Center, Miami, Florida; Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Konstantinos D
authors.initials: KD
authors.lastname: Sarantopoulos
authors.affiliation: Miami Veterans Administration Medical Center, Miami, Florida; Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida; John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida; John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: rlevitt@med.miami.edu.
authors.forename: Roy C
authors.initials: RC
authors.lastname: Levitt
mesh_terms: D000368:Aged; D059350:Chronic Pain / Q000453:epidemiology* / Q000503:physiopathology; D015331:Cohort Studies; D015897:Comorbidity; D015352:Dry Eye Syndromes / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D010147:Pain Measurement; D013577:Syndrome
keywords: Dry eye symptoms; allodynia; central pain syndromes; chronic overlapping pain syndromes; chronic pain; comorbid pain syndromes; hyperalgesia; neuropathic ocular pain; neuropathic pain