Fear of Movement, Central Sensitization May Worsen Outcomes in Gout

A new study reported that kinesiophobia and central sensitization frequently occur in patients with gout and were linked to increased pain intensity and decreased quality of life, mental health, functionality, and physical activity.1

Kinesiophobia, defined as an excessive fear of physical movement often following a traumatic injury, can significantly impair patients’ quality of life.2 Efforts to avoid movement to prevent pain may paradoxically lead to worsening pain. Kinesiophobia leads to a loss of physical mobility, physical fitness, inactivity, functional decline, and psychological issues with the belief that movement will increase pain. Research has shown that kinesiophobia has contributed to increased levels of disability and pain intensity.

A study published in January 2025 reported that 48.3% of 424 patients with a musculoskeletal disorder had kinesiophobia (95% confidence interval [CI], 43.3 to 53.3).2 Factors included being overweight or obese (adjusted odds ratio [aOR], 3.98), having a moderate pain level (aOR, 3.31), having a severe pain level (aOR, 9.29), physical inactivity (aOR, 3.00), anxiety (aOR, 2.57), and depression (aOR, 8.21).

Another study published in February 2025 identified the prevalence of kinesiophobia in patients with chronic diseases between 42.85% to 93%, depending on the condition.3 However, this study did not include participants with gout, instead focusing on cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases.

In this recent cross-sectional analysis, Kübra Tuncer, from the department of physical medicine and rehabilitation at Cukurova University in Türkiye, and colleagues sought to assess the prevalence of kinesiophobia and central sensitization among patients with gout and age- and gender-matched controls. The team also assessed the association between these factors and clinical gout outcomes.1

Investigators assessed kinesiophobia and central sensitization in patients using the Tampa Scale of Kinesiophobia (TSK) and Central Sensitization Inventory (CSI), respectively. They measured clinical outcomes via the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), Hospital Anxiety and Depression Scale (HADS), International Physical Activity Questionnaire-Short Form (IPAQ-SF), Gout Activity Score (GAS), and Health Assessment Questionnaire-Disability Index (HAQ-DI).1

The study reported a 62.3% and 33.8% prevalence of kinesiophobia and central sensitization in patients with gout, respectively. Patients with gout had greater scores for Tampa Scale of Kinesiophobia, Central Sensitization Inventory, and Hospital Anxiety and Depression Scale compared to controls, but lower scores of SF-36 and International Physical Activity Questionnaire-Short Form.1

Moreover, patients with kinesiophobia displayed statistically greater scores of Gout Activity Score, Central Sensitization Inventory, Hospital Anxiety and Depression Scale, and Health Assessment Questionnaire-Disability Index. These individuals also had lower sub-scores of SF-36, excluding the emotional role, and total International Physical Activity Questionnaire-Short Form scores than those without kinesiophobia.

Additionally, patients with central sensitization had greater scores in the Gout Activity Score, Tampa Scale of Kinesiophobia, Hospital Anxiety and Depression Scale, and Health Assessment Questionnaire-Disability, as well as lower scores in the SF-36 and total International Physical Activity Questionnaire-Short Form.

The analysis revealed that scores in the Tampa Scale of Kinesiophobia and Central Sensitization Inventory had significant positive correlations with each other and with pain, Gout Activity Score, Hospital Anxiety and Depression Scale, and Health Assessment Questionnaire-Disability Index. The regression analyses showed that the Central Sensitization Inventory score appeared to determine kinesiophobia severity.

Overall, this study suggests that mental health plays a large role in influencing central sensitization in gout. The research showed that central sensitization was independently associated with kinesiophobia.

“These close associations lead to challenges in optimizing management, functionality, physical activity level, and quality of life in gout,” investigators wrote.1

References

1. Tuncer K, Kozanoğlu E, Sariyildiz A, Yetişir A. Evaluation of kinesiophobia, central sensitization, and related factors in patients with gout: a cross-sectional study. Clin Rheumatol. Published online December 2, 2025. doi:10.1007/s10067-025-07862-6

2. Mekonnen Y, Gashaw M, Abich Y, Takele MD, Chanie ST, Wayessa DI, Deme S, Kibret AK. Kinesiophobia and associated factors among people with musculoskeletal disorders in Ethiopia: a multicenter cross-sectional study. BMC Musculoskelet Disord. 2025 Jan 15;26(1):55. doi: 10.1186/s12891-025-08306-7. PMID: 39815219; PMCID: PMC11734341.

3. Wlazło M, Szlacheta P, Grajek M, Staśkiewicz-Bartecka W, Rozmiarek M, Malchrowicz-Mośko E, Korzonek-Szlacheta I. The Impact of Kinesiophobia on Physical Activity and Quality of Life in Patients with Chronic Diseases: A Systematic Literature Review. Applied Sciences. 2025; 15(4):2086. https://doi.org/10.3390/app15042086