{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T11:22:40Z","timestamp":1770549760533,"version":"3.49.0"},"reference-count":41,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,4,7]],"date-time":"2024-04-07T00:00:00Z","timestamp":1712448000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: This exploratory study evaluated the presence of sensitization-associated and neuropathic-like symptoms and identified their association with pressure sensitivity, pain, and disability in patients with cervical dystonia (CD). Methods: Thirty-one patients with CD (74.2% women, age: 61.2 years, SD 10.1) participated. Data collected included clinical variables, the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), the Central Sensitization Inventory (CSI), the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), the Hospital Anxiety and Depression Scale (HADS) and the Pittsburgh Sleep Quality Index (PSQI), as well as widespread pressure pain thresholds (PPTs). Results: Patients with CD with pain (n = 20, 64.5%) showed higher scores on the TWSTRS disability subscale and the CSI (p &lt; 0.001), and lower PPTs (p &lt; 0.05). Fifteen patients (15\/31, 48%) showed sensitization-associated symptoms (CSI \u2265 40), whereas five of the patients with pain (5\/20, 25%) exhibited neuropathic-like symptoms (S-LANSS \u2265 12). The CSI and S-LANSS were positively associated with the TWSTRS, HADS-A and HADS-D, and negatively associated with PPTs. HADS-D and S-LANSS explained 72.5% of the variance of the CSI (r2: 0.725), whereas CSI explained 42.3% of the variance of the S-LANSS (r2: 0.423). Conclusions: Pain is an important source of disability in CD, and may be a consequence of different mechanisms, including sensitization.<\/jats:p>","DOI":"10.3390\/jcm13072134","type":"journal-article","created":{"date-parts":[[2024,4,8]],"date-time":"2024-04-08T06:04:58Z","timestamp":1712556298000},"page":"2134","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sensitization-Associated Symptoms and Neuropathic-like Features in Patients with Cervical Dystonia and Pain"],"prefix":"10.3390","volume":"13","author":[{"given":"Diego","family":"de-la-Hoz-L\u00f3pez","sequence":"first","affiliation":[{"name":"Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain"},{"name":"Department of Neurology, Hospital Cl\u00ednico San Carlos, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8246-3743","authenticated-orcid":false,"given":"Mar\u00eda L.","family":"Cuadrado","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain"},{"name":"Department of Neurology, Hospital Cl\u00ednico San Carlos, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"L\u00f3pez-Vald\u00e9s","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain"},{"name":"Department of Neurology, Hospital Cl\u00ednico San Carlos, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roc\u00edo","family":"Garc\u00eda-Ramos","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain"},{"name":"Department of Neurology, Hospital Cl\u00ednico San Carlos, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Alonso-Frech","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain"},{"name":"Department of Neurology, Hospital Cl\u00ednico San Carlos, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Fern\u00e1ndez-Revuelta","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain"},{"name":"Department of Neurology, Hospital Cl\u00ednico San Carlos, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3772-9690","authenticated-orcid":false,"given":"C\u00e9sar","family":"Fern\u00e1ndez-de-las-Pe\u00f1as","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9343-8439","authenticated-orcid":false,"given":"V\u00edctor","family":"G\u00f3mez-Mayordomo","sequence":"additional","affiliation":[{"name":"Synaptia Institute of Neurosciencies, Hospital Universitario Vithas Madrid La Milagrosa, 28010 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1002\/mds.25475","article-title":"Phenomenology and classification of dystonia: A consensus update","volume":"28","author":"Albanese","year":"2013","journal-title":"Mov. Disord."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1016\/S1474-4422(11)70232-0","article-title":"Primary dystonia and dystonia-plus syndromes: Clinical characteristics, diagnosis, and pathogenesis","volume":"10","author":"Phukan","year":"2011","journal-title":"Lancet Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1001\/archneur.1990.00530050070014","article-title":"Natural history of adult-onset idiopathic torticollis","volume":"47","author":"Jahanshahi","year":"1990","journal-title":"Arch. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1136\/jnnp-2019-321794","article-title":"Risk of spread in adult-onset isolated focal dystonia: A prospective international cohort study","volume":"91","author":"Berman","year":"2020","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1007\/s00415-014-7343-6","article-title":"Cervical dystonia and pain: Characteristics and treatment patterns from CD PROBE (Cervical Dystonia Patient Registry for Observation of OnabotulinumtoxinA Efficacy)","volume":"261","author":"Charles","year":"2014","journal-title":"J. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1590\/0004-282X20140044","article-title":"The physical, social and emotional aspects are the most affected in the quality of life of the patients with cervical dystonia","volume":"72","author":"Werle","year":"2014","journal-title":"Arq. Neuropsiquiatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/S0304-3959(96)03296-4","article-title":"Pain in spasmodic torticollis","volume":"69","author":"Kutvonen","year":"1997","journal-title":"Pain"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1080\/14737175.2021.1984230","article-title":"Pain in cervical dystonia: Mechanisms, assessment and treatment","volume":"21","author":"Rosales","year":"2021","journal-title":"Expert. Rev. Neurother."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1007\/s00702-020-02245-4","article-title":"Demographic and clinical determinants of neck pain in idiopathic cervical dystonia","volume":"127","author":"Tinazzi","year":"2020","journal-title":"J. Neural. Transm."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e383","DOI":"10.1016\/S2665-9913(21)00032-1","article-title":"Central sensitisation in chronic pain conditions: Latest discoveries and their potential for precision medicine","volume":"3","author":"Nijs","year":"2021","journal-title":"Lancet Rheumatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1097\/j.pain.0000000000000507","article-title":"Do we need a third mechanistic descriptor for chronic pain states?","volume":"157","author":"Kosek","year":"2016","journal-title":"Pain"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2098","DOI":"10.1016\/S0140-6736(21)00392-5","article-title":"Nociplastic pain: Towards an understanding of prevalent pain conditions","volume":"397","author":"Fitzcharles","year":"2021","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/0304-3959(96)03153-3","article-title":"Pain perception in idiopathic cervical dystonia (spasmodic torticollis)","volume":"67","author":"Lobbezoo","year":"1996","journal-title":"Pain"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1002\/mds.29387","article-title":"Isolated cervical dystonia: Diagnosis and classification","volume":"38","author":"Albanese","year":"2023","journal-title":"Mov. Disord."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1212\/WNL.41.7.1088","article-title":"Cervical dystonia: Clinical findings and associated movement disorders","volume":"41","author":"Jankovic","year":"1991","journal-title":"Neurology"},{"key":"ref_16","first-page":"445","article-title":"The Toronto western spasmodic torticollis rating scale (TWSTRS): Assessment of validity and inter-rater reliability","volume":"40","author":"Consky","year":"1990","journal-title":"Neurology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1111\/j.1533-2500.2011.00493.x","article-title":"The development and psychometric validation of the central sensitization inventory","volume":"12","author":"Mayer","year":"2012","journal-title":"Pain Pract."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.jpain.2012.11.012","article-title":"The Central Sensitization Inventory (CSI): Establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample","volume":"14","author":"Neblett","year":"2013","journal-title":"J. Pain"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.jpain.2017.11.006","article-title":"Dimensionality and reliability of the Central Sensitization Inventory in a pooled multi-country sample","volume":"19","author":"Neblett","year":"2018","journal-title":"J. Pain"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1111\/papr.12636","article-title":"Measurement properties of the central sensitization inventory: A systematic review","volume":"18","author":"Scerbo","year":"2018","journal-title":"Pain Pract."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.jpain.2004.11.007","article-title":"The S-LANSS score for identifying pain of predominantly neuropathic origin: Validation for use in clinical and postal research","volume":"6","author":"Bennett","year":"2005","journal-title":"J. Pain"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_23","unstructured":"Plan Nacional para el SNS del (2008). Grupo de Trabajo de la Gu\u00eda de Pr\u00e1ctica Cl\u00ednica para el Manejo de Pacientes con Trastornos de Ansiedad en Atenci\u00f3n Primaria, Comunidad de Madrid. Gu\u00edas de Pr\u00e1ctica Cl\u00ednica en el SNS: UETS N\u00b0 2006\/10."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.jpain.2005.01.352","article-title":"Temporal summation of pain evoked by mechanical stimulation in deep and superficial tissue","volume":"6","author":"Nie","year":"2005","journal-title":"J. Pain"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Jenkins, D.G., and Quintana-Ascencio, P. (2020). A solution to minimum sample size for regressions. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0229345"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e00592","DOI":"10.1002\/brb3.592","article-title":"Nonmotor symptoms in primary adult-onset cervical dystonia and blepharospasm","volume":"7","author":"Yang","year":"2017","journal-title":"Brain Behav."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1097\/PHM.0000000000001603","article-title":"Pressure pain threshold in patients with chronic pain: A systematic review and meta-analysis","volume":"100","author":"Amiri","year":"2021","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"553","DOI":"10.3389\/fneur.2017.00553","article-title":"Sensory alterations in patients with isolated idiopathic dystonia: An exploratory quantitative sensory testing analysis","volume":"8","author":"Paracka","year":"2017","journal-title":"Front. Neurol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.jphys.2021.10.004","article-title":"Clinimetrics: The Central Sensitisation Inventory: A useful screening tool for clinicians, but not the gold standard","volume":"68","author":"Nijs","year":"2022","journal-title":"J. Physiother."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.parkreldis.2017.08.011","article-title":"When movement disorders hurt: Addressing pain in hyperkinetic disorders","volume":"44","author":"Relja","year":"2017","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1016\/j.pain.2010.09.030","article-title":"Central sensitization: Implications for the diagnosis and treatment of pain","volume":"152","author":"Woolf","year":"2011","journal-title":"Pain"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.parkreldis.2019.06.009","article-title":"Pain in cervical dystonia: Evidence of abnormal inhibitory control","volume":"65","author":"Tinazzi","year":"2019","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e786","DOI":"10.1097\/j.pain.0000000000002576","article-title":"Chronic nociplastic and neuropathic pain: How do they differentiate?","volume":"163","author":"Shala","year":"2022","journal-title":"Pain"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1097\/j.pain.0000000000001184","article-title":"Recently introduced definition of nociplastic pain by the International Association for the Study of Pain needs better formulation","volume":"159","author":"Aydede","year":"2018","journal-title":"Pain"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1097\/j.pain.0000000000002113","article-title":"Methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: A systematic review","volume":"162","author":"Shraim","year":"2021","journal-title":"Pain"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2629","DOI":"10.1097\/j.pain.0000000000002324","article-title":"Chronic nociplastic pain affecting the musculoskeletal system: Clinical criteria and grading system","volume":"162","author":"Kosek","year":"2021","journal-title":"Pain"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Nijs, J., Lahousse, A., Kapreli, E., Bilika, P., Sara\u00e7o\u011flu, \u0130., Malfliet, A., Coppieters, I., De Baets, L., Leysen, L., and Roose, E. (2021). Nociplastic pain criteria or recognition of central sensitization? Pain phenotyping in the past, present and future. J. Clin. Med., 10.","DOI":"10.3390\/jcm10153203"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1080\/14656566.2019.1647166","article-title":"Treatment of central sensitization in patients with chronic pain: Time for change?","volume":"20","author":"Nijs","year":"2019","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.jocn.2020.07.069","article-title":"Pain incidence in cervical dystonia is determined by the disease phenotype","volume":"79","author":"Marciniec","year":"2020","journal-title":"J. Clin. Neurosci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1002\/mds.29452","article-title":"The Pain in Dystonia Scale (PIDS)-Development sand validation in cervical dystonia","volume":"38","author":"Bruno","year":"2023","journal-title":"Mov. Disord."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/7\/2134\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:24:25Z","timestamp":1760106265000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/7\/2134"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,7]]},"references-count":41,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["jcm13072134"],"URL":"https:\/\/doi.org\/10.3390\/jcm13072134","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,7]]}}}