3/16/26
According to a recent study published in Advances in Rheumatology, many people living with axial spondyloarthritis (axSpA) experience central sensitization (i.e., pain amplification), pain catastrophizing (i.e., negative pain-related thinking), and sleep disturbance. These factors are strongly linked to worse symptoms and quality of life.
For people living with axSpA—or caring for someone who does—the idea that the disease can affect sleep and involve complex pain experiences may not seem surprising. However, this study is important because it helps quantify how common these factors are and shows that they are closely associated with disease activity, physical function, and quality of life—sometimes even more strongly than traditional inflammation markers.
In addition to inflammation, the researchers examined three factors that may influence how patients experience their disease: central sensitization, pain catastrophizing, and sleep disturbance. These terms are sometimes misunderstood. They do not mean that pain is “in someone’s head” or that a person is responsible for their symptoms. Rather, they describe biological and psychological processes that can occur in chronic illness. Central sensitization refers to changes in how the nervous system processes pain signals, which can make the body more sensitive to pain. Pain catastrophizing describes patterns of thinking and emotional responses—such as feeling overwhelmed or fearful about pain—that can develop when someone is coping with persistent symptoms. Sleep disturbance includes difficulty falling asleep, staying asleep, or feeling rested.
The study found that these factors were common among people with axSpA. About 59% showed signs of central sensitization, and 53% reported high levels of pain catastrophizing—rates much higher than those seen in healthy individuals. Participants with axSpA also reported significantly poorer sleep.
These factors were also associated with worse disease outcomes. People with higher levels of pain amplification, more negative thoughts about pain, or poorer sleep tended to report higher disease activity, greater difficulty with daily activities, and lower quality of life. Women in the study had higher levels of central sensitization. Interestingly, the researchers found that these neurological and psychological factors were more closely linked to patients’ reported symptoms than objective inflammation markers such as CRP. Patients taking tumor necrosis factor inhibitor (TNFi) biologics also tended to report better sleep.
To examine these relationships, researchers compared 100 people with axSpA to 50 healthy individuals. Participants completed questionnaires measuring pain amplification, thoughts about pain, and sleep problems. The researchers also collected standard rheumatology measures of disease activity, physical function, spinal mobility, quality of life, and blood markers of inflammation.
Overall, the findings suggest that inflammation alone may not fully explain the symptoms many people with axSpA experience. Pain processing in the nervous system, emotional responses to chronic pain, and sleep quality may also influence how the disease affects daily life.
Importantly, this does not mean that axSpA symptoms are “just psychological” or unrelated to inflammation. AxSpA is a well-established inflammatory disease. Instead, the study suggests that additional factors—such as how the nervous system processes pain and how well a person sleeps—may influence the day-to-day experience of living with the condition.
Because of this, the researchers suggest that managing axSpA may benefit from a broader approach that includes strategies to address pain processing, psychological well-being, and sleep health—alongside treatments that target inflammation. In other words, improving outcomes for people with axSpA may involve addressing multiple aspects of the condition, not just inflammation alone.
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