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Yamabe Y, Hasegawa M, Kobayashi G, Tone S, Naito Y, Sudo A. Neuropathic pain in patients with osteoarthritis of the hip before and after total hip arthroplasty. PLoS One 2024; 19:e0301352. [PMID: 38662731 PMCID: PMC11045094 DOI: 10.1371/journal.pone.0301352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/14/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES The pain associated with osteoarthritis (OA) was thought to be nociceptive; however, neuropathic pain is also observed. We investigated the relationship between hip OA and neuropathic pain using the PainDETECT questionnaire (PDQ). METHODS A total of 159 hips of 146 consecutive patients who underwent total hip arthroplasty (THA) with a diagnosis of OA were enrolled in this study. The prevalence of each pain phenotype was evaluated preoperatively and at 6 months postoperatively using the PDQ. Patient characteristics and numerical rating scale (NRS) scores were compared between a group with possible neuropathic pain (NP group) and a group with nociceptive pain (non-NP group). RESULTS Before THA, neuropathic, unclear, and nociceptive pain was observed in 18, 36, and 105 hips, respectively. The prevalence in the NP group was 54 hips, accounting for approximately one-third of all hips, which decreased significantly to seven hips after THA. A significantly higher NRS score was observed in the NP group, both before and after THA. CONCLUSION Approximately one-third of the patients with hip OA had neuropathic pain. Therefore, neuropathic pain should be considered when treating patients with hip OA.
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Affiliation(s)
- Yohei Yamabe
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Masahiro Hasegawa
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Gai Kobayashi
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Shine Tone
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Yohei Naito
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Akihiro Sudo
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
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Pain Sensitization and Neuropathic Pain-like Symptoms Associated with Effectiveness of Exercise Therapy in Patients with Hip and Knee Osteoarthritis. Pain Res Manag 2022; 2022:4323045. [PMID: 36071945 PMCID: PMC9444422 DOI: 10.1155/2022/4323045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/21/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022]
Abstract
Pain sensitization and neuropathic pain-like symptoms are some of the common pain symptoms in patients with lower limbs, including hip and knee, osteoarthritis (HOA/KOA). Exercise therapy has been the first-line treatment; however, the effects differ for each patient. This prospective cohort study investigated the relationship between the effectiveness of exercise therapy and pretreatment characteristics (radiologic severity, pain sensitization, and neuropathic pain-like symptoms) of patients with HOA/KOA. We assessed the pain intensity using a numerical rating scale (NRS) before and after 12 weeks of exercise therapy in patients with HOA/KOA (n = 101). Before treatment, the Kellgren–Lawrence (K-L) grade; minimum joint space width (mJSW); pressure pain threshold (PPT) and temporal summation of pain (TSP) at the affected joint, tibia, and forearm; Central Sensitization Inventory-9; and painDETECT questionnaire (PDQ) were assessed. Cluster analysis was based on the pretreatment NRS and change in NRS with exercise therapy to identify the subgroups of pain reduction. The pretreatment characteristics of each cluster were compared. According to the results of the cluster analyses, patients in cluster 1 had severe pain that did not improve after exercise therapy, patients in cluster 2 had severe pain that improved, and those in cluster 3 had mild pain that improved. The patients in cluster 1 exhibited lower PPT at all measurement sites, higher TSP at the affected joint, and higher PDQ scores than those in other clusters. There was no difference in the K-L grade and mJSW among the clusters. The subgroup with severe pain and pain sensitization or neuropathic pain-like symptoms at pretreatment, even with mild joint deformity, may have difficulty in achieving improvement in pain after 12 weeks of exercise therapy. These findings could be useful for prognosis prediction and for planning exercise therapy and combining with other treatment.
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Blikman T, Rienstra W, van Raaij TM, ten Hagen AJ, Dijkstra B, Zijlstra WP, Bulstra SK, Stevens M, van den Akker-Scheek I. Duloxetine in OsteoArthritis (DOA) study: effects of duloxetine on pain and function in end-stage hip and knee OA – a pragmatic enriched randomized controlled trial. BMC Musculoskelet Disord 2022; 23:115. [PMID: 35123461 PMCID: PMC8818142 DOI: 10.1186/s12891-022-05034-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/10/2022] [Indexed: 12/27/2022] Open
Abstract
Background Some osteoarthritis (OA) patients experience inadequate pain relief from analgesics like acetaminophen and nonsteroidal anti-inflammatory drugs. This could be the result of experienced non-nociceptive centralized pain. Placebo-controlled randomized trials (RCT) have proven the effectiveness of duloxetine for OA and several chronic pain conditions where central sensitization (CS) is one of the key underlying pain mechanisms. Objectives Assess the efficacy of an 8-week duloxetine treatment compared to usual care in end-stage knee and hip OA patients with a level of centralized pain. Design Pragmatic, enriched, open-label RCT. Methods Patients were randomized to duloxetine or to care-as-usual. Primary outcome was pain in the index joint, measured with the pain domain of the Knee injury and Osteoarthritis Outcome Score (KOOS) or the Hip disability and Osteoarthritis Outcome Score (HOOS). The intention-to-treat principle was used, with mixed-model repeated measures to analyze the effect. Results One hundred eleven patients were randomized. Nearly 44% felt much to very much better after duloxetine usage compared to 0% in the care-as-usual group (p < 0.001). The duloxetine group scored 11.3 points (95%CI: 5.8, 16.8) better on the pain domain of the KOOS/HOOS (p < 0.001). Knee patients improved significantly more than hip patients (18.7 [95%CI: 11.3, 26.1] versus 6.0 [95%CI: − 2.6, 14.5] points better). Conclusions Adding duloxetine treatment seems to be beneficial for end-stage knee OA patients with neuropathic-like symptoms (at risk of CS). End stage Hip OA patients seem to be nonresponsive to duloxetine. Trial registration Dutch Trial Registry with number NTR 4744 (15/08/2014) and in the EudraCT database with number 2013–004313-41. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05034-0.
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Miyamoto S, Iida S, Miyashita T, Katou K, Kawarai Y, Nakamura J, Orita S, Ohtori S. Mechanism of Chronic Pain of Symptomatic Hip Osteoarthritis by Association of its Distribution, Nociceptive, Neuropathic, Nociplastic, or Mixed-pain Screening, and the Prevalence of Lumbar Spinal Stenosis: A Cross-sectional Study. Clin J Pain 2021; 38:77-87. [PMID: 34803154 DOI: 10.1097/ajp.0000000000001004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The pain of hip osteoarthritis (OA) is generally recognized as nociceptive in origin because of the local pathology. However, some patients with OA experience a neuropathic pain component as an essential part of some nociplastic pain subtype. Here, we sought to examine the mechanism of chronic pain of symptomatic hip OA by the association of its distribution, complex pain mechanism screening, and the prevalence of lumbar spinal stenosis. MATERIALS AND METHODS We conducted a prospective cross-sectional study of 100 hips in 100 patients with symptomatic hip OA in a chronic state. We examined all baseline clinical characteristics including clinical and functional score, location of pain and numbness, and pain score (PainDETECT questionnaire and the Leeds Assessment of Neuropathic Symptoms and Signs), and magnetic resonance imaging of the hip and lumbar spine. RESULTS The PainDETECT questionnaire and Leeds Assessment of Neuropathic Symptoms and Signs revealed that 23% of the patients had a neuropathic pain component. There were 24 variations of the pain pattern. By contrast, the pain localized around the hip joint was only 15%. Pain distal to the thigh and any numbness was significantly more frequent in the group with neuropathic pain (P<0.001). Lumbar spinal stenosis grade was not significantly different between patients with nociceptive pain and those with neuropathic pain. Pain score was significantly correlated with the pain in clinical and functional scores. DISCUSSION Among patients with symptomatic hip OA, the distribution of pain was various, and about 23% of patients had neuropathic, nociplastic, or mixed pain as a possibility for somatosensory system disturbances.
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Affiliation(s)
- Shuichi Miyamoto
- Department of Orthopaedics Surgery, Matsudo City General Hospital, Matsudo City
| | - Satoshi Iida
- Department of Orthopaedics Surgery, Matsudo City General Hospital, Matsudo City
| | - Tomohiro Miyashita
- Department of Orthopaedics Surgery, Matsudo City General Hospital, Matsudo City
| | - Kei Katou
- Department of Orthopaedics Surgery, Matsudo City General Hospital, Matsudo City
| | - Yuya Kawarai
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University
| | - Junichi Nakamura
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University
| | - Sumihisa Orita
- Division of Spine Surgery, Department of Orthopaedics Surgery, Chiba University Chiba University Center for Frontier Medical Engineering (CFME), Chiba City, Chiba Prefecture, Japan
| | - Seiji Ohtori
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University
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Systematic review and meta-analysis of the prevalence of neuropathic-like pain and/or pain sensitization in people with knee and hip osteoarthritis. Osteoarthritis Cartilage 2021; 29:1096-1116. [PMID: 33971205 DOI: 10.1016/j.joca.2021.03.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 03/03/2021] [Accepted: 03/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the prevalence of neuropathic-like pain (NP) and pain sensitization (PS) defined by self-report questionnaires in knee and hip osteoarthritis, and whether prevalence is potentially explained by disease-severity or affected joint. DESIGN MEDLINE, EMBASE, CINAHL were systematically searched (1990-April 2020) for studies describing the prevalence of NP and PS in knee and hip osteoarthritis using self-report questionnaires. Random-effects meta-analysis was performed. Statistical heterogeneity between studies and sub-groups (affected joint and population source as a proxy for disease severity) was assessed (I2 statistic and the Chi-squared test). RESULTS From 2,706 non-duplicated references, 39 studies were included (2011-2020). Thirty-six studies reported on knee pain and six on hip pain. For knee osteoarthritis, the pooled prevalence of NP was: using PainDETECT, possible NP(score ≥13) 40% (95%CI 32-48%); probable NP(score >18) 20% (95%CI 15-24%); using Self-Report Leeds Assessment of Neuropathic Symptoms and Signs, 32% (95%CI 26-38%); using Douleur Neuropathique (DN4) 41% (95% CI 24-59%). The prevalence of PS using Central Sensitization Inventory (CSI) was 36% (95% CI 12-59%). For hip osteoarthritis, the pooled prevalence of NP was: using PainDETECT, possible NP 29% (95%CI 22-37%%); probable NP 9% (95%CI 6-13%); using DN4 22% (95%CI 12-31%) in one study. The prevalence of possible NP pain was higher at the knee (40%) than the hip (29%) (difference 11% (95% CI 0-22%), P = 0.05). CONCLUSIONS Using self-report questionnaire tools, NP was more prevalent in knee than hip osteoarthritis. The prevalence of NP in knee and hip osteoarthritis were similar for each joint regardless of study population source or tool used. Whether defining NP using self-report questionnaires enables more effective targeted therapy in osteoarthritis requires investigation.
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Takegami Y, Seki T, Osawa Y, Kusano T, Makida K, Ishiguro N. Does unilateral total hip arthroplasty improve pain and function in the non-operative hip joint? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1411-1416. [PMID: 32556581 DOI: 10.1007/s00590-020-02716-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/03/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Some reports suggested that the status of the opposite-side hip affects clinical outcomes of unilateral total hip arthroplasty (THA) for hip osteoarthritis (HOA). This study aimed to determine whether unilateral THA could improve pain and movement of the non-operative hip. METHODS The analysis included 195 patients divided into three groups according to contralateral hip status based on radiographic change assessed by Kellgren-Lawrence (KL) grade: normal hip (Group N: n = 124), HOA with KL grade > 2 (Group O: n = 39), and THA patients who already underwent THA in their opposite hip joint (Group T: n = 32). All patients were interviewed and examined preoperatively and at 1-year intervals after surgery. Hip function was evaluated with Harris Hip Score (HHS) and range of motion (ROM) preoperatively and at 1-year follow-up. We used the Japanese Orthopedic Association Hip-Disease Evaluation Questionnaire (JHEQ) and the Visual Analogue Scale (VAS) for separately evaluated right and left hip joints. RESULTS The mJHEQ movement, which indicated the activity, and flexion of ROM in the non-operative hip improved in group N and group T. The VAS and JHEQ pain values did not differ between preoperative and 1-year follow-up in all groups. In the operative side, HHS function, JHEQ movement values in group O were significantly lower than those of groups N and T at 1-year follow-up. CONCLUSION Unilateral THA may improve non-operative hip movement and active daily life except when the non-operated hip shows osteoarthritis. It did not improve non-operative hip pain, regardless of the condition on the other side. Clinical outcomes of unilateral THA may be affected by opposite hip status each other.
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Affiliation(s)
- Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Taiki Kusano
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Kazuya Makida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
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Maeda K, Sonohata M, Kitajima M, Kawano S, Mawatari M. Risk Factors of Neuropathic Pain after Total Hip Arthroplasty. Hip Pelvis 2018; 30:226-232. [PMID: 30534541 PMCID: PMC6284076 DOI: 10.5371/hp.2018.30.4.226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/16/2018] [Accepted: 09/03/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Pain caused by osteoarthritis is primarily nociceptive pain; however, it is considered that a component of this pain is due to neuropathic pain (NP). We investigated the effects of total hip arthroplasty (THA) in patients with NP diagnosed by the PainDETECT questionnaire. MATERIALS AND METHODS One hundred sixty-three hips (161 patients) were evaluated. All patients were asked to complete the PainDETECT questionnaire based on their experience with NP, and clinical scores were evaluated using the Japanese Orthopaedic Association (JOA) Hip Score before and after THA. RESULTS The patients of 24.5% reported NP before THA; 5.5% reported NP 2 months after THA. Prior to THA, there was no significant correlation between the PainDETECT score and the radiographic severity; however, there was a significant correlation between the PainDETECT score and JOA score. NP at 2 months after THA was not significantly correlated with pain scores at 1 week after THA; however, a significant correlation was observed between the preoperative pain score and NP at 2 months after THA. CONCLUSION THA was useful for relieving nociceptive pain and for relieving NP in patients with hip osteoarthritis. Preoperative pain was a risk factor for NP after THA. Controlling preoperative pain may be effective for reducing postoperative NP.
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Affiliation(s)
- Kazumasa Maeda
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaru Kitajima
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Shunsuke Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Neuropathic-like symptoms and the association with joint-specific function and quality of life in patients with hip and knee osteoarthritis. PLoS One 2018; 13:e0199165. [PMID: 29902245 PMCID: PMC6002060 DOI: 10.1371/journal.pone.0199165] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/01/2018] [Indexed: 01/04/2023] Open
Abstract
Objective There is an association between osteoarthritis-related pain severity and function, yet clear evidence about the sole influence of neuropathic-like symptoms on joint function and health-related quality of life (HRQoL) is lacking. Previous studies among knee OA patients show an association between neuropathic-like symptoms, lower functional status and lower quality of life, however analyses were unadjusted or had limited adjustment for influential covariates like pain intensity. The aim of this study was therefore to determine the influence of neuropathic-like symptoms—adjusted for multiple influential covariates—on joint-specific function and HRQoL in hip and knee OA patients. Methods In this observational study 255 patients (117 with hip OA and 138 with knee OA) completed the modified painDETECT questionnaire (mPDQ) to identify subjects with neuropathic-like symptoms (mPDQ score>12, possible neuropathic pain [NP] phenotype). The WOMAC and the RAND-36 were used to asses respectively function and HRQoL. Results were adjusted stepwise for age, sex and BMI (Model 1); back disorder, painful body regions, comorbidities and previous surgery (Model 2); and pain intensity and analgesic usage (Model 3). Results A possible NP phenotype was experienced by 37% of hip and 46% of knee OA patients. Final model 3 analysis revealed that hip OA patients with neuropathic-like symptoms scored significantly lower on pain-related aspects of HRQoL (ΔRAND-36 bodily pain: 6.8 points, p = 0.047) compared to patients with the unlikely NP phenotype. In knee OA patients, a possible NP phenotype was associated with diminished joint function (ΔWOMAC domains ranging 7.1 to 10.5 points, p<0.05) and more deficits on the physical functional aspect of HRQoL (ΔRAND-36 physical functioning: 6.8 points, p = 0.016). Conclusion Neuropathic-like symptoms deteriorate the subjective rating of pain-related quality of life in hip OA patients and significantly influence function in knee OA patients.
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Wako Y, Nakamura J, Hagiwara S, Miura M, Eguchi Y, Suzuki T, Orita S, Inage K, Kawarai Y, Sugano M, Nawata K, Yoshino K, Masuda Y, Matsumoto K, Ohtori S. Diffusion tensor imaging of the sciatic and femoral nerves in unilateral osteoarthritis of the hip and osteonecrosis of femoral head: Comparison of the affected and normal sides. Mod Rheumatol 2018; 29:693-699. [PMID: 29862862 DOI: 10.1080/14397595.2018.1484545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objective: The aim was to compare the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the sciatic and femoral nerves in patients with unilateral osteoarthritis of the hip (OA) and osteonecrosis of the femoral head (ONFH) using diffusion tensor imaging (DTI) and to investigate the mechanism of hip pain. Methods: Forty-four patients (22 OA and 22 ONFH) underwent DTI of the sciatic and femoral nerves at the level of the hip joint and the S1 roots to visualize the tractography and quantify the FA and ADC values. Results: The tractography of the femoral and the sciatic nerves on the affected side with OA and ONFH were similar to those on the normal side. The mean FA values of the sciatic and femoral nerves, and the S1 roots were 0.542, 0.551, and 0.316 with OA, 0.568, 0.560, and 0.318 with ONFH on the affected side, and 0.559, 0.560, and 0.315 on the normal side, respectively, and did not show significant differences. The FA values of the sciatic nerve on the affected side with OA decreased with longer pain duration. Conclusion: The FA and ADC values of the sciatic and femoral nerves in patients with unilateral OA and ONFH showed no significant differences between the affected and normal sides.
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Affiliation(s)
- Yasushi Wako
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Junichi Nakamura
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Shigeo Hagiwara
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Michiaki Miura
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Yawara Eguchi
- b Department of Orthopedic Surgery , National Hospital Organization Shimoshizu National Hospital , Chiba , Japan
| | - Takane Suzuki
- c Department of Bioenvironmentral Medicine, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Sumihisa Orita
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Kazuhide Inage
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Yuya Kawarai
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Masahiko Sugano
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Kento Nawata
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Kensuke Yoshino
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Yoshitada Masuda
- d Department of Radiology , Chiba University Hospital , Chiba , Japan
| | - Koji Matsumoto
- d Department of Radiology , Chiba University Hospital , Chiba , Japan
| | - Seiji Ohtori
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
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Rienstra W, Blikman T, Dijkstra B, van Raay J, Slager G, Bulstra S, Stevens M, van den Akker-Scheek I. Validity of the Dutch modified painDETECT questionnaire for patients with hip or knee osteoarthritis. Disabil Rehabil 2017; 41:941-947. [PMID: 29221427 DOI: 10.1080/09638288.2017.1413429] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The modified painDETECT questionnaire (PDQ) is a self-reported questionnaire to discriminate between nociceptive and neuropathic-like pain in patients with knee/hip osteoarthritis (OA). This study aims to assess the structural and construct validity of this questionnaire. METHODS Confirmatory factor analysis and hypothesis-testing was used. For 168 patients, predefined hypotheses were formulated on the correlation between the modified painDETECT and several other questionnaires, and in a subsample of 46 with pain pressure thresholds (PPTs). RESULTS Two principal components were confirmed. The pain pattern item did not load on any component. Eighty per cent of the hypotheses on the correlation between modified PDQ and the questionnaires were met, as were 50% concerning PPTs measurements. CONCLUSIONS This study is the first to assess structural and construct validity of the modified PDQ knee/hip by using factor analysis and hypothesis-testing. This questionnaire seems to reflect neuropathic-like pain symptoms experienced by hip/knee OA-patients with adequate validity. The item on pain pattern might not reflect the construct. More than 75% of the predefined hypotheses regarding the modified PDQ and the other questionnaires were met. Only 50% of the hypotheses on PPTs measurements were met, probably due to heterogeneity and limited size of this subsample. Implications for rehabilitation Pain in osteoarthritis (OA) is partly caused by modification of pain transmission in the peripheral and central nervous system, leading to sensitisation. This process seems particularly significant in a subgroup of OA patients. Sensitisation in OA is associated with more disability in daily life, lower quality of life and more widespread pain, as well as poorer outcome of total joint surgery. Screening for sensitisation can help to identify the subgroup of patients who could benefit from multidisciplinary treatment options focussing on desensitisation, cognitive- and behavioural therapy and reducing chronification of widespread pain. Therefore, being particularly important in the field of rehabilitation. The Dutch modified PainDETECT-questionnaire is very useful for rehabilitation professionals as it is one of the first questionnaires specifically validated to assess neuropathic-like symptoms (indicating sensitisation) in patients with knee or hip osteoarthritis.
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Affiliation(s)
- Wietske Rienstra
- a Department of Orthopaedic Surgery , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Tim Blikman
- a Department of Orthopaedic Surgery , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Baukje Dijkstra
- b Department of Orthopaedic Surgery , Medical Center Leeuwarden , Leeuwarden , The Netherlands
| | - Jos van Raay
- c Department of Orthopaedic Surgery , Martini Hospital , Groningen , The Netherlands
| | - Geranda Slager
- d Department of Physical Therapy, School of Health Care Studies , Hanze University of Applied Sciences , Groningen , The Netherlands
| | - Sjoerd Bulstra
- a Department of Orthopaedic Surgery , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Martin Stevens
- a Department of Orthopaedic Surgery , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Inge van den Akker-Scheek
- a Department of Orthopaedic Surgery , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
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Wako Y, Nakamura J, Eguchi Y, Hagiwara S, Miura M, Kawarai Y, Sugano M, Nawata K, Yoshino K, Toguchi Y, Masuda Y, Matsumoto K, Suzuki T, Orita S, Ohtori S. Diffusion tensor imaging and tractography of the sciatic and femoral nerves in healthy volunteers at 3T. J Orthop Surg Res 2017; 12:184. [PMID: 29187253 PMCID: PMC5707804 DOI: 10.1186/s13018-017-0690-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/19/2017] [Indexed: 11/10/2022] Open
Abstract
Background The aim was to clarify the normal fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the sciatic and femoral nerves at the level of the hip joint and to visualize the neural tracts with diffusion tensor imaging (DTI). Methods Twenty-four healthy volunteers (12 men and 12 women, age 20–29 years) underwent DTI for visualization with tractography and quantification of FA and ADC values on a 3 Tesla MRI (b value = 800 s/mm2, motion probing gradient, 11 directions, time to repeat/echo time = 9000/72.6 ms, axial slice orientation, slice thickness = 3.0 mm with no inter-slice gap, field of view = 320 × 320 mm, 96 × 192 matrix, 75 slices, number of acquisitions = 4). Regions of interest in the sciatic nerve were defined at the femoral head, the S1 root, and the midpoint levels. The femoral nerve was evaluated at 3–4 cm proximal to the femoral head level. Results The tractography of the sciatic and femoral nerves were visualized in all participants. The mean FA values of the sciatic nerve were increased distally from the S1 root level, through the midpoint, and to the femoral head level (0.314, 0.446, 0.567, p = 0.001, respectively). The mean FA values of the femoral nerve were 0.565. The mean ADC values of the sciatic nerves were significantly lower in the S1 root level than in the midpoint and the femoral head level (1.481, 1.602, 1.591 × 10−3 × 10−3 mm2/s, p = 0.001, respectively). The ADC values of the femoral nerve were 1.439 × 10−3 mm2/s. FA and ADC values showed moderate to substantial inter- and intra-observer reliability without significant differences in gender or laterality. Conclusion Visualization and quantification of the sciatic and femoral nerves simultaneously around the hip joint were achieved in healthy young volunteers with DTI. Clinical application of DTI is expected to contribute to hip pain research.
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Affiliation(s)
- Yasushi Wako
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan.
| | - Junichi Nakamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Yawara Eguchi
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido city, Chiba, 284-0003, Japan
| | - Shigeo Hagiwara
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Michiaki Miura
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Yuya Kawarai
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Masahiko Sugano
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Kento Nawata
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Kensuke Yoshino
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Yasunari Toguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Yoshitada Masuda
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Koji Matsumoto
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Takane Suzuki
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
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Nakawaki M, Fukushima K, Inoue G, Moriya M, Uchiyama K, Takahira N, Takaso M. Use of the painDETECT questionnaire to differentiate the nature of hip pain associated with a labrum tear. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2017; 11:1-5. [PMID: 29552502 PMCID: PMC5850904 DOI: 10.1016/j.asmart.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/04/2017] [Accepted: 10/18/2017] [Indexed: 11/25/2022]
Abstract
The nature of pain associated with a labrum tear of the hip joint can vary widely among patients and does not always correlate with findings from diagnostic imaging. Identifying the components of the pain (nociceptive, neuropathic, or mixed pattern) is important to direct treatment. This report aimed to describe the use of the painDETECT questionnaire as a screening tool in order to classify the nature of the pain in three patients who presented with pain that was atypical for a labrum tear. The painDETECT questionnaire was an effective tool to identify appropriate pain management strategies in each case.
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Affiliation(s)
- Mitsufumi Nakawaki
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Kensuke Fukushima
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Mitsutoshi Moriya
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Katsufumi Uchiyama
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
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French HP, Smart KM, Doyle F. Prevalence of neuropathic pain in knee or hip osteoarthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2017; 47:1-8. [DOI: 10.1016/j.semarthrit.2017.02.008] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/19/2017] [Accepted: 02/15/2017] [Indexed: 12/01/2022]
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Miyamoto S, Nakamura J, Ohtori S, Orita S, Nakajima T, Omae T, Hagiwara S, Takazawa M, Suzuki M, Suzuki T, Takahashi K. Pain-related behavior and the characteristics of dorsal-root ganglia in a rat model of hip osteoarthritis induced by mono-iodoacetate. J Orthop Res 2017; 35:1424-1430. [PMID: 27543839 DOI: 10.1002/jor.23395] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 08/19/2016] [Indexed: 02/04/2023]
Abstract
The principal aim of this study was to clarify the time course of pain-related behavior and pain-related sensory innervation in a rat model of hip osteoarthritis (OA) induced by intra-articular injection of mono-iodoacetate (MIA). Using 6-week-old male Sprague Dawley rats, 25 μl of sterile saline of 1% Fluoro-Gold solution (FG) (control group; n = 30) and 25 μl of sterile saline of 1% FG with 2 mg of MIA (MIA group; n = 30) was injected into the right hip joints. Gait function was evaluated using a CatWalk system after 7, 14, 28, 42, and 56 days (n = 5, respectively). Neurons in the dorsal root ganglion (DRG) between L1 and L5 were immunostained for calcitonin gene-related peptide (CGRP) and activating transcription factor-3 (ATF3). Gait analysis revealed the mean six parameters of hind paws at all time points were significantly lower in the MIA group (p = 0.05). The number of CGRP-immunoreactive (-IR) DRG neurons was significantly increased on days 7, 14, 28, and 42 peaking at 14 days in the MIA group. By contrast, expression of ATF3-IR in FG-labeled DRG neurons was significantly increased on days 42 and 57. The FG-labeled DRG neurons were distributed between L1 and L5, mainly at the L4 level. Pain-related behavior indicated by gait disturbance was observed in a MIA model of hip OA in rat. Early elevation of CGRP expression and late expression of ATF-3 were demonstrated in DRG neurons, possibly reflecting inflammatory pain and neuropathic pain in hip OA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1424-1430, 2017.
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Affiliation(s)
- Shuichi Miyamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City 260-8677, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City 260-8677, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City 260-8677, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City 260-8677, Chiba, Japan
| | - Takayuki Nakajima
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City 260-8677, Chiba, Japan
| | - Takanori Omae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City 260-8677, Chiba, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City 260-8677, Chiba, Japan
| | - Makoto Takazawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City 260-8677, Chiba, Japan
| | - Miyako Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City 260-8677, Chiba, Japan
| | - Takane Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City 260-8677, Chiba, Japan
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City 260-8677, Chiba, Japan
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Nakamura J, Konno K, Orita S, Hagiwara S, Shigemura T, Nakajima T, Suzuki T, Akagi R, Ohtori S. Distribution of hip pain in patients with idiopathic osteonecrosis of the femoral head. Mod Rheumatol 2016; 27:503-507. [PMID: 27459136 DOI: 10.1080/14397595.2016.1209830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the distribution of referred hip pain in patients with idiopathic osteonecrosis of the femoral head (ION). METHODS We prospectively documented 119 hips in 90 patients with ION (mean age 51 years). Patients identified the location of pain originating in their hip on a drawing of the body. Osteoarthritis of the hip (OA) was used as a historical cohort. RESULTS Referral of pain originating from the hip in patients with ION was 93% (111 hips) to the groin, 68% (81 hips) to the knee, 36% (43 hips) to the anterior thigh, 34% (40 hips) to the buttock, 18% (22 hips) to the lower leg, 9% (11 hips) to the greater trochanter, and 8% (9 hips) to the low back. About 97% (115 hips) of pain was located in the hip region (groin, buttock, and greater trochanter) and 77% (92 hips) showed referred pain (anterior thigh, knee, lower leg, and low back). Pain from ION was significantly more frequent in the knee and lower leg, but significantly less frequent in the lower back than pain from OA. CONCLUSION We should be aware of ION masquerading as pain in the knee or anterior thigh.
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Affiliation(s)
- Junichi Nakamura
- a Department of Orthopaedic Surgery, Graduate School of Medicine , Chiba University , Chiba City , Chiba , Japan
| | - Kenta Konno
- a Department of Orthopaedic Surgery, Graduate School of Medicine , Chiba University , Chiba City , Chiba , Japan
| | - Sumihisa Orita
- a Department of Orthopaedic Surgery, Graduate School of Medicine , Chiba University , Chiba City , Chiba , Japan
| | - Shigeo Hagiwara
- a Department of Orthopaedic Surgery, Graduate School of Medicine , Chiba University , Chiba City , Chiba , Japan
| | - Tomonori Shigemura
- a Department of Orthopaedic Surgery, Graduate School of Medicine , Chiba University , Chiba City , Chiba , Japan
| | - Takayuki Nakajima
- a Department of Orthopaedic Surgery, Graduate School of Medicine , Chiba University , Chiba City , Chiba , Japan
| | - Takane Suzuki
- a Department of Orthopaedic Surgery, Graduate School of Medicine , Chiba University , Chiba City , Chiba , Japan
| | - Ryuichiro Akagi
- a Department of Orthopaedic Surgery, Graduate School of Medicine , Chiba University , Chiba City , Chiba , Japan
| | - Seiji Ohtori
- a Department of Orthopaedic Surgery, Graduate School of Medicine , Chiba University , Chiba City , Chiba , Japan
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16
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Miyamoto S, Nakamura J, Ohtori S, Orita S, Omae T, Nakajima T, Suzuki T, Takahashi K. Intra-articular injection of mono-iodoacetate induces osteoarthritis of the hip in rats. BMC Musculoskelet Disord 2016; 17:132. [PMID: 26992380 PMCID: PMC4797112 DOI: 10.1186/s12891-016-0985-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/11/2016] [Indexed: 11/30/2022] Open
Abstract
Background The mechanism for hip pain has been unclear because of a lack of experimental animal models. We aimed to establish an intra-articular injection technique to the rat hip and to document the effect of intra-articular mono-iodoacetate (MIA) injection to the rat hip with radiography and histology. Methods Using 60 6-week-old male Sprague Dawley rats, 25 μl of sterile saline (control group; n = 30) and 25 μl of sterile saline with 2 mg of MIA (MIA group; n = 30) was injected into the right hip joints via posterior approach using a 27G needle. The animals were examined with X-ray and histology 7, 14, 28, 42, and 56 days later (MIA group [n = 6] and control group [n = 6], respectively). Results The MIA group showed progressive radiographic changes to the hip joint during the experimental period, whereas the control group maintained a normal appearance. The microanatomic appearance was consistent with X-ray images of progressive destruction in the MIA group and normal tissue in the control group. Osteoarthritic (OA) changes became apparent at 42 and 56 days in the MIA group. Conclusions We established an intra-articular injection technique to the rat hip, creating a hip OA model in the rat by intra-articular injection of MIA.
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Affiliation(s)
- Shuichi Miyamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan.
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Takanori Omae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Takayuki Nakajima
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Takane Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
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Blikman T, Rienstra W, van Raaij TM, ten Hagen AJ, Dijkstra B, Zijlstra WP, Bulstra SK, van den Akker-Scheek I, Stevens M. Duloxetine in OsteoArthritis (DOA) study: study protocol of a pragmatic open-label randomised controlled trial assessing the effect of preoperative pain treatment on postoperative outcome after total hip or knee arthroplasty. BMJ Open 2016; 6:e010343. [PMID: 26932142 PMCID: PMC4785324 DOI: 10.1136/bmjopen-2015-010343] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/14/2015] [Accepted: 12/17/2015] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Residual pain is a major factor in patient dissatisfaction following total hip arthroplasty or total knee arthroplasty (THA/TKA). The proportion of patients with unfavourable long-term residual pain is high, ranging from 7% to 34%. There are studies indicating that a preoperative degree of central sensitisation (CS) is associated with poorer postoperative outcomes and residual pain. It is thus hypothesised that preoperative treatment of CS could enhance postoperative outcomes. Duloxetine has been shown to be effective for several chronic pain syndromes, including knee osteoarthritis (OA), in which CS is most likely one of the underlying pain mechanisms. This study aims to evaluate the postoperative effects of preoperative screening and targeted duloxetine treatment of CS on residual pain compared with care-as-usual. METHODS AND ANALYSIS This multicentre, pragmatic, prospective, open-label, randomised controlled trial includes patients with idiopathic hip/knee OA who are on a waiting list for primary THA/TKA. Patients at risk for CS will be randomly allocated to the preoperative duloxetine treatment programme group or the care-as-usual control group. The primary end point is the degree of postoperative pain 6 months after THA/TKA. Secondary end points at multiple time points up to 12 months postoperatively are: pain, neuropathic pain-like symptoms, (pain) sensitisation, pain catastrophising, joint-associated problems, physical activity, health-related quality of life, depressive and anxiety symptoms, and perceived improvement. Data will be analysed on an intention-to-treat basis. ETHICS AND DISSEMINATION The study is approved by the local Medical Ethics Committee (METc 2014/087) and will be conducted according to the principles of the Declaration of Helsinki (64th, 2013) and the Good Clinical Practice standard (GCP), and in compliance with the Medical Research Involving Human Subjects Act (WMO). TRIAL REGISTRATION NUMBER 2013-004313-41; Pre-results.
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Affiliation(s)
- T Blikman
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - W Rienstra
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T M van Raaij
- Department of Orthopaedics, Martini Hospital Groningen, Groningen, The Netherlands
| | - A J ten Hagen
- Department of Anaesthesiology, Martini Hospital Groningen, Groningen, The Netherlands
| | - B Dijkstra
- Department of Orthopaedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - W P Zijlstra
- Department of Orthopaedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - S K Bulstra
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - I van den Akker-Scheek
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Stevens
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Rienstra W, Blikman T, Mensink FB, van Raay JJAM, Dijkstra B, Bulstra SK, Stevens M, van den Akker-Scheek I. The Modified painDETECT Questionnaire for Patients with Hip or Knee Osteoarthritis: Translation into Dutch, Cross-Cultural Adaptation and Reliability Assessment. PLoS One 2015; 10:e0146117. [PMID: 26720417 PMCID: PMC4697818 DOI: 10.1371/journal.pone.0146117] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/14/2015] [Indexed: 01/18/2023] Open
Abstract
There is a growing amount of evidence that alteration in pain processing by the peripheral and central nervous system play a role in osteoarthritis pain, leading to neuropathic-like symptoms. It is essential to identify knee and hip osteoarthritis patients with a neuropathic pain profile in order to offer such patients education and additional treatment options besides conventional pain treatment. The painDETECT Questionnaire is a self-report questionnaire developed to discriminate between nociceptive and neuropathic pain. This questionnaire was modified to fit patients suffering from knee osteoarthritis. The aim of this study was to translate and cross-culturally adapt the modified painDETECT Questionnaire to the Dutch language and to provide a modified version to fit patients with hip osteoarthritis. Reliability for internal consistency, repeatability and floor and ceiling effects were subsequently assessed. A total of 278 patients were included in the reliability study and 123 patients in the repeatability analysis. The Dutch modified painDETECT Questionnaire shows good internal consistency and small relative measurement errors, represented by a good intraclass correlation coefficient. Absolute measurement error, represented by the Standard Error of Measurement, was acceptable. However, a measurement bias might be present when it comes to repeatability. To our knowledge, this study is the first to provide a Dutch modified painDETECT Questionnaire to fit hip and knee osteoarthritis patients and to assess internal consistency, reliability and agreement. International guidelines were followed in the translation process and this study has ample sample size with an adequate time interval for repeatability. Based on this study, the Dutch modified painDETECT Questionnaire seems to be fit as a discriminative tool to identify knee and hip osteoarthritis patients with a neuropathic pain profile. Whether it is also suitable as an evaluative tool to record changes over time or after an intervention remains open to further investigation.
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Affiliation(s)
- Wietske Rienstra
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Tim Blikman
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
| | - Frans B. Mensink
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Baukje Dijkstra
- Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Sjoerd K. Bulstra
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
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Omae T, Nakamura J, Ohtori S, Orita S, Yamauchi K, Miyamoto S, Hagiwara S, Kishida S, Takahashi K. A novel rat model of hip pain by intra-articular injection of nerve growth factor-characteristics of sensory innervation and inflammatory arthritis. Mod Rheumatol 2015; 25:931-6. [PMID: 25736365 DOI: 10.3109/14397595.2015.1023977] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine the direct effects of intra-articular injection of nerve growth factor (NGF) into normal rat hips and the time course of pain-related mediator appearance. METHODS Using 36 numbers of 8-week-old male Sprague-Dawley rats, 30 μl of 1% Fluoro-Gold solution (FG) (Sham-operated group; n = 12), 30 μl of 1% FG with 50 μg/ml NGF (NGF50 group; n = 12), and 30 μl of 1% FG with 100 μg/ml NGF (NGF100 group; n = 12) were injected into the left hip joints. Neurons in the dorsal root ganglion (DRG) labeled with FG, and FG and calcitonin gene-related peptide-immunoreactivity (CGRP-IR) were counted. The synovia in the left hip joint was examined histologically. RESULTS The NGF50 and NGF100 groups showed evidence of synovitis without cartilage degeneration compared with the Sham-operated group. At 7 days, the proportions of CGRP-IR FG-labeled to total FG-labeled neurons were 12%, 18%, and 36% in the Sham-operated, NGF50, and NGF100 groups, respectively. At 14 days, the proportions were 13%, 22%, and 35% in the Sham-operated, NGF50, and NGF100 groups, respectively. At 7 and 14 days, the NGF50 and NGF100 groups showed a significantly higher proportion of CGRP-IR FG-labeled neurons than the Sham-operated group. CONCLUSIONS Intra-articular administration of NGF into the hip joint produces a novel rat model for hip pain.
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Affiliation(s)
- Takanori Omae
- a Department of Orthopaedic Surgery , Graduate School of Medicine, Chiba University , Chiba City , Chiba , Japan
| | - Junichi Nakamura
- a Department of Orthopaedic Surgery , Graduate School of Medicine, Chiba University , Chiba City , Chiba , Japan
| | - Seiji Ohtori
- a Department of Orthopaedic Surgery , Graduate School of Medicine, Chiba University , Chiba City , Chiba , Japan
| | - Sumihisa Orita
- a Department of Orthopaedic Surgery , Graduate School of Medicine, Chiba University , Chiba City , Chiba , Japan
| | - Kazuyo Yamauchi
- a Department of Orthopaedic Surgery , Graduate School of Medicine, Chiba University , Chiba City , Chiba , Japan
| | - Shuichi Miyamoto
- a Department of Orthopaedic Surgery , Graduate School of Medicine, Chiba University , Chiba City , Chiba , Japan
| | - Shigeo Hagiwara
- a Department of Orthopaedic Surgery , Graduate School of Medicine, Chiba University , Chiba City , Chiba , Japan
| | - Shunji Kishida
- a Department of Orthopaedic Surgery , Graduate School of Medicine, Chiba University , Chiba City , Chiba , Japan
| | - Kazuhisa Takahashi
- a Department of Orthopaedic Surgery , Graduate School of Medicine, Chiba University , Chiba City , Chiba , Japan
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Assessment of the patient with osteoarthritis and measurement of outcomes. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00178-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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21
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Neuropathic pain in osteoarthritis: a review of pathophysiological mechanisms and implications for treatment. Semin Arthritis Rheum 2014; 44:145-54. [PMID: 24928208 DOI: 10.1016/j.semarthrit.2014.05.011] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/06/2014] [Accepted: 05/09/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Osteoarthritis (OA) is the leading cause of musculoskeletal pain and functional disability worldwide, affecting a growing number of individuals in the western society. Despite various conservative and interventional treatment approaches, the overall management of the condition is problematic, and pain-the major clinical problem of the disease-remains sub-optimally controlled. The objectives of this review are to present the pathophysiologic mechanisms underlying the complexity of pain in OA and to discuss the challenges for new treatment strategies aiming to translate experimental findings into daily clinical practice. METHODS A narrative literature review of studies investigating the existence of a neuropathic component in OA pain was conducted. We searched PubMed, Embase and Scopus for English language publications. A hand-search of reference lists of relevant studies was also performed. RESULTS Recent advances have shed additional light on the pathophysiology of osteoarthritic pain, highlighting the contribution of central pain pathways together with the sensitisation of peripheral joint receptors and changes of the nociceptive process induced by local joint inflammation and structural bone tissue changes. Thus, a neuropathic pain component may be predominant in individuals with minor joint changes but with high levels of pain refractory to analgesic treatment, providing an alternative explanation for osteoarthritic pain perception. CONCLUSION A growing amount of evidence suggests that the pain in OA has a neuropathic component in some patients. The deeper understanding of multiple mechanisms of OA pain has led to the use of centrally acting medicines that may have a benefit on alleviating osteoarthritic pain. The ineffective pain management and the increasing rates of disability associated with OA mandate for change in our treatment paradigm.
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Nakamura J, Oinuma K, Ohtori S, Watanabe A, Shigemura T, Sasho T, Saito M, Suzuki M, Takahashi K, Kishida S. Distribution of hip pain in osteoarthritis patients secondary to developmental dysplasia of the hip. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0638-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University,
1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - Kazuhiro Oinuma
- Funabashi Orthopaedic Hospital,
1-833 Hasama, Funabashi, Chiba 274-0822, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University,
1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center,
3426-3 Anesaki, Ichihara, Chiba 299-0111, Japan
| | - Tomonori Shigemura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University,
1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University,
1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - Masahiko Saito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University,
1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - Masahiko Suzuki
- Chiba University Research Center for Frontier Medical Engineering,
1-33 Yayoi-cho, Inage-ku, Chiba, Chiba 263-8522, Japan
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University,
1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - Shunji Kishida
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University,
1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan
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Elias LA, Yilmaz Z, Smith JG, Bouchiba M, van der Valk RA, Page L, Barker S, Renton T. PainDETECT: a suitable screening tool for neuropathic pain in patients with painful post-traumatic trigeminal nerve injuries? Int J Oral Maxillofac Surg 2013; 43:120-6. [PMID: 23928156 DOI: 10.1016/j.ijom.2013.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 07/01/2013] [Accepted: 07/03/2013] [Indexed: 10/26/2022]
Abstract
The PainDETECT questionnaire (PD-Q), originally developed and validated in a multicentre study of neuropathic pain (NeP) patients with back pain, is increasingly being applied to other pain conditions. The present study assessed whether the PD-Q would be a suitable screening tool for detecting NeP in patients with post-traumatic inferior alveolar nerve injury (IANI) and lingual nerve injury (LNI). A prospective cohort of patients with clinically diagnosed neuropathy was given the PD-Q at their clinic appointment, or it was sent to them after their consultation. Eighty-nine patients (IANI = 56, LNI = 33) were included in the study, 75 of whom suffered from painful neuropathy. Of the patients who completed the questionnaire fully (n = 56), allowing a summary score to be calculated, 34% were classified as having 'likely NeP' according to the PD-Q; 41% of patients scored in the uncertain classification range and the remaining quarter in the 'likely nociceptive' classification. There was a significant association between PD-Q scores and pain intensity levels across the sample, with those classified as likely NeP reporting high levels of pain. The results suggest that the PD-Q in its current format is not a suitable screening tool for NeP associated with IANI or LNI.
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Affiliation(s)
- L-A Elias
- Department of Oral Surgery, King's College London Dental Institute, London, UK
| | - Z Yilmaz
- Department of Oral Surgery, King's College London Dental Institute, London, UK
| | - J G Smith
- Section of Mental Health, Division of Population Health Sciences and Education, St George's, University of London, London, UK
| | - M Bouchiba
- Department of Oral Surgery, King's College London Dental Institute, London, UK
| | - R A van der Valk
- Department of Oral Surgery, King's College London Dental Institute, London, UK
| | - L Page
- Department of Oral Surgery, King's College London Dental Institute, London, UK
| | - S Barker
- Department of Oral Surgery, King's College London Dental Institute, London, UK
| | - T Renton
- Department of Oral Surgery, King's College London Dental Institute, London, UK.
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Nakamura J, Oinuma K, Ohtori S, Watanabe A, Shigemura T, Sasho T, Saito M, Suzuki M, Takahashi K, Kishida S. Distribution of hip pain in osteoarthritis patients secondary to developmental dysplasia of the hip. Mod Rheumatol 2012; 23:119-24. [PMID: 22492057 DOI: 10.1007/s10165-012-0638-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 03/15/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Our aim was to clarify the distribution of hip pain in patients with osteoarthritis of the hip secondary to developmental dysplasia of the hip (DDH). METHODS We retrospectively studied 443 hips in 369 patients with osteoarthritis secondary to DDH; mean age was 61 years, and follow-up rate was 84 %. Hip pain was defined as preoperative pain that was relieved 3 months after total hip arthroplasty. RESULTS Distribution of pain originating in the hip was 89 % (393 hips) to the groin, 38 % (170 hips) to the buttock, 33 % (144 hips) to the anterior thigh, 29 % (130 hips) to the knee, 27 % (118 hips) to the greater trochanter, 17 % (76 hips) to the low back, and 8 % (34 hips) to the lower leg. When the groin, buttock, and greater trochanter were combined as the hip region, 95 % (421 hips) of pain was located in the hip region. On the other hand, when the anterior thigh, knee, lower leg, and low back were combined as the referral region, 55 % (242 hips) showed referred pain. CONCLUSIONS We suggest that rheumatologists be aware of hip disease masquerading as knee pain or low back pain.
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Affiliation(s)
- Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan.
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