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Ho KWD, Wallace MR, Sibille KT, Bartley EJ, Cruz-Almeida Y, Glover TL, King CD, Goodin BR, Addison A, Edberg JC, Staud R, Bradley LA, Fillingim RB. Single Nucleotide Polymorphism in the COL11A2 Gene Associated with Heat Pain Sensitivity in Knee Osteoarthritis. Mol Pain 2018; 13:1744806917724259. [PMID: 28741447 PMCID: PMC5562334 DOI: 10.1177/1744806917724259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pain is one of the most prominent symptoms of osteoarthritis. However, there is often discordance between the pain experienced by individuals with osteoarthritis and the degree of articular pathology. This suggests that individual differences, including genetic variability in the central processing of nociceptive stimuli, may impact the presentation of osteoarthritis. Here, we show that the single nucleotide polymorphism rs16868943 in the collagen gene COL11A2 is significantly associated with lowered heat pain tolerance on the arm in participants with knee osteoarthritis (P = 1.21 × 10−6, P = 0.0053 after Bonferroni correction, beta = −3.42). A total of 161 knee osteoarthritis participants were included and evaluated for heat, punctate and pressure pain sensitivity of the affected knee and the ipsilateral arm. Each participant was genotyped for 4392 single nucleotide polymorphisms in genes implicated in pain perception, inflammation and mood and tested for association with pain sensitivity. The minor A allele of single nucleotide polymorphism rs16868943 was significantly associated with lower arm heat pain tolerance after correction for age, gender, race, and study site. This single nucleotide polymorphism was also nominally associated with other measures of heat pain sensitivity, including lowered knee heat pain tolerance (P = 1.14 × 10−5, P = 0.05 after Bonferroni correction), lowered arm heat pain threshold (P = 0.0039, uncorrected) and lowered knee heat pain threshold (P = 0.003, uncorrected). Addition of genotypes from 91 participants without knee pain produced a significant interaction between knee osteoarthritis status and the rs16868943 single nucleotide polymorphism in heat pain tolerance (P = 1.71 × 10−5), such that rs16868943 was not associated with heat pain tolerance in participants without knee pain (P = 0.12, beta = 1.3). This is the first study to show genetic association with heat pain tolerance in individuals with osteoarthritis. The association is specific to participants who have already developed knee osteoarthritis, suggesting that the COL11A2 gene, which has previously been associated with familial osteoarthritis, may play a role in pain sensitization after the development of osteoarthritis.
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Affiliation(s)
| | - Margaret R Wallace
- Department of Molecular Genetics & Microbiology, University of Florida, Gainesville, FL
| | - Kimberly T Sibille
- Department of Aging & Geriatric Research, University of Florida, Gainesville, FL
| | - Emily J Bartley
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL
| | - Yenisel Cruz-Almeida
- Department of Aging & Geriatric Research, University of Florida, Gainesville, FL
| | - Toni L Glover
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL
| | - Christopher D King
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Adriana Addison
- Division of Clinical Immunology & Rheumatotology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Jeffrey C Edberg
- Division of Clinical Immunology & Rheumatotology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Roland Staud
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL
| | - Laurence A Bradley
- Division of Clinical Immunology & Rheumatotology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL
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Arendt-Nielsen L, Simonsen O, Laursen M, Roos E, Rathleff M, Rasmussen S, Skou S. Pain and sensitization after total knee replacement or nonsurgical treatment in patients with knee osteoarthritis: Identifying potential predictors of outcome at 12 months. Eur J Pain 2018; 22:1088-1102. [DOI: 10.1002/ejp.1193] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- L. Arendt-Nielsen
- SMI, Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
| | - O. Simonsen
- SMI, Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
- Orthopedic Surgery Research Unit; Aalborg University Hospital; Denmark
- Department of Clinical Medicine; Aalborg University; Denmark
| | - M.B. Laursen
- SMI, Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
- Orthopedic Surgery Research Unit; Aalborg University Hospital; Denmark
- Department of Clinical Medicine; Aalborg University; Denmark
| | - E.M. Roos
- Research Unit for Musculoskeletal Function and Physiotherapy; Department of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense Denmark
| | - M.S. Rathleff
- SMI, Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
| | - S. Rasmussen
- SMI, Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
- Orthopedic Surgery Research Unit; Aalborg University Hospital; Denmark
- Department of Clinical Medicine; Aalborg University; Denmark
| | - S.T. Skou
- SMI, Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
- Orthopedic Surgery Research Unit; Aalborg University Hospital; Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy; Department of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense Denmark
- Department of Physiotherapy and Occupational Therapy; Naestved-Slagelse-Ringsted Hospitals, Region Zealand; Slagelse Denmark
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Age Interactions on Pain Sensitization in Patients With Severe Knee Osteoarthritis and Controls. Clin J Pain 2018; 33:1081-1087. [PMID: 28277434 DOI: 10.1097/ajp.0000000000000495] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Widespread pressure hyperalgesia, facilitated temporal summation of pain (TSP), and impaired conditioned pain modulation (CPM) have been found in knee osteoarthritis (KOA) patients compared with controls and these parameters have further been suggested to be altered in the elderly. This study investigated the influence of age on pressure hyperalgesia, TSP, and CPM in patients with KOA and controls. MATERIALS AND METHODS One hundred thirty-three severe KOA patients and 50 age-matched and sex-matched asymptomatic controls were assessed by cuff algometry and handheld pressure algometry. Pain sensitivity was assessed around the head of the gastrocnemius muscle to identify mild pain detection threshold (MPDT) and pressure tolerance threshold (PTT). TSP was assessed by visual analogue scale scores of the pain evoked by 10 repetitive cuff stimulations. CPM was assessed as the difference in PTT before and during cuff-induced tonic arm pain. Pressure pain thresholds (PPTs) were assessed by handheld algometry at the tibialis anterior muscle. Two subgroups were analyzed in the age range below and above 65 years. Pearson correlations between age and pain parameters were applied. RESULTS Patients demonstrated reduced MPDT, PTT, and PPT (P<0.01), facilitated TSP (P<0.02), and a trend toward impaired CPM (P=0.06) compared with controls. A negative correlation was found between MPDT, PTT, and PPT and age (P<0.05) but no age-related association was found for TSP and CPM. DISCUSSION Pressure hyperalgesia was affected by age whereas dynamic pain mechanisms such as TSP and CPM were unaffected suggesting that these parameters are robust for a larger age range and reliable for long-term follow-up studies.
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Jaber K, O'Leary S, Pedler A, Sterling M, McAuliffe M. Evidence of generalised mechanical hyperalgesia in patients with advanced knee osteoarthritis undergoing total knee arthroplasty. Knee 2018; 25:459-465. [PMID: 29685500 DOI: 10.1016/j.knee.2018.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/11/2017] [Accepted: 03/01/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Persistent pain is reported in up to 34% of patients following total knee arthroplasty (TKA) for management of knee osteoarthritis (KOA). Persistent pain in this group is thought to be at least partly reflective of pain sensory hypersensitivity. The objective of this study was to evaluate sensory hypersensitivity, using mechanical and thermal quantitative sensory testing, in patients about to undergo TKA. DESIGN AND METHODS Pressure pain thresholds (PPT) and cold pain thresholds (CPT) were recorded from 30 participants prior to their TKA, and compared with recordings taken from 30 healthy control participants of similar age and gender. Thresholds were recorded locally and remotely (other knee, deltoid) to the operative knee. Group comparisons (KOA, control, groups) were made using a general linear mixed models approach with age, gender, and body mass index (BMI) included as covariates. Pairwise comparisons were conducted with Bonferonni correction for multiple comparisons. RESULTS Significantly lower PPTs were at all measured sites in the KOA group compared to the control group (P<0.001 at all sites, except the deltoid P=0.004). Males demonstrated higher pain threshold compared to females, averaged over all sites, P=0.02. There were no observed between-group differences in CPT (P=0.122). CONCLUSIONS This study suggested that some individuals about to undergo TKA for their advanced KOA demonstrated widespread mechanical sensory hypersensitivity. These findings have potentially important clinical implications regarding perioperative and longer-term pain management in these patients.
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Affiliation(s)
- Khalid Jaber
- Ipswich General Hospital, Queensland Health, Ipswich, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Shaun O'Leary
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Ashley Pedler
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery After Road Traffic Injury, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery After Road Traffic Injury, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Michael McAuliffe
- Ipswich General Hospital, Queensland Health, Ipswich, Australia; The CJM Centre, Ipswich, Australia; The Mater Private Hospital, Springfield Lakes, Australia; St Andrew's Ipswich Private Hospital, Ipswich, Australia
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O'Leary H, Smart KM, Moloney NA, Blake C, Doody CM. Pain sensitization associated with nonresponse after physiotherapy in people with knee osteoarthritis. Pain 2018; 159:1877-1886. [DOI: 10.1097/j.pain.0000000000001288] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Wan DWL, Arendt-Nielsen L, Wang K, Xue CC, Wang Y, Zheng Z. Pain Adaptability in Individuals With Chronic Musculoskeletal Pain Is Not Associated With Conditioned Pain Modulation. THE JOURNAL OF PAIN 2018; 19:897-909. [PMID: 29597084 DOI: 10.1016/j.jpain.2018.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 09/03/2017] [Accepted: 03/03/2018] [Indexed: 11/16/2022]
Abstract
Healthy humans can be divided into the pain adaptive (PA) and the pain nonadaptive (PNA) groups; PA showed a greater decrease in pain rating to a cold pressor test (CPT) than PNA. This study examined if the dichotomy of pain adaptability existed in individuals with chronic musculoskeletal pain. CPTs at 2°C and 7°C were used to assess the status of pain adaptability in participants with either chronic nonspecific low back pain or knee osteoarthritis. The participants' potency of conditioned pain modulation (CPM) and local inhibition were measured. The strengths of pain adaptability at both CPTs were highly correlated. PA and PNA did not differ in their demographic characteristics, pain thresholds from thermal and pressure stimuli, or potency of local inhibition or CPM. PA reached their maximum pain faster than PNA (t41 = -2.76, P < .01), and had a gradual reduction of pain unpleasantness over 7 days whereas PNA did not (F6,246 = 3.01, P = .01). The dichotomy of pain adaptability exists in musculoskeletal pain patients. Consistent with the healthy human study, the strength of pain adaptability and potency of CPM are not related. Pain adaptability could be another form of endogenous pain inhibition of which clinical implication is yet to be understood. PERSPECTIVE The dichotomy of pain adaptability was identified in healthy humans. The current study confirms that this dichotomy also exists in individuals with chronic musculoskeletal pain, and could be reliably assessed with CPTs at 2°C and 7°C. Similar to the healthy human study, pain adaptability is not associated with CPM, and may reflect the temporal aspect of pain inhibition.
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Affiliation(s)
- Dawn Wong Lit Wan
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Kelun Wang
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Charlie Changli Xue
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Yanyi Wang
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia.
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Louw A, Zimney K, Reed J, Landers M, Puentedura EJ. Immediate preoperative outcomes of pain neuroscience education for patients undergoing total knee arthroplasty: A case series. Physiother Theory Pract 2018; 35:543-553. [PMID: 29589782 DOI: 10.1080/09593985.2018.1455120] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Standard preoperative education for total knee arthroplasty (TKA) has been shown to have no effect on postoperative outcomes. This may be because such education programs fail to educate patients about pain. Pain neuroscience education (PNE) focuses on teaching people more about pain from a neurobiological and neurophysiological perspective. DESIGN AND SETTING Case Series. AIM To determine the immediate effects, if any, of providing PNE before TKA surgery on patient self-report measures. PARTICIPANTS Twelve patients (female = 10) prior to TKA for knee osteoarthritis (OA). INTERVENTION Preoperative educational session by a physical therapist on the neuroscience of pain, accompanied by an evidence-based booklet. MAIN OUTCOME MEASURES Comparison of pre- and post-PNE self-report measures on knee pain (NPRS), Pain Catastrophization Scale (PCS), fear of movement (TSK), and beliefs about TKA; as well as three physical performance measures - knee flexion active range of motion, 40 m self-paced walk, and pressure pain threshold (PPT). RESULTS Immediately following the PNE, patients had statistically significant lower TSK scores, increased PPT, and improved beliefs about their upcoming surgery. There were no significant changes in knee pain, function, or flexion active range of motion. CONCLUSIONS Results appear to suggest that immediately after PNE, patients scheduled for TKA had statistically significant changes in fear of movement, decreased sensitivity to pain and positive shifts in their beliefs about their future knee surgery. Larger trials with control/comparison groups are warranted to determine the true effects of preoperative PNE for patients about to undergo TKA.
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Affiliation(s)
- Adriaan Louw
- a International Spine and Pain Institute , Story City , IA , USA
| | - Kory Zimney
- b Department of Physical Therapy, School of Health Sciences , University of South Dakota , Vermillion , SD , USA
| | - Jordan Reed
- c Rehabilitation Services , Spencer Hospital , Spencer , IA , USA
| | - Merrill Landers
- d Department of Physical Therapy, School of Allied Health Sciences , University of Nevada Las Vegas , Las Vegas , NV , USA
| | - Emilio J Puentedura
- d Department of Physical Therapy, School of Allied Health Sciences , University of Nevada Las Vegas , Las Vegas , NV , USA
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Individual Variation in Pain Sensitivity and Conditioned Pain Modulation in Acute Low Back Pain: Effect of Stimulus Type, Sleep, and Psychological and Lifestyle Factors. THE JOURNAL OF PAIN 2018; 19:942.e1-942.e18. [PMID: 29597080 DOI: 10.1016/j.jpain.2018.02.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/18/2018] [Accepted: 02/22/2018] [Indexed: 02/08/2023]
Abstract
Generalized hyperalgesia and impaired pain modulation are reported in chronic low back pain (LBP). Few studies have tested whether these features are present in the acute phase. This study aimed to test for differences in pain presentation in early-acute LBP and evaluate the potential contribution of other factors to variation in sensitivity. Individuals within 2 weeks of onset of acute LBP (n = 126) and pain-free controls (n = 74) completed questionnaires related to their pain, disability, behavior, and psychological status before undergoing conditioned pain modulation (CPM) and pain threshold (heat, cold, and pressure) testing at the back and forearm/thumb. LBP participants were more sensitive to heat and cold at both sites and pressure at the back than controls, without differences in CPM. Only those with high-pain (numeric rating scale ≥4) were more sensitive to heat at the forearm and pressure at the back. Four subgroups with distinct features were identified: "high sensitivity," "low CPM efficacy," "high sensitivity/low CPM efficacy," and "low sensitivity/high CPM efficacy." Various factors such as sleep and alcohol were associated with each pain measure. Results provide evidence for generalized hyperalgesia in many, but not all, individuals during acute LBP, with variation accounted for by several factors. Specific pain phenotypes provide candidate features to test in longitudinal studies of LBP outcome. PERSPECTIVE Sensory changes indicative of increased/decreased central processing of pain and nociceptive input presented differently between individuals with acute LBP and were related to factors such as sleep and alcohol. This may underlie variation in outcome and suggest potential for early identification of individuals with poor long-term outcome.
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Pressure Pain Threshold and Anxiety in Adolescent Females With and Without Juvenile Fibromyalgia: A Pilot Study. Clin J Pain 2018; 33:620-626. [PMID: 27841836 DOI: 10.1097/ajp.0000000000000444] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Reduced pain thresholds have been documented in adult fibromyalgia, but there are no quantitative studies of altered pain sensitivity in adolescents with juvenile fibromyalgia (JFM). The current study examined differences in pressure pain sensitivity between adolescent females with JFM and healthy controls. The relationship between levels of anxiety and pain were also examined. METHODS A total of 34 JFM (15.4±1.4 y old) and 31 controls (14.5±1.3 y old) completed self-report measures of pain and anxiety. Pressure pain threshold was assessed (palm and forehead sites) with a hand-held algometer. Participants indicated the first sensation of pain and then rated the intensity of pain on a Numerical Rating Scale. RESULTS Adolescents with JFM exhibited greater sensitivity to pressure pain compared with controls. While the difference between JFM and controls was only observed at the forehead, the intensity of pain produced by the pressure algometry at both sites was significantly higher in the JFM participants compared with controls. Correlations between clinical pain and anxiety were significant for the JFM group only. No relationships were observed between anxiety and pressure pain for either group. DISCUSSION This study is a first step toward investigating mechanisms of altered pain processing in adolescents with JFM. Adolescents with JFM were found be more sensitive to pressure pain than their healthy peers, which suggests a propensity for sensitization of peripheral and/or central nociceptive information often reported in adult fibromyalgia, and which does not appear to be affected by anxiety.
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Neuropathic pain in end-stage hip and knee osteoarthritis: differential associations with patient-reported pain at rest and pain on activity. Osteoarthritis Cartilage 2018; 26:363-369. [PMID: 29326061 DOI: 10.1016/j.joca.2018.01.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/22/2017] [Accepted: 01/03/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We investigated whether pain at rest and pain on activity were differentially associated with neuropathic pain scores in individuals with end-stage hip and knee OA. DESIGN Study participants were 843 patients with hip or knee OA scheduled for total joint arthroplasty. In pre-surgery questionnaires, measures of socio-demographics, health status, medication use, neuropathic pain (painDETECT), pain at rest and pain on activity (WOMAC pain items), depression (HADS) and pain catastrophizing (PCS) were collected. Multivariable linear regression models were estimated for men and women separately to examine the association between neuropathic pain scores (outcome) and study measures, entered in blocks. RESULTS Sample mean age was 65.1 years (SD: 9.6); 57.1% were women. Mean painDETECT scores were significantly higher (P ≤ֹ 0.001) for women (11.2 ± 6.6 out of 38) than men (9.3 ± 7.0), with 35.6% of women and 27.7% of men meeting cut-offs for possible or likely neuropathic pain. In the final regression model for women, the coefficients for both types of pain were statistically significant, although the coefficient for pain at rest was 1.6 times greater than that for pain on activity. For men, only pain at rest was significantly associated with neuropathic pain scores. CONCLUSIONS Findings support that possible neuropathic pain is experienced by a notable proportion of patients with end-stage hip and knee OA and is more strongly associated with pain at rest than pain on activity, particularly in men. Clinical presentation of pain at rest may warrant more thorough evaluation for potential neuropathic pain and have implications for appropriate pain management.
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The Role of Preoperative Radiologic Severity, Sensory Testing, and Temporal Summation on Chronic Postoperative Pain Following Total Knee Arthroplasty. Clin J Pain 2018; 34:193-197. [DOI: 10.1097/ajp.0000000000000528] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Bevilaqua-Grossi D, Zanin M, Benedetti C, Florencio L, Oliveira A. Thermal and mechanical pain sensitization in patients with osteoarthritis of the knee. Physiother Theory Pract 2018; 35:139-147. [PMID: 29482419 DOI: 10.1080/09593985.2018.1441930] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim was to assess sensitization using quantitative sensory testing in mechanical and thermal modes in individuals with and without osteoarthritis (OA) of the knee. Pain thresholds were correlated with functionality, symptoms of depression and intensity of pain. METHODS Thirty control volunteers and 30 patients with OA of the knee were assessed. Punctate pain thresholds using Von Frey filaments and thermal pain thresholds using a Thermal Sensory Analyzer were evaluated in the periarticular region of the knee and forearm. Using a digital pressure algometer, pressure pain thresholds were assessed in the periarticular region of the knee and on the root exit zone on the lumbar and sacral spine. RESULTS Punctate, pressure, and thermal pain thresholds differed significantly between participants with and without OA (p < 0.05). Values in those with OA were consistent with pain sensitization. Pressure pain thresholds also showed moderate and negative correlations with data on functionality, symptoms of depression and intensity of pain (-0.36 < r > -0.56), contributing up to 30% of their variability. CONCLUSIONS Allodynia and hyperalgesia were demonstrated in the OA group, suggesting central sensitization in patients with mild to moderate severity of joint damage. Correlation between mechanical hypersensitivity and psychosocial factors seems to be small, despite of its significance.
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Affiliation(s)
| | - Marilia Zanin
- a Ribeirão Preto Medical School , University of São Paulo , Ribeirão Preto-SP , Brazil
| | - Camila Benedetti
- a Ribeirão Preto Medical School , University of São Paulo , Ribeirão Preto-SP , Brazil
| | - Lidiane Florencio
- a Ribeirão Preto Medical School , University of São Paulo , Ribeirão Preto-SP , Brazil
| | - Anamaria Oliveira
- a Ribeirão Preto Medical School , University of São Paulo , Ribeirão Preto-SP , Brazil
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Arendt‐Nielsen L, Morlion B, Perrot S, Dahan A, Dickenson A, Kress H, Wells C, Bouhassira D, Drewes AM. Assessment and manifestation of central sensitisation across different chronic pain conditions. Eur J Pain 2018; 22:216-241. [DOI: 10.1002/ejp.1140] [Citation(s) in RCA: 378] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
AbstractDifferent neuroplastic processes can occur along the nociceptive pathways and may be important in the transition from acute to chronic pain and for diagnosis and development of optimal management strategies. The neuroplastic processes may result in gain (sensitisation) or loss (desensitisation) of function in relation to the incoming nociceptive signals. Such processes play important roles in chronic pain, and although the clinical manifestations differ across condition processes, they share some common mechanistic features. The fundamental understanding and quantitative assessment of particularly some of the central sensitisation mechanisms can be translated from preclinical studies into the clinic. The clinical perspectives are implementation of such novel information into diagnostics, mechanistic phenotyping, prevention, personalised treatment, and drug development. The aims of this paper are to introduce and discuss (1) some common fundamental central pain mechanisms, (2) how they may translate into the clinical signs and symptoms across different chronic pain conditions, (3) how to evaluate gain and loss of function using quantitative pain assessment tools, and (4) the implications for optimising prevention and management of pain. The chronic pain conditions selected for the paper are neuropathic pain in general, musculoskeletal pain (chronic low back pain and osteoarthritic pain in particular), and visceral pain (irritable bowel syndrome in particular). The translational mechanisms addressed are local and widespread sensitisation, central summation, and descending pain modulation.SignificanceCentral sensitisation is an important manifestation involved in many different chronic pain conditions. Central sensitisation can be different to assess and evaluate as the manifestations vary from pain condition to pain condition. Understanding central sensitisation may promote better profiling and diagnosis of pain patients and development of new regimes for mechanism based therapy. Some of the mechanisms underlying central sensitisation can be translated from animals to humans providing new options in development of therapies and profiling drugs under development.
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Affiliation(s)
| | - B. Morlion
- The Leuven Centre for Algology University Hospitals Leuven University of Leuven Belgium
| | - S. Perrot
- INSERM U987 Pain Center Cochin Hospital Paris Descartes University Paris France
| | - A. Dahan
- Department of Anesthesiology Leiden University Medical Center Leiden The Netherlands
| | - A. Dickenson
- Neuroscience Physiology & Pharmacology University College London UK
| | - H.G. Kress
- Department of Special Anaesthesia and Pain Therapy Medizinische Universität/AKH Wien Vienna Austria
| | | | - D. Bouhassira
- INSERM U987 Centre d'Evaluation et de Traitement de la Douleur Hôpital Ambroise Paré Boulogne Billancourt France
| | - A. Mohr Drewes
- Mech‐Sense Department of Gastroenterology and Hepatology Clinical Institute Aalborg University Hospital Aalborg Denmark
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Mason KJ, O’Neill TW, Lunt M, Jones AK, McBeth J. Psychosocial factors partially mediate the relationship between mechanical hyperalgesia and self-reported pain. Scand J Pain 2018; 18:59-69. [DOI: 10.1515/sjpain-2017-0109] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/07/2017] [Indexed: 01/01/2023]
Abstract
Abstract
Background and aims:
Amplification of sensory signalling within the nervous system along with psychosocial factors contributes to the variation and severity of knee pain. Quantitative sensory testing (QST) is a non-invasive test battery that assesses sensory perception of thermal, pressure, mechanical and vibration stimuli used in the assessment of pain. Psychosocial factors also have an important role in explaining the occurrence of pain. The aim was to determine whether QST measures were associated with self-reported pain, and whether those associations were mediated by psychosocial factors.
Methods:
Participants with knee pain identified from a population-based cohort completed a tender point count and a reduced QST battery of thermal, mechanical and pressure pain thresholds, temporal summation, mechanical pain sensitivity (MPS), dynamic mechanical allodynia (DMA) and vibration detection threshold performed following the protocol by the German Research Network on Neuropathic Pain. QST assessments were performed at the most painful knee and opposite forearm (if pain-free). Participants were asked to score for their global and knee pain intensities within the past month (range 0–10), and complete questionnaire items investigating anxiety, depression, illness perceptions, pain catastrophising, and physical functioning. QST measures (independent variable) significantly correlated (Spearman’s rho) with self-reported pain intensity (dependent variable) were included in structural equation models with psychosocial factors (latent mediators).
Results:
Seventy-two participants were recruited with 61 participants (36 women; median age 64 years) with complete data included in subsequent analyses. Tender point count was significantly correlated with global pain intensity. DMA at the knee and MPS at the most painful knee and opposite pain-free forearm were significantly correlated with both global pain and knee pain intensities. Psychosocial factors including pain catastrophising sub-scales (rumination and helplessness) and illness perceptions (consequences and concern) were significant partial mediators of the association with global pain intensity when loaded on to a latent mediator for: tender point count [75% total effect; 95% confidence interval (CI) 22%, 100%]; MPS at the knee (49%; 12%, 86%); and DMA at the knee (63%; 5%, 100%). Latent psychosocial factors were also significant partial mediators of the association between pain intensity at the tested knee with MPS at the knee (30%; 2%, 58%), but not for DMA at the knee.
Conclusions:
Measures of mechanical hyperalgesia at the most painful knee and pain-free opposite forearm were associated with increased knee and global pain indicative of altered central processing. Psychosocial factors were significant partial mediators, highlighting the importance of the central integration of emotional processing in pain perception.
Implications:
Associations between mechanical hyperalgesia at the forearm and knee, psychosocial factors and increased levels of clinical global and knee pain intensity provide evidence of altered central processing as a key mechanism in knee pain, with psychological factors playing a key role in the expression of clinical pain.
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Affiliation(s)
- Kayleigh J. Mason
- BADBIR, Rutherford House (Unit 1) , Manchester Science Park, 40 Pencroft Way , Manchester, M15 6SZ , UK , Tel.: +44 (0) 161 306 1908, Fax: +44 (0) 161 306 1912
- Division of Musculoskeletal and Dermatological Sciences , The University of Manchester , Manchester , UK
| | - Terence W. O’Neill
- Division of Musculoskeletal and Dermatological Sciences , The University of Manchester , Manchester , UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre , Manchester , UK
- Department of Rheumatology , Salford Royal NHS Foundation Trust , Salford , UK
| | - Mark Lunt
- Division of Musculoskeletal and Dermatological Sciences , The University of Manchester , Manchester , UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre , Manchester , UK
| | - Anthony K.P. Jones
- Department of Rheumatology , Salford Royal NHS Foundation Trust , Salford , UK
- Human Pain Research Group , Division of Neuroscience and Experimental Psychology , The University of Manchester , Manchester , UK
| | - John McBeth
- Division of Musculoskeletal and Dermatological Sciences , The University of Manchester , Manchester , UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre , Manchester , UK
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Dell’Isola A, Steultjens M. Classification of patients with knee osteoarthritis in clinical phenotypes: Data from the osteoarthritis initiative. PLoS One 2018; 13:e0191045. [PMID: 29329325 PMCID: PMC5766143 DOI: 10.1371/journal.pone.0191045] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 12/27/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The existence of phenotypes has been hypothesized to explain the large heterogeneity characterizing the knee osteoarthritis. In a previous systematic review of the literature, six main phenotypes were identified: Minimal Joint Disease (MJD), Malaligned Biomechanical (MB), Chronic Pain (CP), Inflammatory (I), Metabolic Syndrome (MS) and Bone and Cartilage Metabolism (BCM). The purpose of this study was to classify a sample of individuals with knee osteoarthritis (KOA) into pre-defined groups characterized by specific variables that can be linked to different disease mechanisms, and compare these phenotypes for demographic and health outcomes. METHODS 599 patients were selected from the OAI database FNIH at 24 months' time to conduct the study. For each phenotype, cut offs of key variables were identified matching the results from previous studies in the field and the data available for the sample. The selection process consisted of 3 steps. At the end of each step, the subjects classified were excluded from the further classification stages. Patients meeting the criteria for more than one phenotype were classified separately into a 'complex KOA' group. RESULTS Phenotype allocation (including complex KOA) was successful for 84% of cases with an overlap of 20%. Disease duration was shorter in the MJD while the CP phenotype included a larger number of Women (81%). A significant effect of phenotypes on WOMAC pain (F = 16.736 p <0.001) and WOMAC physical function (F = 14.676, p < 0.001) was identified after controlling for disease duration. CONCLUSION This study signifies the feasibility of a classification of KOA subjects in distinct phenotypes based on subgroup-specific characteristics.
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Affiliation(s)
- A. Dell’Isola
- Institute of Applied Health Research/ School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - M. Steultjens
- Institute of Applied Health Research/ School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
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Goodin BR, Owens MA, Yessick LR, Rainey RL, Okunbor JI, White DM, Mushatt KA, Harmon OA, Heath SL, Merlin JS. Detectable Viral Load May Be Associated with Increased Pain Sensitivity in Persons Living with HIV: Preliminary Findings. PAIN MEDICINE (MALDEN, MASS.) 2017; 18:2289-2295. [PMID: 28398572 PMCID: PMC5914379 DOI: 10.1093/pm/pnx057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Animal models have previously shown that HIV is associated with hyperalgesia, or heightened sensitivity to painful stimuli. Efforts to determine whether this finding translates to humans are presently lacking. Among persons living with HIV (PLWH), those with detectable viral loads may be at greatest risk for heightened pain sensitivity. It was hypothesized that PLWH with detectable viral loads would be more sensitive to painful stimuli compared with PLWH without detectable viral loads and healthy controls without HIV. DESIGN A total of 47 PLWH and 50 community-dwelling, healthy adults without HIV (controls) were recruited. Participants completed a quantitative sensory testing protocol to assess threshold, tolerance, and temporal summation in response to painful mechanical and heat stimuli. Most recent viral load was collected from medical records, and viral load was considered detectable if the count was greater than 50 copies/mL of blood. Of the 47 PLWH, 11 (23.4%) had detectable viral loads, the median viral load count was 10,200 copies/mL. RESULTS PLWH with detectable viral loads demonstrated significantly lower pain thresholds for mechanical stimuli (F2,89 = 3.15, P = 0.049), significantly lower heat pain tolerances (F2,89 = 3.38, P = 0.039), and significantly greater temporal summation of heat pain at 48 °C (F2,89 = 10.66, P < 0.001) and 50 °C (F2,89 = 3.82, P = 0.026), compared with PLWH without detectable viral loads and healthy controls. CONCLUSIONS These preliminary results tentatively suggest that the detectable presence of the virus may sensitize PLWH to painful mechanical and heat stimuli.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jessica S Merlin
- Division of Infectious Diseases
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
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Do Psychosocial Factors Predict Muscle Strength, Pain, or Physical Performance in Patients With Knee Osteoarthritis? J Clin Rheumatol 2017; 23:308-316. [DOI: 10.1097/rhu.0000000000000560] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cruz-Almeida Y, Cardoso J, Riley JL, Goodin B, King CD, Petrov M, Bartley EJ, Sibille KT, Glover TL, Herbert MS, Bulls HW, Addison A, Staud R, Redden D, Bradley LA, Fillingim RB. Physical performance and movement-evoked pain profiles in community-dwelling individuals at risk for knee osteoarthritis. Exp Gerontol 2017; 98:186-191. [PMID: 28842222 DOI: 10.1016/j.exger.2017.08.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/07/2017] [Accepted: 08/18/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Knee pain associated with osteoarthritis is a significant contributor to decreased physical function. Recent evidence supports the inter-individual heterogeneity associated with knee pain presentation, but whether there is similar heterogeneity in physical performance among these individuals has not been previously examined. The aim of the present study was to characterize the variability in physical performance profiles and the pain evoked by their performance (i.e., movement-evoked pain). METHODS In a secondary analysis of the community-based study Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD), individuals (n=270) completed functional, pain, psychological, and somatosensory assessments. Hierarchical cluster analysis was used to derive physical function profiles that were subsequently compared across several clinical, psychological and experimental pain measures. RESULTS Our results support the hypothesis that among persons with knee OA pain, three different physical performance profiles exist with varying degrees of movement-evoked pain. Even as all three groups experienced moderate to severe levels of spontaneous knee pain, those individuals with the most severe movement-evoked pain and lowest physical functional performance also had the least favorable psychological characteristics along with increased mechanical pain sensitivity and temporal summation. CONCLUSIONS Our findings support the need for the assessment and consideration of movement-evoked pain during physical performance tasks as these have the potential to increase the value of functional and pain assessments clinically. The identification of the mechanisms driving pain burden within homogeneous groups of individuals will ultimately allow for targeted implementation of treatments consistent with a biopsychosocial model of pain.
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Affiliation(s)
- Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, USA; Institute on Aging, University of Florida, USA; Cognitive Aging & Memory Clinical Translational Research Program, University of Florida, USA; Department of Aging & Geriatric Research, College of Medicine, University of Florida, USA; Department of Neuroscience, College of Medicine, University of Florida, USA; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, USA.
| | - Josue Cardoso
- Pain Research & Intervention Center of Excellence, University of Florida, USA; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, USA
| | - Joseph L Riley
- Pain Research & Intervention Center of Excellence, University of Florida, USA; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, USA
| | - Burel Goodin
- Department of Psychology, University of Alabama at Birmingham, USA
| | - Christopher D King
- Pain Research Center, Cincinnati Children's Hospital Medical Center, USA
| | - Megan Petrov
- College of Nursing & Health Innovation, Arizona State University, USA
| | - Emily J Bartley
- Pain Research & Intervention Center of Excellence, University of Florida, USA; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, USA
| | - Kimberly T Sibille
- Pain Research & Intervention Center of Excellence, University of Florida, USA; Institute on Aging, University of Florida, USA; Department of Aging & Geriatric Research, College of Medicine, University of Florida, USA; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, USA
| | - Toni L Glover
- Pain Research & Intervention Center of Excellence, University of Florida, USA; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, USA
| | | | - Hailey W Bulls
- Department of Psychology, University of Alabama at Birmingham, USA
| | - Adriana Addison
- Department of Psychology, University of Alabama at Birmingham, USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - David Redden
- Departments of Biostatistics and Medicine and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laurence A Bradley
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roger B Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, USA; Institute on Aging, University of Florida, USA; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, USA
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Horn-Hofmann C, Wolf D, Wolff S, Heesen M, Knippenberg-Bigge K, Lang PM, Lautenbacher S. Startle modulation by heat pain with varying threat levels in chronic pain patients and pain-free controls. J Pain Res 2017; 10:1787-1800. [PMID: 28814894 PMCID: PMC5546785 DOI: 10.2147/jpr.s136416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Empirical evidence suggests that affective responses to pain are changed in chronic pain. The investigation of startle responses to pain might contribute to clarifying whether such alterations also expand to motivational defensive reactions. We aimed at comparing startle responses to tonic heat pain with high threat (HT) or low threat (LT) in patients with chronic musculoskeletal pain and controls. As pain-related anxiety and catastrophizing are typically elevated in chronic pain, we expected to find stronger startle responses in patients specifically under experimental HT. Methods Patients with chronic musculoskeletal, preferentially, back pain (N = 19) and matched pain-free controls (N = 19) underwent two pain-related threat conditions (high and low) in balanced order. Only, in the HT condition, 50% of the trials were announced to include a short further noxious temperature increase at the end. Startle responses to loud tones were always assessed prior to a potential temperature increase in the phase of anticipation and were recorded by surface electromyogram. Results Surprisingly, we observed no differences in startle responses and ratings of emotional and pain responses between patients and controls despite significantly higher pain-related anxiety and catastrophizing in the patients. Overall, startle was potentiated in the HT condition, but only in participants who started with this condition. Conclusion Our results suggest that, in general, patients with pain are not more responsive emotionally to experimental threat manipulations despite elevated pain anxiety and catastrophizing. Instead, exaggerated responses in patients might be triggered only by individual concerns relating to pain, which are not sufficiently mirrored by our threat paradigm.
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Affiliation(s)
- C Horn-Hofmann
- Department of Physiological Psychology, University of Bamberg, Germany
| | - D Wolf
- Department of Physiological Psychology, University of Bamberg, Germany
| | - S Wolff
- Department of Physiological Psychology, University of Bamberg, Germany
| | - M Heesen
- Department of Anesthesiology and Pain Therapy, Kantonsspital Baden, Switzerland
| | - K Knippenberg-Bigge
- Department of Anesthesiology and Pain Therapy, Sozialstiftung Bamberg, Bamberg, Germany
| | - P M Lang
- Department of Anesthesiology and Pain Therapy, Sozialstiftung Bamberg, Bamberg, Germany
| | - S Lautenbacher
- Department of Physiological Psychology, University of Bamberg, Germany
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Lluch E, Nijs J, Courtney CA, Rebbeck T, Wylde V, Baert I, Wideman TH, Howells N, Skou ST. Clinical descriptors for the recognition of central sensitization pain in patients with knee osteoarthritis. Disabil Rehabil 2017; 40:2836-2845. [DOI: 10.1080/09638288.2017.1358770] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Enrique Lluch
- Department of Physical Therapy, University of Valencia, Valencia, Spain
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, Brussel, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, Brussel, Belgium
| | - Carol A. Courtney
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Trudy Rebbeck
- Faculty of Health Sciences, Discipline of Physiotherapy, John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Vikki Wylde
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Isabel Baert
- Pain in Motion International Research Group, Brussel, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Timothy H. Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Nick Howells
- Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Søren T. Skou
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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Exercise-induced Hypoalgesia in People With Knee Osteoarthritis With Normal and Abnormal Conditioned Pain Modulation. Clin J Pain 2017; 33:395-404. [DOI: 10.1097/ajp.0000000000000418] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Sibille KT, Chen H, Bartley EJ, Riley J, Glover TL, King CD, Zhang H, Cruz-Almeida Y, Goodin BR, Sotolongo A, Petrov ME, Herbert M, Bulls HW, Edberg JC, Staud R, Redden D, Bradley LA, Fillingim RB. Accelerated aging in adults with knee osteoarthritis pain: consideration for frequency, intensity, time, and total pain sites. Pain Rep 2017; 2:e591. [PMID: 29392207 PMCID: PMC5741297 DOI: 10.1097/pr9.0000000000000591] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/23/2017] [Accepted: 02/23/2017] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Individuals with osteoarthritis (OA) show increased morbidity and mortality. Telomere length, a measure of cellular aging, predicts increased morbidity and mortality. Telomeres shorten with persisting biological and psychosocial stress. Living with chronic OA pain is stressful. Previous research exploring telomere length in people with OA has produced inconsistent results. Considering pain severity may clarify the relationship between OA and telomeres. OBJECTIVES We hypothesized that individuals with high OA chronic pain severity would have shorter telomeres than those with no or low chronic pain severity. METHODS One hundred thirty-six adults, ages 45 to 85 years old, with and without symptomatic knee OA were included in the analysis. Peripheral blood leukocyte telomere length was measured, and demographic, clinical, and functional data were collected. Participants were categorized into 5 pain severity groups based on an additive index of frequency, intensity, time or duration, and total number of pain sites (FITT). Covariates included age, sex, race or ethnicity, study site, and knee pain status. RESULTS The no or low chronic pain severity group had significantly longer telomeres compared with the high pain severity group, P = 0.025. A significant chronic pain severity dose response emerged for telomere length, P = 0.034. The FITT chronic pain severity index was highly correlated with the clinical and functional OA pain measures. However, individual clinical and functional measures were not associated with telomere length. CONCLUSION Results demonstrate accelerated cellular aging with high knee OA chronic pain severity and provide evidence for the potential utility of the FITT chronic pain severity index in capturing the biological burden of chronic pain.
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Affiliation(s)
- Kimberly T. Sibille
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Huaihou Chen
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Emily J. Bartley
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Joseph Riley
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Toni L. Glover
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Christopher D. King
- Department of Anesthesia, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Hang Zhang
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adriana Sotolongo
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Megan E. Petrov
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Matthew Herbert
- Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System and University of California, San Diego, CA, USA
| | - Hailey W. Bulls
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey C. Edberg
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - David Redden
- Biostatistics Department, School of Public Health University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laurence A. Bradley
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
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Abstract
Osteoarthritis (OA)-associated pain is a leading cause of disability. Central sensitization (CS), as a result of OA, is recognized as an important facet of human patients' chronic pain and has been measured in people using quantitative sensory testing (QST) testing. The spontaneous canine OA model has been suggested as a good translational model, but CS has not been explored in this model. In this study, QST was performed on dogs with and without spontaneous hip or stifle OA to determine whether OA is associated with CS in this model. Mechanical (von Frey and blunt pressure) and thermal (hot and cold) sensory thresholds obtained in dogs with chronic OA-associated pain (n = 31) were compared with those of normal dogs (n = 23). Dogs were phenotyped and joint-pain scored, and testing was performed at the OA-affected joint, cranial tibial muscle, and dorsal metatarsal region. QST summary data were evaluated using mixed-effect models to understand the influence of OA status and covariates, and dogs with OA and control dogs were compared. The presence of OA was strongly associated with hyperalgesia across all QST modalities at the index joint, cranial tibial muscle, and metatarsal site. Mechanical QST scores were significantly moderately negatively correlated with total joint-pain scores. The spontaneous canine OA model is associated with somatosensory sensitivity, likely indicative of CS. These data further validate the canine spontaneous OA model as an appropriate model of the human OA pain condition.
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Abstract
The development of patient profiles to subgroup individuals on a variety of variables has gained attention as a potential means to better inform clinical decision making. Patterns of pain sensitivity response specific to quantitative sensory testing (QST) modality have been demonstrated in healthy subjects. It has not been determined whether these patterns persist in a knee osteoarthritis population. In a sample of 218 participants, 19 QST measures along with pain, psychological factors, self-reported function, and quality of life were assessed before total knee arthroplasty. Component analysis was used to identify commonalities across the 19 QST assessments to produce standardized pain sensitivity factors. Cluster analysis then grouped individuals who exhibited similar patterns of standardized pain sensitivity component scores. The QST resulted in 4 pain sensitivity components: heat, punctate, temporal summation, and pressure. Cluster analysis resulted in 5 pain sensitivity profiles: a "low pressure pain" group, an "average pain" group, and 3 "high pain" sensitivity groups who were sensitive to different modalities (punctate, heat, and temporal summation). Pain and function differed between pain sensitivity profiles, along with sex distribution; however, no differences in osteoarthritis grade, medication use, or psychological traits were found. Residualizing QST data by age and sex resulted in similar components and pain sensitivity profiles. Furthermore, these profiles are surprisingly similar to those reported in healthy populations, which suggests that individual differences in pain sensitivity are a robust finding even in an older population with significant disease.
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Øhrn AM, Nielsen CS, Schirmer H, Stubhaug A, Wilsgaard T, Lindekleiv H. Pain Tolerance in Persons With Recognized and Unrecognized Myocardial Infarction: A Population-Based, Cross-Sectional Study. J Am Heart Assoc 2016; 5:e003846. [PMID: 28003255 PMCID: PMC5210406 DOI: 10.1161/jaha.116.003846] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/26/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Unrecognized myocardial infarction (MI) is a prevalent condition associated with a similar risk of death as recognized MI. It is unknown why some persons experience MI with few or no symptoms; however, one possible explanation is attenuated pain sensitivity. To our knowledge, no previous study has examined the association between pain sensitivity and recognition of MI. METHODS AND RESULTS We conducted a population-based cross-sectional study with 4849 included participants who underwent the cold pressor test (a common experimental pain assay) and ECG. Unrecognized MI was present in 387 (8%) and recognized MI in 227 (4.7%) participants. Participants with unrecognized MI endured the cold pressor test significantly longer than participants with recognized MI (hazard ratio for aborting the cold pressor test, 0.64; CI, 0.47-0.88), adjusted for age and sex. The association was attenuated and borderline significant after multivariable adjustment. The association between unrecognized MI and lower pain sensitivity was stronger in women than in men, and statistically significant in women only, but interaction testing was not statistically significant (P for interaction=0.14). CONCLUSIONS Our findings suggest that persons who experience unrecognized MI have reduced pain sensitivity compared with persons who experience recognized MI. This may partially explain the lack of symptoms associated with unrecognized MI.
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Affiliation(s)
- Andrea Milde Øhrn
- Faculty of Health Sciences, University of Tromsø, Norway
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
| | | | - Henrik Schirmer
- Faculty of Health Sciences, University of Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Tom Wilsgaard
- Faculty of Health Sciences, University of Tromsø, Norway
| | - Haakon Lindekleiv
- Faculty of Health Sciences, University of Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
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Facilitated temporal summation of pain correlates with clinical pain intensity after hip arthroplasty. Pain 2016; 158:323-332. [DOI: 10.1097/j.pain.0000000000000764] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Dell'Isola A, Allan R, Smith SL, Marreiros SSP, Steultjens M. Identification of clinical phenotypes in knee osteoarthritis: a systematic review of the literature. BMC Musculoskelet Disord 2016; 17:425. [PMID: 27733199 PMCID: PMC5062907 DOI: 10.1186/s12891-016-1286-2] [Citation(s) in RCA: 189] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/07/2016] [Indexed: 01/08/2023] Open
Abstract
Background Knee Osteoarthritis (KOA) is a heterogeneous pathology characterized by a complex and multifactorial nature. It has been hypothesised that these differences are due to the existence of underlying phenotypes representing different mechanisms of the disease. Methods The aim of this study is to identify the current evidence for the existence of groups of variables which point towards the existence of distinct clinical phenotypes in the KOA population. A systematic literature search in PubMed was conducted. Only original articles were selected if they aimed to identify phenotypes of patients aged 18 years or older with KOA. The methodological quality of the studies was independently assessed by two reviewers and qualitative synthesis of the evidence was performed. Strong evidence for existence of specific phenotypes was considered present if the phenotype was supported by at least two high-quality studies. Results A total of 24 studies were included. Through qualitative synthesis of evidence, six main sets of variables proposing the existence of six phenotypes were identified: 1) chronic pain in which central mechanisms (e.g. central sensitisation) are prominent; 2) inflammatory (high levels of inflammatory biomarkers); 3) metabolic syndrome (high prevalence of obesity, diabetes and other metabolic disturbances); 4) Bone and cartilage metabolism (alteration in local tissue metabolism); 5) mechanical overload characterised primarily by varus malalignment and medial compartment disease; and 6) minimal joint disease characterised as minor clinical symptoms with slow progression over time. Conclusions This study identified six distinct groups of variables which should be explored in attempts to better define clinical phenotypes in the KOA population. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1286-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Dell'Isola
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK.
| | - R Allan
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
| | - S L Smith
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
| | - S S P Marreiros
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
| | - M Steultjens
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
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79
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Fillingim RB, Loeser JD, Baron R, Edwards RR. Assessment of Chronic Pain: Domains, Methods, and Mechanisms. THE JOURNAL OF PAIN 2016; 17:T10-20. [PMID: 27586827 PMCID: PMC5010652 DOI: 10.1016/j.jpain.2015.08.010] [Citation(s) in RCA: 191] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/11/2015] [Accepted: 08/27/2015] [Indexed: 12/28/2022]
Abstract
UNLABELLED Accurate classification of chronic pain conditions requires reliable and valid pain assessment. Moreover, pain assessment serves several additional functions, including documenting the severity of the pain condition, tracking the longitudinal course of pain, and providing mechanistic information. Thorough pain assessment must address multiple domains of pain, including the sensory and affective qualities of pain, temporal dimensions of pain, and the location and bodily distribution of pain. Where possible, pain assessment should also incorporate methods to identify pathophysiological mechanisms underlying the pain. This article discusses assessment of chronic pain, including approaches available for assessing multiple pain domains and for addressing pathophysiological mechanisms. We conclude with recommendations for optimal pain assessment. PERSPECTIVE Pain assessment is a critical prerequisite for accurate pain classification. This article describes important features of pain that should be assessed, and discusses methods that can be used to assess the features and identify pathophysiological mechanisms contributing to pain.
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Affiliation(s)
- Roger B Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida.
| | - John D Loeser
- University of Washington, Department of Neurological Surgery, Seattle, Washington
| | - Ralf Baron
- University of Kiel, Department of Neurology, Kiel, Germany
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80
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Cardoso JS, Riley JL, Glover T, Sibille KT, Bartley EJ, Goodin BR, Bulls HW, Herbert M, Addison AS, Staud R, Redden DT, Bradley LA, Fillingim RB, Cruz-Almeida Y. Experimental pain phenotyping in community-dwelling individuals with knee osteoarthritis. Pain 2016; 157:2104-2114. [PMID: 27340911 PMCID: PMC4988907 DOI: 10.1097/j.pain.0000000000000625] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pain among individuals with knee osteoarthritis (OA) is associated with significant disability in older adults, and recent evidence demonstrates enhanced experimental pain sensitivity. Although previous research showed considerable heterogeneity in the OA clinical pain presentation, less is known regarding the variability in responses to experimental pain. The present study included individuals with knee OA (n = 292) who participated in the Understanding Pain and Limitations in Osteoarthritic Disease study and completed demographic and psychological questionnaires followed by a multimodal quantitative sensory testing (QST) session. Quantitative sensory testing measures were subjected to variable reduction procedures to derive pain sensitivity index scores, which in turn were entered into a cluster analysis. Five clusters were significantly different across all pain sensitivity index variables (P < 0.001) and were characterized by: (1) low pain sensitivity to pressure pain (N = 39); (2) average pain sensitivity across most modalities (N = 88); (3) high temporal summation of punctate pain (N = 38); (4) high cold pain sensitivity (N = 80); and (5) high sensitivity to heat pain and temporal summation of heat pain (N = 41). Clusters differed significantly by race, gender, somatic reactivity, and catastrophizing (P < 0.05). Our findings support the notion that there are distinct subgroups or phenotypes based on experimental pain sensitivity in community-dwelling older adults with knee OA, expanding previous findings of similar cluster characterizations in healthy adults. Future research is needed to further understand the pathophysiological mechanisms underlying pain within these subgroups, which may be of added value in tailoring effective treatments for people with OA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Yenisel Cruz-Almeida
- Corresponding Author: Yenisel Cruz-Almeida, MSPH, PhD, 2004 Mowry Road, Suite 2144, Gainesville, FL 32607, , Phone: 352-294-5845
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81
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Bartley EJ, King CD, Sibille KT, Cruz-Almeida Y, Riley JL, Glover TL, Goodin BR, Sotolongo AS, Herbert MS, Bulls HW, Staud R, Fessler BJ, Redden DT, Bradley LA, Fillingim RB. Enhanced Pain Sensitivity Among Individuals With Symptomatic Knee Osteoarthritis: Potential Sex Differences in Central Sensitization. Arthritis Care Res (Hoboken) 2016; 68:472-80. [PMID: 26434740 DOI: 10.1002/acr.22712] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 07/15/2015] [Accepted: 08/18/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Symptomatic knee osteoarthritis (OA) is a condition commonly associated with increased pain, disability, and functional limitations. Given the poor correspondence between radiographic evidence and clinical pain, central sensitization has been implicated as a potential mechanism underlying pain facilitation in knee OA. Sex may be a moderator of centrally mediated changes in knee OA pain; however, few studies have systematically assessed this. Therefore, the aim of this study was to examine differences in peripheral and central sensitization in men and women with symptomatic knee OA, as well as to determine whether these differences vary across age (middle age versus older age). METHODS Participants (n = 288) between the ages of 45 and 85 years completed a battery of quantitative sensory pain procedures assessing sensitivity to contact heat, cold pressor, mechanical pressure, and punctate stimuli. Differences in temporal summation (TS) were examined, as well as measures of clinical pain and functional performance. RESULTS When compared to men, women exhibited greater sensitivity to multiple pain modalities (i.e., lower heat, cold, pressure thresholds/tolerances, greater TS of pain); however, there were no sex differences in clinical pain, with the exception of greater widespread pain observed in women. Although there were select age-related differences in pain sensitivity, sex differences in pain varied minimally across the age cohort. CONCLUSION Overall, these findings provide evidence for greater overall sensitivity to experimental pain in women with symptomatic knee OA compared to men, suggesting that enhanced central sensitivity may be an important contributor to pain in this group.
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82
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Neogi T, Guermazi A, Roemer F, Nevitt MC, Scholz J, Arendt-Nielsen L, Woolf C, Niu J, Bradley LA, Quinn E, Law LF. Association of Joint Inflammation With Pain Sensitization in Knee Osteoarthritis: The Multicenter Osteoarthritis Study. Arthritis Rheumatol 2016; 68:654-61. [PMID: 26554395 DOI: 10.1002/art.39488] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/22/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Pain sensitization is associated with pain severity in knee osteoarthritis (OA), but its cause in humans is not well understood. We examined whether inflammation, assessed as synovitis and effusion on magnetic resonance imaging (MRI), or mechanical load, assessed as bone marrow lesions (BMLs), was associated with sensitization in knee OA. METHODS Subjects in the Multicenter Osteoarthritis Study, a National Institutes of Health-funded cohort of persons with or at risk of knee OA, underwent radiography and MRI of the knee, and standardized quantitative sensory testing (temporal summation and pressure pain threshold [PPT]) of the wrist and patellae at baseline and 2 years later. We examined the relation of synovitis, effusion, and BMLs to temporal summation and PPT cross-sectionally and longitudinally. RESULTS There were 1,111 subjects in the study sample (mean age 67 years, mean body mass index 30 kg/m(2) , 62% female). Synovitis was associated with a significant decrease in PPT at the patella (i.e., more sensitized) over 2 years (adjusted β -0.30 [95% confidence interval (95% CI) -0.52, -0.08]). Effusion was similarly associated with a decrease in PPT at the wrist (adjusted β -0.24 [95% CI -0.41, -0.08]) and with risk of incident temporal summation at the patella (adjusted OR 1.54 [95% CI 1.01, 2.36]). BMLs were not associated with either quantitative sensory testing measure. CONCLUSION Inflammation, as evidenced by synovitis or effusion, is associated with pain sensitization in knee OA. In contrast, BMLs do not appear to contribute to sensitization in knee OA. Early targeting of inflammation is a reasonable strategy to test for prevention of sensitization and through this, reduction of pain severity, in knee OA.
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Affiliation(s)
| | | | | | | | - Joachim Scholz
- Columbia University College of Physicians and Surgeons, New York, New York
| | | | | | - Jingbo Niu
- Boston University, Boston, Massachusetts
| | | | | | - Laura Frey Law
- University of Iowa Carver College of Medicine, Iowa City
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83
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Pazzinatto MF, de Oliveira Silva D, Barton C, Rathleff MS, Briani RV, de Azevedo FM. Female Adults with Patellofemoral Pain Are Characterized by Widespread Hyperalgesia, Which Is Not Affected Immediately by Patellofemoral Joint Loading. PAIN MEDICINE 2016; 17:1953-1961. [DOI: 10.1093/pm/pnw068] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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84
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Kim K, Lee HY, Lim SJ. Effects of increased standing balance on pain in patients with knee osteoarthritis. J Phys Ther Sci 2016; 28:87-9. [PMID: 26957734 PMCID: PMC4755980 DOI: 10.1589/jpts.28.87] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/09/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the relationship between standing balance increased through muscle-strengthening exercises and pain in knee osteoarthritis patients. [Subjects and Methods] Thirty knee osteoarthritis patients were equally divided into a strengthening exercise group and an unstable exercise group. Before and after the six-week experiment, the visual analogue scale was measured, and bilateral one-leg standing tests were performed. [Results] In both the strengthening exercise group and unstable exercise group, the bilateral one-leg standing time significantly increased after the six-week experiment. Regarding the visual analogue scale, a pain measurement scale, the strengthening exercise group had significantly decreased pain. The unstable exercise group also had decreased pain, but the decrease was not statistically significant. [Conclusion] In knee osteoarthritis patients, exercises using an unstable base of support and knee-extensor strengthening exercises with gradually increased loads had a positive effect on improving balance ability and decreasing pain.
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Affiliation(s)
- Kyung Kim
- Department of Physical Therapy, Daegu University, Republic of Korea
| | - Hae-Yong Lee
- Department of Physical Therapy, Youngsan University, Republic of Korea
| | - Sung-Joon Lim
- Department of Rehabilitation Science, Graduate School, Daegu University, Republic of Korea
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85
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Baert IAC, Lluch E, Mulder T, Nijs J, Noten S, Meeus M. Does pre-surgical central modulation of pain influence outcome after total knee replacement? A systematic review. Osteoarthritis Cartilage 2016; 24:213-23. [PMID: 26382109 DOI: 10.1016/j.joca.2015.09.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 08/21/2015] [Accepted: 09/01/2015] [Indexed: 02/06/2023]
Abstract
The aim of this study is to systematically review whether the presence of altered central pain modulation pre-surgical influences outcome after total knee replacement (TKR) in patients with knee osteoarthritis (OA), and if so which indices of central pain modulation predict poor outcome after TKR. To identify relevant articles, PubMed and Web of Science were searched. The search strategy was a combination of key words related to "Knee Osteoarthritis and Total Knee Replacement", "Central Pain Modulation" and "Post-Surgical Outcome Measures". Articles fulfilling the inclusion criteria were screened for methodological quality and results were analyzed and summarized. Sixteen prospective cohort studies were included. Strong evidence is available that presence of catastrophic thinking and poor coping strategies predict more pain after TKR and that there is no association between fear of movement and post-surgical pain or function. Evidence on other psychosocial influences is limited or conflicting. Literature on the influence of other signs of altered central pain modulation on post-surgical outcome is scarce. It is plausible that pre-surgical signs of altered central pain modulation, such as joint pain at rest or widespread pain sensitization, predict more post-surgical pain. Surgeons should be attentive for patients with signs of altered central pain modulation before surgery as they might be at risk for unfavorable outcome. A broader therapeutic approach aiming to desensitize the central nervous system can be adapted in these patients. Further research is however needed to identify the influence of central pain modulation pre-surgical in predicting outcome after TKR.
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Affiliation(s)
- I A C Baert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Pain in Motion Research Group (Belgium, Netherlands, Spain, UK).
| | - E Lluch
- Pain in Motion Research Group (Belgium, Netherlands, Spain, UK); Department of Human Physiology, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Rehabilitation Sciences, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Physical Therapy, University of Valencia, Valencia, Spain.
| | - T Mulder
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium.
| | - J Nijs
- Pain in Motion Research Group (Belgium, Netherlands, Spain, UK); Department of Human Physiology, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Rehabilitation Sciences, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium.
| | - S Noten
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Pain in Motion Research Group (Belgium, Netherlands, Spain, UK).
| | - M Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Pain in Motion Research Group (Belgium, Netherlands, Spain, UK); Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
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86
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Moss P, Knight E, Wright A. Subjects with Knee Osteoarthritis Exhibit Widespread Hyperalgesia to Pressure and Cold. PLoS One 2016; 11:e0147526. [PMID: 26809009 PMCID: PMC4726459 DOI: 10.1371/journal.pone.0147526] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/05/2016] [Indexed: 12/22/2022] Open
Abstract
Hyperalgesia to mechanical and thermal stimuli are characteristics of a range of disorders such as tennis elbow, whiplash and fibromyalgia. This study evaluated the presence of local and widespread mechanical and thermal hyperalgesia in individuals with knee osteoarthritis, compared to healthy control subjects. Twenty-three subjects with knee osteoarthritis and 23 healthy controls, matched for age, gender and body mass index, were recruited for the study. Volunteers with any additional chronic pain conditions were excluded. Pain thresholds to pressure, cold and heat were tested at the knee, ipsilateral heel and ipsilateral elbow, in randomized order, using standardised methodology. Significant between-groups differences for pressure pain and cold pain thresholds were found with osteoarthritic subjects demonstrating significantly increased sensitivity to both pressure (p = .018) and cold (p = .003) stimuli, compared with controls. A similar pattern of results extended to the pain-free ipsilateral ankle and elbow indicating widespread pressure and cold hyperalgesia. No significant differences were found between groups for heat pain threshold, although correlations showed that subjects with greater sensitivity to pressure pain were also likely to be more sensitive to both cold pain and heat pain. This study found widespread elevated pain thresholds in subjects with painful knee osteoarthritis, suggesting that altered nociceptive system processing may play a role in ongoing arthritic pain for some patients.
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Affiliation(s)
- Penny Moss
- School of Physiotherapy and Exercise Science, Curtin University of Technology, Perth, Western Australia, Australia
- * E-mail:
| | - Emma Knight
- School of Physiotherapy and Exercise Science, Curtin University of Technology, Perth, Western Australia, Australia
| | - Anthony Wright
- School of Physiotherapy and Exercise Science, Curtin University of Technology, Perth, Western Australia, Australia
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87
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Postural Stability in Osteoarthritis of the Knee and Hip: Analysis of Association With Pain Catastrophizing and Fear-Avoidance Beliefs. PM R 2015; 8:618-28. [PMID: 26578431 DOI: 10.1016/j.pmrj.2015.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 11/01/2015] [Accepted: 11/04/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Persons with knee osteoarthritis (OA) are at risk of having sensations of instability and sometimes experience buckling. The instability has been associated with psychosocial dysfunction, such as fear of movement, and impaired physical functioning. A high degree of fear of movement is positively correlated with avoidance in other conditions. OBJECTIVE To evaluate the relationship between postural stability, the degree of pain catastrophizing, and fear-avoidance beliefs in subjects with knee and hip OA. DESIGN Descriptive, cross-sectional study. SETTING Four primary health care centers. SUBJECTS Eighty subjects with knee or combined knee and hip OA. INTERVENTIONS Not applicable. MAIN OUTCOME MEASUREMENTS Postural stability was evaluated using the Multi-Directional Functional Reach Test (MDFRT), and a battery of self-reports was used to assess the following aspects: pain catastrophizing (Pain Catastrophizing Scale), fear-avoidance beliefs (Tampa Scale for Kinesiophobia [TSK-11] and the Fear-Avoidance Beliefs Questionnaire), pain (visual analog scale), disability (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), and self-efficacy (Chronic Pain Self-Efficacy Scale [CPSS]). RESULTS The correlation analysis showed that scores on the MDFRT were negatively associated with scores on the TSK-11 for activity avoidance (r = -0.54; P < .001) and positively associated with the scores on the CPSS for coping (r = 0.59; P < .001). The scores for the MDFRT to the right and the total WOMAC were negatively associated (r = -0.61, P <.001). The scores for the MDFRT to the left were positively associated with the CPSS scores for coping (r = 0.64, P < .001). The scores for the MDFRT forward were predicted by CPSS and TSK-11 scores (28.9% of variance), as well as activity avoidance, avoidance of physical activity, helplessness (34.7% of variance), and CPSS pain coping (34.3% of variance). CONCLUSIONS These findings suggest that pain catastrophizing and fear-avoidance beliefs are related with postural stability in subjects with knee and hip OA. Postural stability is negatively correlated with pain catastrophizing and TSK activity avoidance. Thus, based on these results, psychosocial factors should be taken into consideration in the assessment and treatment of patients with hip and knee OA.
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88
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Wylde V, Sayers A, Lenguerrand E, Gooberman-Hill R, Pyke M, Beswick AD, Dieppe P, Blom AW. Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis. Pain 2015; 156:47-54. [PMID: 25599300 PMCID: PMC4280282 DOI: 10.1016/j.pain.0000000000000002] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Supplemental Digital Content is Available in the Text. Preoperative widespread pressure pain sensitivity is not predictive of the amount of pain relief that patients gain from total hip or knee replacement. Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalized sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Data were analyzed from 254 patients receiving THR and 239 patients receiving TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. In both the THR and TKR cohort, lower PPTs (heightened widespread pain sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity.
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Affiliation(s)
- Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, England North Bristol NHS Trust, Southmead Hospital, Bristol, England Medical School, University of Exeter, Exeter, England
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89
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Glover TL, Horgas AL, Fillingim RB, Goodin BR. Vitamin D status and pain sensitization in knee osteoarthritis: a critical review of the literature. Pain Manag 2015; 5:447-53. [PMID: 26399462 DOI: 10.2217/pmt.15.43] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Diagnostic imaging of disease severity has been found thus far to be a relatively modest predictor of knee osteoarthritis (OA) pain and disability, suggesting that other factors likely contribute to clinical symptoms in this condition. Recent evidence suggests that sensitization of the peripheral and central pathways that process nociceptive information (i.e., pain sensitization) is an important contributor to knee OA clinical symptoms. Furthermore, low levels of vitamin D have been found to be associated with the presence of pain sensitization, as well as the overall experience of clinical pain severity in knee OA. African-Americans with knee OA may be at increased risk for poor clinical outcomes given evidence of lower vitamin D levels as well as greater pain sensitization compared with non-Hispanic whites. Whether vitamin D supplementation is effective for alleviating knee OA clinical symptoms is an important topic to be addressed in future research with racially diverse samples that include sufficient numbers of African-Americans.
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Affiliation(s)
- Toni L Glover
- University of Florida, College of Nursing, Biobehavioral Nursing Science, Gainesville, FL 32610, USA.,University of Florida, Pain Research & Intervention Center of Excellence (PRICE), Gainesville, FL 32610, USA
| | - Ann L Horgas
- University of Florida, College of Nursing, Biobehavioral Nursing Science, Gainesville, FL 32610, USA
| | - Roger B Fillingim
- University of Florida, Pain Research & Intervention Center of Excellence (PRICE), Gainesville, FL 32610, USA.,University of Florida, College of Dentistry, Department of Community Dentistry & Behavioral Science, Gainesville, FL 32610, USA
| | - Burel R Goodin
- University of Alabama at Birmingham, Departments of Psychology & Anesthesiology & Perioperative Medicine, Birmingham, AL 35294, USA
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90
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Fingleton C, Smart K, Moloney N, Fullen BM, Doody C. Pain sensitization in people with knee osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2015; 23:1043-56. [PMID: 25749012 DOI: 10.1016/j.joca.2015.02.163] [Citation(s) in RCA: 286] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 02/18/2015] [Accepted: 02/23/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Emerging evidence suggests that pain sensitization plays an important role in pain associated with knee osteoarthritis (OA). This systematic review and meta-analysis examined the evidence for pain sensitization in people with knee OA and the relationship between pain sensitization and symptom severity. METHODS A search of electronic databases and reference lists was carried out. All full text observational studies published between 2000 and 2014 with the aim of investigating pain sensitization in humans with knee OA using quantitative sensory testing (QST) measures of hyperalgesia and central hyperexcitability were eligible for inclusion. Meta-analysis of data was carried out using a random effects model, which included results comparing knee OA participants to controls, and results comparing high symptom severity to low symptom severity. RESULTS Fifteen studies were identified following screening and quality appraisal. For the meta-analysis, pressure pain threshold (PPT) and heat pain threshold (HPT) means and standard deviations were pooled using random effects models. The point estimate was large for differences in PPTs between knee OA participants and controls [-0.85; confidence interval (CI): -1.1 to -0.6], and moderate for PPT differences between knee OA participants with high symptom severity vs those with low symptom severity (0.51; CI: -0.73 to -0.30). A small point estimate was found for differences in HPTs between knee OA participants and controls (-0.42; CI: -0.87 to 0.02). CONCLUSION Evidence from this systematic review and meta-analysis suggests that pain sensitization is present in people with knee OA and may be associated with knee OA symptom severity.
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Affiliation(s)
- C Fingleton
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland.
| | - K Smart
- St. Vincent's University Hospital, Dublin, Ireland
| | - N Moloney
- Department of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - B M Fullen
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - C Doody
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
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91
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Coronado RA, George SZ, Devin CJ, Wegener ST, Archer KR. Pain Sensitivity and Pain Catastrophizing Are Associated With Persistent Pain and Disability After Lumbar Spine Surgery. Arch Phys Med Rehabil 2015; 96:1763-70. [PMID: 26101845 DOI: 10.1016/j.apmr.2015.06.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/10/2015] [Accepted: 06/13/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery. DESIGN Prospective observational cohort study. SETTING Academic medical center. PARTICIPANTS Patients (N=68; mean age, 57.9±13.1y; 40 women [58.8%]) undergoing spine surgery for a degenerative condition from March 1, 2012 to April 30, 2013 were assessed 6 weeks, 3 months, and 6 months after surgery. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The main outcome measures were persistent back pain intensity, pain interference, and disability. Patients with persistent back pain intensity, pain interference, or disability were identified as those patients reporting Brief Pain Inventory scores ≥4 and Oswestry Disability Index scores ≥21 at all postoperative time points. RESULTS From 6 weeks to 6 months after surgery, approximately 12.9%, 24.2%, and 46.8% of patients reported persistent back pain intensity, pain interference, or disability, respectively. Increased pain sensitivity at 6 weeks was associated with having persistent back pain intensity (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.0-4.1) after surgery. Increased pain catastrophizing at 6 weeks was associated with having persistent back pain intensity (OR, 1.1; 95% CI, 1.0-1.2), pain interference (OR, 1.1; 95% CI, 1.0-1.2), and disability (OR, 1.3; 95% CI, 1.1-1.4). An interaction effect was not found between pain sensitivity and pain catastrophizing on persistent outcomes (P>.05). CONCLUSIONS The findings suggest the importance of early postoperative screening for pain sensitivity and pain catastrophizing to identify patients at risk for poor postoperative pain intensity, pain interference, and/or disability outcomes. Future research should consider the benefit of targeted therapeutic strategies for patients with these postoperative prognostic factors.
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Affiliation(s)
| | - Steven Z George
- Department of Physical Therapy, University of Florida, Gainesville, FL; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL
| | - Clinton J Devin
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN; Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN.
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92
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O'Leary H, Smart KM, Moloney NA, Blake C, Doody CM. Pain sensitisation and the risk of poor outcome following physiotherapy for patients with moderate to severe knee osteoarthritis: protocol for a prospective cohort study. BMJ Open 2015; 5:e007430. [PMID: 26059523 PMCID: PMC4466621 DOI: 10.1136/bmjopen-2014-007430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Pain is the dominant symptom of knee osteoarthritis (OA), and recent evidence suggests factors outside of local joint pathology, such as pain sensitisation, can contribute significantly to the pain experience. It is unknown how pain sensitisation influences outcomes from commonly employed interventions such as physiotherapy. The aims of this study are, first, to provide a comprehensive description of the somatosensory characteristics of people with pain associated with knee OA. Second, we will investigate if indicators of pain sensitisation in patients with knee osteoarthritis are predictive of non-response to physiotherapy. METHODS AND ANALYSIS This is a multicentre prospective cohort study with 140 participants. Eligible patients with moderate to severe symptomatic knee osteoarthritis will be identified at outpatient orthopaedic and rheumatology clinics. A baseline assessment will provide a comprehensive description of the somatosensory characteristics of each participant by means of clinical examination, quantitative sensory testing, and validated questionnaires measuring pain and functional capacity. Participants will then undergo physiotherapy treatment. The primary outcome will be non-response to physiotherapy on completion of the physiotherapy treatment programme as defined by the Osteoarthritis Research Society International treatment responder criteria. A principal component analysis will identify measures related to pain sensitisation to include in the predictive model. Regression analyses will explore the relationship between responder status and pain sensitisation while accounting for confounders. ETHICS AND DISSEMINATION This study has been approved by St James' Hospital/AMNCH Research Ethics Committee and by the St Vincent's Healthcare Group Ethics and Medical Research Committee. The results will be presented at international conferences and published in a peer review journal. TRIAL REGISTRATION NUMBER NCT02310945.
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Affiliation(s)
- Helen O'Leary
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Keith M Smart
- Physiotherapy Department, St Vincent's University Hospital, Dublin, Ireland
| | - Niamh A Moloney
- Discipline of Physiotherapy, Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Catherine Blake
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Catherine M Doody
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
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Petrov ME, Goodin BR, Cruz-Almeida Y, King C, Glover TL, Bulls HW, Herbert M, Sibille KT, Bartley EJ, Fessler BJ, Sotolongo A, Staud R, Redden D, Fillingim RB, Bradley LA. Disrupted sleep is associated with altered pain processing by sex and ethnicity in knee osteoarthritis. THE JOURNAL OF PAIN 2015; 16:478-90. [PMID: 25725172 DOI: 10.1016/j.jpain.2015.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/21/2015] [Accepted: 02/08/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Studies indicate that improving sleep decreases reported pain in patients with knee osteoarthritis, but it is unclear if this association extends to experimentally induced pain responses. A community-based sample of 88 African American and 52 non-Hispanic white adults (45-76 years) with knee osteoarthritis completed the Insomnia Severity Index and the arousal subscale of the Sleep Hygiene and Practices Scale. Participants underwent quantitative sensory testing, including measures of pain sensitivity and facilitation at the knee, and pain inhibition. Outcomes were analyzed with multiple Tobit hierarchical regression models, with adjustment for relevant covariates. Ethnicity and sex by sleep interactions were also entered into the models. After covariate adjustment, main associations were not observed. However, sex interacted with insomnia severity to predict greater temporal summation of heat and punctate pressure pain among women and lower heat temporal summation among men. Men and women who engaged in frequent arousal-associated sleep behaviors demonstrated higher and lower heat temporal summation, respectively. Non-Hispanic whites with greater insomnia severity displayed lower pressure pain thresholds and pain inhibition. Our findings are the first to demonstrate that disrupted sleep is associated with altered pain processing differentially by sex and ethnicity/race among people with knee osteoarthritis. PERSPECTIVE This article presents the association between insomnia severity, maladaptive sleep behaviors, and experimentally induced pain responses among people with knee osteoarthritis. Disrupted sleep was associated with altered pain processing by sex and ethnicity/race. Offering sleep interventions may help ameliorate pain, but treatment may need to be tailored by sex and ethnicity/race.
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Affiliation(s)
- Megan E Petrov
- College of Nursing & Health Innovation, Arizona State University, Phoenix, Arizona.
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yenisel Cruz-Almeida
- Department of Aging & Geriatric Research, University of Florida, Gainesville, Florida
| | - Chris King
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida
| | - Toni L Glover
- College of Nursing, University of Florida, Gainesville, Florida
| | - Hailey W Bulls
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew Herbert
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kimberly T Sibille
- Department of Aging & Geriatric Research, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Emily J Bartley
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Barri J Fessler
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Adriana Sotolongo
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roland Staud
- Division of Rheumatology and Clinical Immunology, College of Medicine, University of Florida, Gainesville, Florida
| | - David Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Laurence A Bradley
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
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94
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Abnormal quantitative sensory testing is associated with persistent pain one year after TKA. Clin Orthop Relat Res 2015; 473:246-54. [PMID: 25293497 PMCID: PMC4390964 DOI: 10.1007/s11999-014-3990-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 09/29/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Up to 15% of patients report at least moderate persistent pain after TKA. Such pain may be associated with the presence of widespread hyperalgesia and neuropathic-type pain. QUESTIONS/PURPOSES We asked if there was a difference among patients who report moderate to severe pain or no pain at least 12 months after TKA regarding (1) pressure pain threshold, (2) thermal (cold/heat) pain and detection thresholds, and (3) self-reported neuropathic pain. PATIENTS AND METHOD Fifty-three volunteers were recruited from patients reporting no pain or moderate to severe pain, according to the Knee Society Score©. Differences between the moderate-to-severe and no-pain groups regarding pressure pain, heat and cold thresholds, and self-reported neuropathic-type pain were analyzed using independent t-tests. RESULTS Patients in the moderate-to-severe pain group exhibited reduced pressure pain threshold in the knee with the TKA (p=0.025) and at the elbow (p=0.002). This group also showed greater pain sensitivity to cold at the knee (p=0.008) and elbow (p=0.010), and increased heat pain sensitivity at the elbow (p=0.032). Cold and heat detection thresholds were impaired in this group at the elbow (cold, p=0.034; heat, p=0.010), although only heat detection was impaired at the knee (p=0.009). The moderate-to-severe pain group also reported more neuropathic-type pain (p=0.001). CONCLUSION Persistent pain after TKA was associated with widespread pressure, cold hyperalgesia, and greater neuropathic-type pain. LEVEL OF EVIDENCE Level III, prognostic study.
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95
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A possible mechanism underlying conditioned pain modulation. Pain 2014; 155:1047-1048. [DOI: 10.1016/j.pain.2014.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 02/11/2014] [Accepted: 02/12/2014] [Indexed: 11/22/2022]
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96
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Baert IAC, Nijs J, Meeus M, Lluch E, Struyf F. The effect of lateral wedge insoles in patients with medial compartment knee osteoarthritis: balancing biomechanics with pain neuroscience. Clin Rheumatol 2014; 33:1529-38. [DOI: 10.1007/s10067-014-2668-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/01/2014] [Accepted: 05/04/2014] [Indexed: 01/05/2023]
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97
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Temporal summation of pain as a prospective predictor of clinical pain severity in adults aged 45 years and older with knee osteoarthritis: ethnic differences. Psychosom Med 2014; 76:302-10. [PMID: 24804882 PMCID: PMC4066647 DOI: 10.1097/psy.0000000000000058] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Enhanced pain facilitation is reportedly an important contributor to the clinical pain experiences of individuals with knee osteoarthritis (OA). Ethnic differences in the prevalence and severity of knee OA in addition to associated pain are also well documented. Temporal summation (TS) of pain is a widely applicable quantitative sensory testing method that invokes neural mechanisms related to pain facilitatory processes. This study tested whether TS of pain, an index of pain facilitation, differentially predicts the clinical pain experiences of African Americans and non-Hispanic whites with symptomatic knee OA. METHODS A total of 225 study participants underwent assessment of TS of mechanical and heat pain stimuli applied to their most symptomatic knee and their ipsilateral hand (mechanical) or forearm (heat). Using telephone-based surveys, participants subsequently reported their average and worst clinical pain severity across four consecutive weeks after the assessment of TS. RESULTS In predicting future clinical pain, ethnicity interacted with TS of mechanical pain (but not heat pain), such that TS of mechanical pain at the knee significantly predicted greater clinical ratings of average (b = 0.02, p = .016) and worst (b = 0.02, p = .044) clinical pain for non-Hispanic whites but not African Americans (p values > .30). CONCLUSIONS These results reveal the importance of considering ethnicity when examining pain facilitation and the clinical pain of individuals with symptomatic knee OA. The results of this study are discussed in terms of ethnic differences in the predictors of clinical pain experiences among African Americans and non-Hispanic whites with knee OA.
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98
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Riley JL, Cruz-Almeida Y, Glover TL, King CD, Goodin BR, Sibille KT, Bartley EJ, Herbert MS, Sotolongo A, Fessler BJ, Redden DT, Staud R, Bradley LA, Fillingim RB. Age and race effects on pain sensitivity and modulation among middle-aged and older adults. THE JOURNAL OF PAIN 2014; 15:272-82. [PMID: 24239561 PMCID: PMC4005289 DOI: 10.1016/j.jpain.2013.10.015] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 10/29/2013] [Accepted: 10/31/2013] [Indexed: 11/24/2022]
Abstract
UNLABELLED This study tested the effects of aging and race on responses to noxious stimuli using a wide range of stimulus modalities. The participants were 53 non-Hispanic blacks and 138 non-Hispanic white adults, ages 45 to 76 years. The participants completed a single 3-hour sensory testing session where responses to thermal, mechanical, and cold stimuli were assessed. The results suggest that there are selected age differences, with the older group less sensitive to warm and painful heat stimuli than middle-aged participants, particularly at the knee. This site effect supports the hypothesis that the greatest decrement in pain sensitivity associated with aging occurs in the lower extremities. In addition, there were several instances where age and race effects were compounded, resulting in greater race differences in pain sensitivity among the older participants. Overall, the data suggest that previously reported race differences in pain sensitivity emerged in our older samples, and this study contributes new findings in that these differences may increase with age in non-Hispanic blacks for temporal summation and both heat and cold immersion tolerance. We have added to the aging and pain literature by reporting several small to moderate differences in responses to heat stimuli between middle- and older-age adults. PERSPECTIVE This study found that the greatest decline in pain sensitivity with aging occurs in the lower extremities. In addition, race differences in pain sensitivity observed in younger adults were also found in our older sample.
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Affiliation(s)
- Joseph L Riley
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida.
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Toni L Glover
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida; College of Nursing, University of Florida, Gainesville, Florida
| | - Christopher D King
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Burel R Goodin
- Department of Psychology, University of Alabama-Birmingham, Birmingham, Alabama
| | - Kimberly T Sibille
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Emily J Bartley
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Matthew S Herbert
- Department of Psychology, University of Alabama-Birmingham, Birmingham, Alabama
| | - Adriana Sotolongo
- Division of Clinical Immunology and Rheumatology, University of Alabama-Birmingham College of Medicine, Birmingham, Alabama
| | - Barri J Fessler
- Division of Clinical Immunology and Rheumatology, University of Alabama-Birmingham College of Medicine, Birmingham, Alabama
| | - David T Redden
- Department of Biostatistics, School of Public Health, University of Alabama-Birmingham, Birmingham, Alabama
| | - Roland Staud
- College of Medicine, University of Florida, Gainesville, Florida
| | - Laurence A Bradley
- Division of Clinical Immunology and Rheumatology, University of Alabama-Birmingham College of Medicine, Birmingham, Alabama
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
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Cruz-Almeida Y, Fillingim RB. Can quantitative sensory testing move us closer to mechanism-based pain management? PAIN MEDICINE (MALDEN, MASS.) 2014; 15:61-72. [PMID: 24010588 PMCID: PMC3947088 DOI: 10.1111/pme.12230] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This review summarizes the scientific literature relating to the use of quantitative sensory testing (QST) for mechanism-based pain management. DESIGN A literature search was undertaken using PubMed and search terms including quantitative sensory testing, pain, chronic pain, response to treatment, outcome measure. SETTINGS AND PATIENTS Studies including QST in healthy individuals and those with painful disorders were reviewed. MEASURES Publications reported on QST methodological issues including associations among measures and reliability. We also included publications on the use of QST measures in case-control studies, their associations with biopsychosocial mechanisms, QST measures predicting clinical pain, as well as predicting and reflecting treatment responses. RESULTS Although evidence suggests that QST may be useful in a mechanism-based classification of pain, there are gaps in our current understanding that need to be addressed including making QST more applicable in clinical settings. There is a need for developing shorter QST protocols that are clinically predictive of various pain subtypes and treatment responses without requiring expensive equipment. Future studies are needed, examining the clinical predictive value of QST including sensitivity and specificity for pain classification or outcome prediction. These findings could enable third-party payers' reimbursement, which would facilitate clinical implementation of QST. CONCLUSIONS With some developments, QST could become a cost-effective and clinically useful component of pain assessment and diagnosis, which can further our progress toward the goal of mechanism-based personalized pain management.
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Affiliation(s)
- Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry & Behavioral Science, University of Florida, Gainesville, Florida, USA
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