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Pan L, Nagib L, Ganguly S, Moorthy A, Tahir H. A comprehensive review of phase 2/3 trials in osteoarthritis: an expert opinion. Expert Opin Emerg Drugs 2024:1-13. [PMID: 39087391 DOI: 10.1080/14728214.2024.2386174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/19/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION Osteoarthritis (OA) is a chronic, degenerative, and debilitating disease associated with significant long-term morbidity and disability. The pathogenesis of OA is not completely understood but involves an interplay between environmental risk factors, joint mechanics, abnormal pain pathways and upregulation of inflammatory signaling pathways. Current therapeutic options for patients are limited to conservative management, minimal pharmacological options or surgical management, with significant caveats to all approaches. AREAS COVERED In this review, we have set out to investigate current phase II/III clinical trials by undertaking a PubMed search. Examined clinical trials have explored a myriad of potential therapeutics from conventional disease-modifying anti-rheumatic drugs and biologics usually used in the treatment of inflammatory arthritides, to more novel approaches targeting inflammatory pathways implicated in OA, cartilage degeneration or pain pathways. EXPERT OPINION Unfortunately, most completed phase II/III clinical trials have shown little impact on patient pain scores, with the exception of the traditional DMARD methotrexate and Sprifermin. Methotrexate has been shown to be beneficial when used in the correct patient cohort (MRI proven synovitis). Sprifermin has the longest follow-up data of 5 years and has been shown to reduce loss of MRI-measured cartilage thickness and pain scores.
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Affiliation(s)
- Liyang Pan
- General internal medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Lydia Nagib
- General internal medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Sujata Ganguly
- Department of rheumatology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Arumugam Moorthy
- Department of rheumatology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Hasan Tahir
- General internal medicine, Royal Free London NHS Foundation Trust, London, UK
- Department of rheumatology, University College London, London, UK
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Lee S, Neogi T, McGinley B, Wang N, Frey Law L, Torabian KA, Aoyagi K, Stefanik JJ, Carlesso LC, Hausdorff JM, Gazit E, Segal NA, Lewis CE, Nevitt MC, Kumar D. Associations of pain sensitivity and conditioned pain modulation with physical activity: findings from the Multicenter Osteoarthritis Study (MOST). Osteoarthritis Cartilage 2024; 32:982-989. [PMID: 38763431 PMCID: PMC11254545 DOI: 10.1016/j.joca.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE Individuals with chronic pain due to knee osteoarthritis (OA) are insufficiently physically active, and alterations of facilitatory and inhibitory nociceptive signaling are common in this population. Our objective was to examine the association of these alterations in nociceptive signaling with objective accelerometer-based measures of physical activity in a large observational cohort. DESIGN We used data from the Multicenter Osteoarthritis Study. Measures of peripheral and central pain sensitivity included pressure pain threshold at the knee and mechanical temporal summation at the wrist, respectively. The presence of descending pain inhibition was assessed by conditioned pain modulation (CPM). Physical activity was quantitatively assessed over 7 days using a lower back-worn activity monitor. Summary metrics included steps/day, activity intensity, and sedentary time. Linear regression analyses were used to evaluate the association of pain sensitivity and the presence of descending pain inhibition with physical activity measures. RESULTS Data from 1873 participants was analyzed (55.9% female, age = 62.8 ± 10.0 years). People having greater peripheral and central sensitivity showed lower step counts. CPM was not significantly related to any of the physical activity measures, and none of the exposures were significantly related to sedentary time. CONCLUSIONS In this cohort, greater peripheral and central sensitivity were associated with reduced levels of objectively-assessed daily step counts. Further research may investigate ways to modify or treat heightened pain sensitivity as a means to increase physical activity in older adults with knee OA.
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Affiliation(s)
- Soyoung Lee
- Department of Physical Therapy, Boston University, Boston, MA, USA.
| | - Tuhina Neogi
- Division of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Brooke McGinley
- School of Public Health, Boston University, Boston, MA, USA.
| | - Na Wang
- School of Public Health, Boston University, Boston, MA, USA.
| | - Laura Frey Law
- Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, IA, USA.
| | - Kaveh A Torabian
- Department of Physical Therapy, Boston University, Boston, MA, USA.
| | - Kosaku Aoyagi
- Division of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Joshua J Stefanik
- Division of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Department of Physical Therapy, Northeastern University, Boston, MA, USA.
| | - Lisa C Carlesso
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
| | - Jeffrey M Hausdorff
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Rush University Medical Center, Chicago, IL, USA.
| | - Eran Gazit
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Neil A Segal
- Department of Rehabilitation Medicine, University of Kansas, Kansas City, KS, USA.
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Michael C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Deepak Kumar
- Department of Physical Therapy, Boston University, Boston, MA, USA; Division of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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Hertel E, Arendt-Nielsen L, Olesen AE, Andersen MS, Petersen KKS. Quantitative sensory testing, psychological factors, and quality of life as predictors of current and future pain in patients with knee osteoarthritis. Pain 2024; 165:1719-1726. [PMID: 38381930 DOI: 10.1097/j.pain.0000000000003194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/08/2024] [Indexed: 02/23/2024]
Abstract
ABSTRACT Substantial interindividual variability characterizes osteoarthritis (OA) pain. Previous findings identify quantitative sensory testing (QST), psychological factors, and health-related quality of life as contributors to OA pain and predictors of treatment outcomes. This exploratory study aimed to explain baseline OA pain intensity and predict OA pain after administration of a nonsteroidal anti-inflammatory drug in combination with paracetamol for 3 weeks. The Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score was used to estimate OA pain presentation. One hundred one patients were assessed at baseline and follow-up using QST (pressure pain thresholds and temporal summation of pain [TSP]), symptoms of depression and anxiety, pain catastrophizing scales (PCSs), and health-related quality of life. Linear regression with backward selection identified that PCS significantly explained 34.2% of the variability in baseline KOOS pain, with nonsignificant contributions from TSP. Pain catastrophizing score and TSP predicted 29.3% of follow-up KOOS pain, with nonsignificant contributions from symptoms of anxiety. When assessed separately, PCS was the strongest predictor (32.2% of baseline and 24.1% of follow-up pain), but QST, symptoms of anxiety and depression, PCS, and quality of life also explained some variability in baseline and follow-up knee OA pain. Further analyses revealed that only TSP and PCS were not mediated by any other included variables, highlighting their role as unique contributors to OA pain presentation. This study emphasizes the importance of embracing a multimodal approach to OA pain and highlights PCS and TSP as major contributors to the baseline OA pain experience and the OA pain experience after OA treatment.
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Affiliation(s)
- Emma Hertel
- Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Department of Materials and Production, Aalborg University, Aalborg, Denmark
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Estrup Olesen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark
| | - Michael Skipper Andersen
- Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | - Kristian Kjær-Staal Petersen
- Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Department of Materials and Production, Aalborg University, Aalborg, Denmark
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Meert L, Vervullens S, Heusdens CHW, Smeets RJEM, Meeus M, Mertens MGCAM. Unravelling relationships between obesity, diabetes, and factors related to somatosensory functioning in knee osteoarthritis patients. Clin Rheumatol 2024; 43:2637-2645. [PMID: 38913223 PMCID: PMC11269413 DOI: 10.1007/s10067-024-07022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE This study explores the association between obesity, diabetes, and somatosensory functioning in patients with knee osteoarthritis (OA), aiming to understand how metabolic conditions are related to pain mechanisms in this patient population. We hypothesized that higher body mass index (BMI), fat mass, and glycated hemoglobin levels (HbA1c) are associated with signs of altered somatosensory functioning. METHODS A cross-sectional analysis was conducted as part of a larger multicentre prospective cohort study. Data were collected from patients awaiting total knee arthroplasty in Belgium and the Netherlands. Associations between BMI, fat mass, HbA1c, and various pain-related variables were examined employing Pearson and Spearman correlation analyses which were further analyzed with linear regression techniques. RESULTS The study included 223 participants. Analysis revealed a significant although weak negative correlation between fat mass and pressure pain thresholds (PPT) at multiple locations, suggesting a link between higher fat mass and increased mechanical hyperalgesia. There were no significant correlations between BMI and pain-related outcomes. HbA1c levels showed very weak positive correlations with pain measures but did not withstand correction for multiple testing. CONCLUSION The findings indicate that fat mass may be closely associated with altered somatosensory functioning in patients with knee OA. However, no significant correlations were found between BMI or HbA1c levels and pain-related outcomes. Future research should focus on longitudinal studies to elucidate the causal relationships and further explore the impact of metabolic factors on pain mechanisms in this patient population. Key Points • The findings indicate that fat mass may be closely associated with altered somatosensory functioning in patients with knee OA.
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Affiliation(s)
- Lotte Meert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
- Pain in Motion International Research Group (PiM), Brussels, Belgium.
| | - Sophie Vervullens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
- Pain in Motion International Research Group (PiM), Brussels, Belgium
| | - Christiaan H W Heusdens
- Department of Orthopedics and Traumatology, University Hospital of Antwerp, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Rob J E M Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
- Pain in Motion International Research Group (PiM), Brussels, Belgium
- CIR Clinics in Revalidatie, Eindhoven, The Netherlands
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group (PiM), Brussels, Belgium
| | - Michel G C A M Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
- Pain in Motion International Research Group (PiM), Brussels, Belgium
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Liebano RE, Awad N, Bellino C, Bray K, Rosentrater H, Roy J, Tate C. The combined effect of transcutaneous electrical nerve stimulation and transcutaneous auricular vagus nerve stimulation on pressure and heat pain thresholds in pain-free subjects: a randomized cross-over trial. Trials 2024; 25:516. [PMID: 39085951 PMCID: PMC11290061 DOI: 10.1186/s13063-024-08352-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Transcutaneous electrical nerve stimulation (TENS) is a non-invasive modality that utilizes electrical currents to modulate pain in populations with acute and chronic pain. TENS has been demonstrated to produce hypoalgesic effects in postoperative pain, fibromyalgia, knee osteoarthritis, and healthy subjects. Transcutaneous auricular vagus nerve stimulation (TaVNS) is a non-invasive modality that modulates the vagus nerve by stimulating its auricular branches. The effects of the combination of TENS and TaVNS on producing an analgesic response have not been studied. Considering that TENS and TaVNS both stimulate similar analgesic pathways but through different means of activation, we can hypothesize that a combination of both methods can produce a more pronounced analgesic response. Therefore, the objective of this study is to assess the hypoalgesic effect of a combination of TENS and TaVNS in pain-free subjects. METHODS/DESIGN The study will be a simple crossover design conducted at the University of Hartford. Subjects will be recruited from the University of Hartford population via oral communication, digital flyers, and posters on campus. Thirty participants will undergo two sessions in a crossover manner with one week in between. During one session, the participants will receive TENS with active TaVNS and the other session will be a placebo procedure (TENS with placebo TaVNS). The order of these sessions will be randomized. Importantly, the pressure pain threshold (PPT) and heat pain threshold (HPT) assessors will be blinded to the treatment category. For active TaVNS, a frequency of 25 Hz will be applied with a pulse duration of 200 µs. For placebo TaVNS, the intensity will be increased to a sensory level and then decreased to 0 mA. High-frequency TENS of 100 Hz will be applied in both sessions, with a pulse duration of 200 µsec, asymmetrical biphasic square waveform, and intensity of maximal tolerance without pain. TENS and TaVNS will be turned on for 30 min after a baseline measurement of outcomes. TENS and TaVNS will then be turned off, but the electrodes will remain on until completion of post-treatment assessment. Pressure pain threshold, heat pain threshold, blood pressure, oxygen saturation, and heart rate will be tested 4 times: Once pre-intervention, once during intervention, once immediately after the intervention, and once 15 min post-intervention. Statistical analysis of the data obtained will consider a significance level of p < 0.05. DISCUSSION This study will provide evidence concerning the combined effects of TENS and TaVNS on pain threshold in pain-free participants. Based on the outcomes, a greater understanding of how TENS and TaVNS, when used in conjunction, can modulate pain pathways. TRIAL REGISTRATION ClinicalTrials.gov NCT06361381. Registered on 09 April 2024.
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Affiliation(s)
- Richard E Liebano
- Department of Rehabilitation Sciences, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT, 06117, USA.
| | - Noura Awad
- Department of Rehabilitation Sciences, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT, 06117, USA
| | - Christopher Bellino
- Department of Rehabilitation Sciences, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT, 06117, USA
| | - Katherine Bray
- Department of Rehabilitation Sciences, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT, 06117, USA
| | - Heidi Rosentrater
- Department of Rehabilitation Sciences, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT, 06117, USA
| | - Joshua Roy
- Department of Rehabilitation Sciences, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT, 06117, USA
| | - Camryn Tate
- Department of Rehabilitation Sciences, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT, 06117, USA
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Hestehave S, Allen HN, Gomez K, Duran P, Calderon-Rivera A, Loya-López S, Rodríguez-Palma EJ, Khanna R. Small molecule targeting NaV1.7 via inhibition of CRMP2-Ubc9 interaction reduces pain-related outcomes in a rodent osteoarthritic model. Pain 2024:00006396-990000000-00667. [PMID: 39106443 DOI: 10.1097/j.pain.0000000000003357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/30/2024] [Indexed: 08/09/2024]
Abstract
ABSTRACT Osteoarthritis (OA) is a highly prevalent and disabling joint disease, characterized by pathological progressive joint deformation and clinical symptoms of pain. Disease-modifying treatments remain unavailable, and pain-mitigation is often suboptimal, but recent studies suggest beneficial effects by inhibition of the voltage-gated sodium channel NaV1.7. We previously identified compound 194 as an indirect inhibitor of NaV1.7 by preventing SUMOylation of the NaV1.7-trafficking protein, collapsin response mediator protein 2. Compound 194 reduces the functional activity of NaV1.7 channels and produces effective analgesia in a variety of acute and neuropathic pain models. However, its effectiveness has not yet been evaluated in models of OA. Here, we explore the effects of 194 on pain-related outcomes in the OA-like monoiodoacetate model using behavioral assessment, biochemistry, novel in vivo fiber photometry, and patch clamp electrophysiology. We found that the monoiodoacetate model induced (1) increased pain-like behaviors and calcium responses of glutamatergic neurons in the parabrachial nucleus after evoked cold and mechanical stimuli, (2) conditioned place aversion to mechanical stimulation, (3) functional weight bearing asymmetry, (4) increased sodium currents in dorsal root ganglia neurons, and (5) increased calcitonin gene-related peptide-release in the spinal cord. Crucially, administration of 194 improved all these pain-related outcomes. Collectively, these findings support indirect inhibition of NaV1.7 as an effective treatment of OA-related pain through the inhibition of collapsin response mediator protein 2-SUMOylation via compound 194.
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Affiliation(s)
- Sara Hestehave
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, United States
- Pain Research Center, New York University, New York, NY, United States. Dr. Hestehave is now with the Department of Experimental Medicine, University of Copenhagen, Copenhagen N, Denmark. Dr. Allen, Dr. Gomez, Dr. Calderon-Rivera, Dr. Loya-López, Dr. Rodríguez-Palma, and Dr. Khanna are now with the Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Heather N Allen
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, United States
- Pain Research Center, New York University, New York, NY, United States. Dr. Hestehave is now with the Department of Experimental Medicine, University of Copenhagen, Copenhagen N, Denmark. Dr. Allen, Dr. Gomez, Dr. Calderon-Rivera, Dr. Loya-López, Dr. Rodríguez-Palma, and Dr. Khanna are now with the Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Kimberly Gomez
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, United States
- Pain Research Center, New York University, New York, NY, United States. Dr. Hestehave is now with the Department of Experimental Medicine, University of Copenhagen, Copenhagen N, Denmark. Dr. Allen, Dr. Gomez, Dr. Calderon-Rivera, Dr. Loya-López, Dr. Rodríguez-Palma, and Dr. Khanna are now with the Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Paz Duran
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, United States
- Pain Research Center, New York University, New York, NY, United States. Dr. Hestehave is now with the Department of Experimental Medicine, University of Copenhagen, Copenhagen N, Denmark. Dr. Allen, Dr. Gomez, Dr. Calderon-Rivera, Dr. Loya-López, Dr. Rodríguez-Palma, and Dr. Khanna are now with the Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Aida Calderon-Rivera
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, United States
- Pain Research Center, New York University, New York, NY, United States. Dr. Hestehave is now with the Department of Experimental Medicine, University of Copenhagen, Copenhagen N, Denmark. Dr. Allen, Dr. Gomez, Dr. Calderon-Rivera, Dr. Loya-López, Dr. Rodríguez-Palma, and Dr. Khanna are now with the Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Santiago Loya-López
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, United States
- Pain Research Center, New York University, New York, NY, United States. Dr. Hestehave is now with the Department of Experimental Medicine, University of Copenhagen, Copenhagen N, Denmark. Dr. Allen, Dr. Gomez, Dr. Calderon-Rivera, Dr. Loya-López, Dr. Rodríguez-Palma, and Dr. Khanna are now with the Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Erick J Rodríguez-Palma
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, United States
- Pain Research Center, New York University, New York, NY, United States. Dr. Hestehave is now with the Department of Experimental Medicine, University of Copenhagen, Copenhagen N, Denmark. Dr. Allen, Dr. Gomez, Dr. Calderon-Rivera, Dr. Loya-López, Dr. Rodríguez-Palma, and Dr. Khanna are now with the Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Rajesh Khanna
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, United States
- Pain Research Center, New York University, New York, NY, United States. Dr. Hestehave is now with the Department of Experimental Medicine, University of Copenhagen, Copenhagen N, Denmark. Dr. Allen, Dr. Gomez, Dr. Calderon-Rivera, Dr. Loya-López, Dr. Rodríguez-Palma, and Dr. Khanna are now with the Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL, United States
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Imai R, Tanaka S, Kubo T, Hida M, Nakao H, Imaoka M, Nishigami T. Differences in self-reported signs related to central sensitization and pressure pain threshold related to knee osteoarthritis and sarcopenia. Eur Geriatr Med 2024:10.1007/s41999-024-01018-6. [PMID: 39012448 DOI: 10.1007/s41999-024-01018-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/26/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE Neuroinflammation, which occurs in knee osteoarthritis and sarcopenia, has attracted attention as a mechanism of central sensitization, but the relationship between central sensitization and these conditions has not been widely studied. This study investigates differences in self-reported signs of central sensitization and pressure pain threshold in individuals with knee osteoarthritis and sarcopenia. METHODS We examined 340 patients (mean age ± standard deviation: 76 ± 5.9, women were 86.9%) with knee osteoarthritis scheduled to undergo total knee arthroplasty. For comparison, 129 community-dwelling older people (mean age ± standard deviation: 76 ± 5.5, women were 68.9%) individuals without a history of knee osteoarthritis or any other diagnosed illnesses were matched for age and sex. We assessed central sensitization inventory-9, pressure pain threshold, pain-related factors, skeletal muscle mass index, and hand grip strength. ANCOVA using 2 (patients with knee osteoarthritis and community older people without knee osteoarthritis) × 2 (sarcopenia and robust) was performed to assess outcome measurements. RESULTS The prevalence of sarcopenia among patients with knee osteoarthritis was 50.3%. ANCOVA revealed an interaction effect for the central sensitization inventory-9. For the main effect of knee osteoarthritis, there was a significant difference in central sensitization inventory-9, and for the main effect of sarcopenia, there was a significant difference in pressure pain threshold. CONCLUSIONS Discrepancies in the evaluation of central sensitization were identified between knee osteoarthritis and sarcopenia. Individuals with knee osteoarthritis had elevated score of self-reported indications of central sensitization, whereas sarcopenic patients had reduced pressure pain thresholds.
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Affiliation(s)
- Ryota Imai
- Graduate School of Rehabilitation, Osaka Kawasaki Rehabilitation University, 158 Mizuma, Kaizuka City, Osaka, 597-0104, Japan.
| | - So Tanaka
- Department of Clinical Research Center, Fukuoka Orthopaedic Hospital, 2-10-50 Yanagochi, Minami-ku, Fukuoka, Fukuoka, 815-0063, Japan
| | - Takanari Kubo
- Graduate School of Rehabilitation, Osaka Kawasaki Rehabilitation University, 158 Mizuma, Kaizuka City, Osaka, 597-0104, Japan
| | - Mitsumasa Hida
- Graduate School of Rehabilitation, Osaka Kawasaki Rehabilitation University, 158 Mizuma, Kaizuka City, Osaka, 597-0104, Japan
| | - Hidetoshi Nakao
- Department of Physical Therapy, Faculty of Social Work Studies, Josai International University, Togane City, Chiba, 283-0002, Japan
| | - Masakazu Imaoka
- Graduate School of Rehabilitation, Osaka Kawasaki Rehabilitation University, 158 Mizuma, Kaizuka City, Osaka, 597-0104, Japan
| | - Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, 1-1 Gakuen-cho, Mihara, Hiroshima, 723-0053, Japan
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Peral Pérez J, Mortensen SR, Lluch Girbés E, Grønne DT, Thorlund JB, Roos EM, Skou ST. Association between widespread pain and psychosocial factors in people with knee osteoarthritis: a cross-sectional study of patients from primary care in Denmark. Physiother Theory Pract 2024:1-11. [PMID: 38946473 DOI: 10.1080/09593985.2024.2372381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 06/20/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION The relationship between psychosocial factors and bodily pain in people with knee osteoarthritis (KOA) is unclear. PURPOSE To examine whether widespread pain was associated with poorer self-efficacy, more anxiety, depression, and kinesiophobia in people with KOA. METHODS This was a cross-sectional study based on data from Good Life with osteoArthritis in Denmark (GLA:D®). The association between widespread pain (multiple pain sites) and self-efficacy (Arthritis Self-Efficacy Scale), anxiety and depression (item from the EQ-5D-5 L), and kinesiophobia (yes/no) was examined using multiple linear tobit or logistic regression models. RESULTS Among 19,323 participants, 10% had no widespread pain, 37% had 2 pain sites, 26% had 3-4 pain sites, and 27% had ≥5 pain sites. Widespread pain was associated with poorer self-efficacy (-0.9 to -8.3 points), and the association was stronger with increasing number of pain sites (p-value <.001). Significant increasing odds ratios (ORs) were observed for having anxiety or depression with 3-4 pain sites (OR 1.29, 95% CI 1.12; 1.49) and ≥5 pain sites (OR 1.80, 95% CI 1.56; 2.07). Having 2 and 3-4 pain sites were associated with lower odds of kinesiophobia compared to having no widespread pain. CONCLUSION Widespread pain was associated with lower self-efficacy and more anxiety and depression but also lower kinesiophobia in people with KOA.
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Affiliation(s)
- Javier Peral Pérez
- Department of Physiotherapy, Cardenal Herrera University CEU, CEU Universities, Valencia, Spain
- Department of Physiotherapy, University of Alcala, Alcala, Spain
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Sofie Rath Mortensen
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Enrique Lluch Girbés
- Department of Physiotherapy, University of Valencia, Valencia, Spain
- Pain in Motion International Research Group, Brussels, Belgium
| | - Dorte T Grønne
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jonas B Thorlund
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ewa M Roos
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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9
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Irvine KA, Shi XY, Ferguson AR, Clark JD. Designer Receptor Exclusively Activated by Designer Drug (DREADD)-Mediated Activation of the Periaqueductal Gray Restores Nociceptive Descending Inhibition After Traumatic Brain Injury in Rats. J Neurotrauma 2024; 41:e1761-e1779. [PMID: 38588130 DOI: 10.1089/neu.2024.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Traumatic brain injury (TBI) patients frequently experience chronic pain that can enhance their suffering and significantly impair rehabilitative efforts. Clinical studies suggest that damage to the periaqueductal gray matter (PAG) following TBI, a principal center involved in endogenous pain control, may underlie the development of chronic pain. We hypothesized that TBI would diminish the usual pain control functions of the PAG, but that directly stimulating this center using a chemogenetic approach would restore descending pain modulation. We used a well-characterized lateral fluid percussion model (1.3 ± 0.1 atm) of TBI in male rats (n = 271) and measured hindpaw mechanical nociceptive withdrawal thresholds using von Frey filaments. To investigate the role of the PAG in pain both before and after TBI, we activated the neurons of the PAG using a Designer Receptor Exclusively Activated by Designer Drug (DREADD) viral construct. Immunohistochemical analysis of brain tissue was used to assess the location and confirm the appropriate expression of the viral constructs in the PAG. Activation of the PAG DREADD using clozapine N-oxide (CNO) caused hindpaw analgesia that could be blocked using opioid receptor antagonist, naloxone, in uninjured but not TBI rats. Due to the importance of descending serotonergic signaling in modulating nociception, we ablated spinal serotonin signaling using 5,7-DHT. This treatment strongly reduced CNO-mediated anti-nociceptive effects in TBI but not uninjured rats. To define the serotonergic receptor(s) required for the CNO-stimulated effects in TBI rats, we administered 5-HT7 (SB-269970) and 5-HT1A (WAY-100635) receptor antagonists but observed no effects. The selective 5-HT2A receptor antagonist ketanserin, however, blocked CNO's effects in the DREADD expressing TBI but not DREADD expressing sham TBI animals. Blockade of alpha-1 adrenergic receptors with prazosin also had no effect after TBI. Descending pain control originating in the PAG is mediated through opioid receptors in uninjured rats. TBI, however, fundamentally alters the descending nociceptive control circuitry such that serotonergic influences predominate, and those are mediated by the 5-HT2A receptor. These results provide further evidence that the PAG is a key target for anti-nociception after TBI.
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Affiliation(s)
- Karen-Amanda Irvine
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology Service Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Xiao-You Shi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology Service Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Adam R Ferguson
- Brain and Spinal Injury Center, Department of Neurosurgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA
| | - J David Clark
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology Service Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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10
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Lane CY, Thoma LM, Alvarez C, Givens DL, Nelson AE, Goode AP, Foucher KC, Golightly YM. Diminished vibration perception and greater pressure pain sensitivity are associated with worse knee osteoarthritis outcomes across sex and race. Osteoarthritis Cartilage 2024:S1063-4584(24)01258-5. [PMID: 38880428 DOI: 10.1016/j.joca.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 05/03/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To examine associations of vibration sensitivity and pressure pain sensitivity with knee osteoarthritis (OA) outcomes across sex and race, which may relate to known sex and race disparities in clinical outcomes. DESIGN Data were from the 2013-2015 visit of the Johnston County Osteoarthritis Project. Exposures were vibration perception threshold (VPT) measured at the bilateral medial femoral condyle (MFC) and first metatarsophalangeal joint (MTP), and pressure pain threshold (PPT) measured at the bilateral upper trapezius. Outcomes were knee pain severity and presence of knee symptoms, radiographic knee OA, and symptomatic knee OA in each knee. Cross-sectional associations of the exposures with the outcomes were examined using logistic regression models, overall and separately by sex and race. RESULTS In the VPT and PPT analyses, 851 and 862 participants (mean age 71 years, 68% female, 33% Black, body mass index 31 kg/m2) and 1585 and 1660 knees were included, respectively. Higher VPT (lower vibration sensitivity) at the MFC and first MTP joint was associated with all outcomes. Lower PPT (greater pressure pain sensitivity) was associated with greater knee pain severity. Associations of VPT and PPT with all outcomes were similar among females and males and Black and White individuals. CONCLUSIONS Diminished vibration perception and greater pressure pain sensitivity were cross-sectionally associated with worse knee OA outcomes. Despite differences in VPT and PPT among females and males and Black and White adults, associations with knee OA outcomes did not differ by sex or race, suggesting neurophysiological differences do not relate to established disparities.
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Affiliation(s)
- Chris Y Lane
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Louise M Thoma
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Deborah L Givens
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Adam P Goode
- Department of Orthopedic Surgery, Duke University, Durham, NC, United States.
| | - Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States.
| | - Yvonne M Golightly
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, United States.
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11
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Vigotsky AD, Cong O, Pinto CB, Barroso J, Perez J, Petersen KK, Arendt-Nielsen L, Hardt KD, Manning D, Apkarian AV, Branco P. Prognostic value of preoperative mechanical hyperalgesia and neuropathic pain qualities for postoperative pain after total knee replacement. Eur J Pain 2024. [PMID: 38850090 DOI: 10.1002/ejp.2295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/26/2024] [Accepted: 05/20/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Total knee replacement (TKR) is the gold standard treatment for end-stage chronic osteoarthritis pain, yet many patients report chronic postoperative pain after TKR. The search for preoperative predictors for chronic postoperative pain following TKR has been studied with inconsistent findings. METHODS This study investigates the predictive value of quantitative sensory testing (QST) and PainDETECT for postoperative pain 3, 6 and 12 months post-TKR. We assessed preoperative and postoperative (3 and 6 months) QST measures in 77 patients with knee OA (KOA) and 41 healthy controls, along with neuropathic pain scores in patients (PainDETECT). QST parameters included pressure pain pressure threshold (PPT), pain tolerance threshold (PTT), conditioned pain modulation (CPM) and temporal summation (TS) using cuff algometry, alongside mechanical hyperalgesia and temporal summation to repeated pinprick stimulation. RESULTS Compared to healthy controls, KOA patients at baseline demonstrated hyperalgesia to pinprick stimulation at the medial knee undergoing TKR, and cuff pressure at the calf. Lower cuff algometry PTT and mechanical pinprick hyperalgesia were associated with preoperative KOA pain intensity. Moreover, preoperative pinprick pain hyperalgesia explained 25% of variance in pain intensity 12 months post-TKR and preoperative neuropathic pain scores also captured 30% and 20% of the variance in postoperative pain at 6 and 12 months respectively. A decrease in mechanical pinprick hyperalgesia from before surgery to 3 months after TKR was associated with lower postoperative pain at the 12 months post-TKR follow-up. CONCLUSION Our findings suggest that preoperative pinprick hyperalgesia and neuropathic-like pain symptoms show predictive value for the development of chronic post-TKR pain. SIGNIFICANCE STATEMENT This study's findings hold significant implications for chronic pain management in knee osteoarthritis patients, particularly those undergoing total knee replacement surgery (TKR). Mechanical hyperalgesia and neuropathic pain-like characteristics predict postoperative pain 1 year after TKR, emphasizing the importance of understanding pain phenotypes in OA for selecting appropriate pain management strategies. The normalization of hyperalgesia after surgery correlates with better long-term outcomes, further highlighting the therapeutic potential of addressing abnormal pain processing mechanisms pre- and post-TKR.
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Affiliation(s)
- Andrew D Vigotsky
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering and Statistics, Northwestern University, Evanston, Illinois, USA
| | - Olivia Cong
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Camila B Pinto
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joana Barroso
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer Perez
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kristian Kjaer Petersen
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Material and Production, Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Faculty of Engineering and Science, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Material and Production, Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Faculty of Engineering and Science, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Kevin D Hardt
- Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Manning
- Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - A Vania Apkarian
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Paulo Branco
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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12
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McAuliffe M, Pillay T, Jaber K, Sterling M, O'Leary S. Pre-operative pain pressure threshold association with patient satisfaction following Total Knee Arthroplasty. J Orthop 2024; 52:21-27. [PMID: 38404700 PMCID: PMC10881419 DOI: 10.1016/j.jor.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
Background Total knee arthroplasty (TKA) is commonly performed for the treatment of knee osteoarthritis (KOA). Poor satisfaction continues to be seen after TKA. Whilst reasons for poor patient satisfaction are multifactorial, there is a strong correlation with persistent pain following TKA. Studies have shown an association between local and remote mechanical hypersensitivity, measured using pressure pain thresholds (PPTs), and severity of knee osteoarthritis and functional status. We aimed to determine if the pre-operative PPTs were associated with patient satisfaction following TKA. Methods A prospective longitudinal study of 77 individuals was undertaken. Regression modelling assessed the relationship between Patient Satisfaction using the Knee Society Score (satisfaction subscale) following TKA for KOA, and PPTs recorded pre-operatively locally and remote to the affected knee, while accounting for potentially confounding patient demographic and psychosocial factors. Results Lower PPTs (indicating increased mechanical hypersensitivity) locally and remote to the operative knee were modestly associated with lower patient satisfaction in the short-term (six weeks) following TKA (β 0.25-0.28, adjR2 = 0.14-0.15), independent of demographic or psychosocial influences. However, this relationship progressively diminished in the intermediate and long-term post TKA. Conclusion While pre-operative PPT measures may provide some foresight to patient satisfaction post TKA in the short term, these measures appear to provide little insight to patient satisfaction in the intermediate and longer term.
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Affiliation(s)
- Michael McAuliffe
- Ipswich General Hospital, Queensland Health, Ipswich, QLD, 4305, Australia
- The CJM Centre, Ipswich, QLD, 4305, Australia
- The Mater Private Hospital, Springfield Lakes, QLD, 4300, Australia
- St Andrew's Ipswich Private Hospital, Ipswich, QLD, 4305, Australia
| | - Tristan Pillay
- The CJM Centre, Ipswich, QLD, 4305, Australia
- The Mater Private Hospital, Springfield Lakes, QLD, 4300, Australia
- St Andrew's Ipswich Private Hospital, Ipswich, QLD, 4305, Australia
| | - Khalid Jaber
- Ipswich General Hospital, Queensland Health, Ipswich, QLD, 4305, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Qld, Herston, 4006, Australia
| | - Shaun O'Leary
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia
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13
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Sethi V, Anand C, Della Pasqua O. Clinical Assessment of Osteoarthritis Pain: Contemporary Scenario, Challenges, and Future Perspectives. Pain Ther 2024; 13:391-408. [PMID: 38662319 PMCID: PMC11111648 DOI: 10.1007/s40122-024-00592-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/06/2024] [Indexed: 04/26/2024] Open
Abstract
The multifaceted nature of osteoarthritis (OA) pain presents a challenge in understanding and managing the condition. The diverse pain experiences, progression rates, individual responses to treatments, and complex disease mechanisms contribute to heterogeneity in the clinical studies outcomes. The lack of a standardized methodology for assessing and classifying OA pain challenges healthcare practitioners. This complicates the establishment of universally applicable protocols or standardized guidelines for treatment. This article explores the heterogeneity observed in clinical studies evaluating OA pain treatments, highlighting the necessity for refined methodologies, personalized patient categorization, and consistent outcome measures. It discusses the role of the multidimensional nature of OA pain, underlying pain mechanisms, and other contributing factors to the heterogeneity in outcome measures. Addressing these variations is crucial to establishing a more consistent framework for evidence-based treatments and advancing care of the patient with OA pain.
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Affiliation(s)
- Vidhu Sethi
- Haleon (Formerly GSK Consumer Healthcare), GSK Asia House, Rochester Park, Singapore, 139234, Singapore.
| | - Chetan Anand
- Advanced Pain Management Centre, Hackettstown, NJ, USA
| | - Oscar Della Pasqua
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Brentford, UK
- Clinical Pharmacology and Therapeutics Group, University College London, BMA House, Tavistock Square, London, UK
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14
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Huisman D, Mansfield M, Cummins TM, Moss-Morris R, McMahon SB, Bannister K. Gastrointestinal pain: A systematic review of temporal summation of pain paradigms and outcomes. Eur J Pain 2024. [PMID: 38817207 DOI: 10.1002/ejp.2283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 03/31/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Since targeted treatment for gastrointestinal pain is elusive, identifying the mechanistic underpinning of this pain type is important. Facilitation of spinal neuronal responses underpins certain pain types, and the psychophysical temporal summation of pain (TSP) paradigm provides a proxy measure of spinal facilitatory processes. Our aim was to systematically review whether facilitated TSP is a feature of gastrointestinal pain in patients with, or pain-free people experiencing experimentally induced, gastrointestinal pain. DATABASES AND DATA TREATMENT EMBASE, MEDLINE, PsychInfo, CINAHL, and Web of Science were systematically searched, from inception to July 2023, for human studies reporting TSP paradigm outcomes in the context of gastrointestinal pain. The Appraisal tool for Cross-Sectional studies was used for quality assessment and applied independently by two researchers. RESULTS Fifteen papers consisting of cross-sectional (n = 6), case-control (n = 8), and retrospective cohort (n = 1) studies, were included. Thirteen studies investigated TSP in people with gastrointestinal pain with (n = 5) or without (n = 8) defined pathology. Two studies evoked TSP by repetitive gut stimulation in people undergoing abdominal medical procedures. Preliminary evidence showed that facilitated TSP correlated with the presence of functional gastrointestinal pain in women, and those with a history of trauma. No effect was observed in people with inflammatory bowel disease, although it was often unclear if they experienced pain. CONCLUSIONS It is not possible to conclude whether facilitated TSP is a feature of gastrointestinal pain. We recommend that subgroup findings are corroborated and that TSP paradigms are standardized in order that direct comparisons between studies may be made. SIGNIFICANCE STATEMENT Evidence indicated that pain facilitatory processes, as evidenced by a facilitated TSP outcome, contribute to functional gastrointestinal pain in women and those with a history of trauma. However, heterogeneity of study populations and paradigms precluded statistical synthesis and findings would need be corroborated. Studies exploring facilitatory processes in people with inflammatory bowel diseases did not report significant results, but pain is not a given in these conditions and, conversely, may be driven by peripheral inflammation during active disease. This should be taken in consideration in future explorations. REGISTRATION REVIEW PROSPERO CRD42022341845.
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Affiliation(s)
- Danielle Huisman
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael Mansfield
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Tatum M Cummins
- Neurorestoration Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephen B McMahon
- Neurorestoration Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kirsty Bannister
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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15
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Dalla Fontana M, Anesi S, Czopowicz M, Corr SA. Assessment of potential maladaptive pain in dogs with elbow osteoarthritis using a von Frey aesthesiometer. Vet Rec 2024; 194:e4043. [PMID: 38575548 DOI: 10.1002/vetr.4043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/11/2023] [Accepted: 02/15/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND This study aimed to investigate the possible presence of maladaptive pain in the thoracic limbs of dogs with elbow osteoarthritis (OA) using an electronic von Frey aesthesiometer (eVFA). METHODS Twenty-eight client- and staff-owned dogs (OA, n = 14; controls, n = 14) were enrolled in the study. Every dog underwent a full orthopaedic examination, and then five von Frey measurements were obtained from each carpal pad of each dog. A maximum test threshold of 400 g was set and approved by an ethics committee. RESULTS eVFA thresholds were significantly lower (p < 0.001) in dogs with OA (median 248 g, range 128-369 g) than in control dogs (median 390 g, range 371-400 g). In the OA group, the sensory threshold was significantly lower (p = 0.048) in the more severely affected limb than the less severely affected limb. LIMITATION The low maximum threshold required for ethical approval may influence the variability in the control group. CONCLUSIONS Dogs with elbow OA had significantly lower sensory thresholds than control dogs, which is compatible with the presence of maladaptive pain, potentially due to central sensitisation. Further research is required to evaluate the potential use of the eVFA for monitoring clinical progression and treatment response in dogs with elbow OA.
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Affiliation(s)
- Maria Dalla Fontana
- Small Animal Hospital, School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Scotland, UK
- Blaise Veterinary Referral, Birmingham, UK
| | - Simone Anesi
- Small Animal Hospital, School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Scotland, UK
- Willows Veterinary Centre and Referral Service, Solihull, UK
| | - Michal Czopowicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Sandra A Corr
- Small Animal Hospital, School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Scotland, UK
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16
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Gisler J, Chiavaccini L, Blum S, Montavon S, Spadavecchia C. Pressure pain mapping of equine distal joints: feasibility and reliability. FRONTIERS IN PAIN RESEARCH 2024; 5:1342954. [PMID: 38726353 PMCID: PMC11079115 DOI: 10.3389/fpain.2024.1342954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
Background Osteoarthritis is a prevalent degenerative joint disease initiating chronic pain and lameness in horses. While several objective gait analysis systems have been developed and validated to quantify lameness severity in horses, methods to evaluate whether peripheral sensitization contributes to the pain experienced are missing. Objectives To evaluate whether periarticular pressure pain mapping could be proposed as an auxiliary assessment tool in horses. Specific aims were to evaluate the feasibility and intra- and inter-rater reliability of pressure pain thresholds (PPT) determination at sites overlying the distal thoracic limb joints of clinically healthy horses. Study design Prospective, randomized validation study. Methods For feasibility assessment, PPT were measured with a hand-held digital algometer at six periarticular landmarks (2 sites per joint, 3 joints) bilaterally on the distal thoracic limb of 40 healthy horses (20 warmblood and 20 Freiberger). The joints tested were the metacarpophalangeal, on the latero-palmar and dorsal aspects (L-MCP and D-MCP), the proximal interphalangeal, on the dorsal and palmar aspect (D-PIP and P-PIP) and the distal interphalangeal, on the dorsal and lateral aspect (D-DIP and L-DIP). A feasibility score, ranging from 0 to 5, was attributed to each testing session. For intra- and inter-rater reliability assessment, L-MCP and D-MCP were selected to be tested again at 2 weeks intervals in 20 out of the 40 horses. Data were analyzed using a mixed-effect linear model to test differences in threshold per site and limb. Intra- and inter-rater correlation was calculated. Bland-Altman plots were performed to evaluate the variability of the measures. Results The procedure was considered feasible (score <2) in 95% of horses (95% CI 88%-100%). Overall, median [interquartile range (IQR)] PPT was 9.4 (7.5-11.3) N. No significant side differences were found. P-PIP and D-DIP recorded significantly lower PPT (p < 0.001 and p = 0.002, respectively) than L-MCP. Median (IQR) were 9.9 (7.3-12.4) N, 8.4 (6.1-10.5) N and 9.0 (7.4-10.6) N for L-MCP, P-PIP and D-DIP, respectively. The intra-rater agreement was 0.68 (95% CI 0.35-0.86) for L-MCP, and 0.50 (95% CI 0.08-0.76) for D-MCP. Inter-rater agreement was 0.85 (95% CI 0.66-0.94) for L-MCP and 0.81 (0.57, 0.92) for D-MCP. Main limitations Evaluation of feasibility was performed only for distal thoracic limbs joints; no data are provided for hind limbs or proximal joints. Only warmblood and Freiberger horses were included. Intra- and inter-rater reliability assessments were performed exclusively on data collected at the MCP joint. Conclusion Pressure pain mapping of distal thoracic limb joints was feasible in horses. Local sensitivity differed among sites and no side differences were noticed. Data collected from the MCP joint suggest highly variable, subject dependent intra-rater reliability, ranging from poor to good, and good to excellent inter-rater reliability. Further studies evaluating pathologic vs. healthy joints are needed before recommendations can be made about clinical usability and diagnostic validity.
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Affiliation(s)
- Jana Gisler
- Department of Clinical Veterinary Medicine, Anaesthesiology and Pain Therapy Section, Vetsuisse Faculty, University of Bern, Bern, Switzerland
- Veterinary Department of the SwissArmed Forces, Bern, Switzerland
| | - Ludovica Chiavaccini
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Severin Blum
- Department of Clinical Veterinary Medicine, Anaesthesiology and Pain Therapy Section, Vetsuisse Faculty, University of Bern, Bern, Switzerland
- Veterinary Department of the SwissArmed Forces, Bern, Switzerland
| | | | - Claudia Spadavecchia
- Department of Clinical Veterinary Medicine, Anaesthesiology and Pain Therapy Section, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Li B, Yang Z, Li Y, Zhang J, Li C, Lv N. Exploration beyond osteoarthritis: the association and mechanism of its related comorbidities. Front Endocrinol (Lausanne) 2024; 15:1352671. [PMID: 38779455 PMCID: PMC11110169 DOI: 10.3389/fendo.2024.1352671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/12/2024] [Indexed: 05/25/2024] Open
Abstract
Osteoarthritis is the most prevalent age-related degenerative joint disease and a leading cause of pain and disability in aged people. Its etiology is multifaceted, involving factors such as biomechanics, pro-inflammatory mediators, genetics, and metabolism. Beyond its evident impact on joint functionality and the erosion of patients' quality of life, OA exhibits symbiotic relationships with various systemic diseases, giving rise to various complications. This review reveals OA's extensive impact, encompassing osteoporosis, sarcopenia, cardiovascular diseases, diabetes mellitus, neurological disorders, mental health, and even cancer. Shared inflammatory processes, genetic factors, and lifestyle elements link OA to these systemic conditions. Consequently, recognizing these connections and addressing them offers opportunities to enhance patient care and reduce the burden of associated diseases, emphasizing the need for a holistic approach to managing OA and its complications.
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Affiliation(s)
| | | | | | | | | | - Naishan Lv
- The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine (Shandong Hospital of integrated traditional Chinese and Western medicine), Jinan, China
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18
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Cheng S, Zeng F, Zhou J, Dong X, Yang W, Yin T, Huang K, Liang F, Li Z. Altered static and dynamic functional brain network in knee osteoarthritis: A resting-state functional magnetic resonance imaging study: Static and dynamic FNC in KOA. Neuroimage 2024; 292:120599. [PMID: 38608799 DOI: 10.1016/j.neuroimage.2024.120599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 03/26/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
This study aimed to investigate altered static and dynamic functional network connectivity (FNC) and its correlation with clinical symptoms in patients with knee osteoarthritis (KOA). One hundred and fifty-nine patients with KOA and 73 age- and gender-matched healthy subjects (HS) underwent resting-state functional magnetic resonance imaging (rs-fMRI) and clinical evaluations. Group independent component analysis (GICA) was applied, and seven resting-state networks were identified. Patients with KOA had decreased static FNC within the default mode network (DM), visual network (VS), and cerebellar network (CB) and increased static FNC between the subcortical network (SC) and VS (p < 0.05, FDR corrected). Four reoccurring FNC states were identified using k-means clustering analysis. Although abnormalities in dynamic FNCs of KOA patients have been found using the common window size (22 TR, 44 s), but the results of the clustering analysis were inconsistent when using different window sizes, suggesting dynamic FNCs might be an unstable method to compare brain function between KOA patients and HS. These recent findings illustrate that patients with KOA have a wide range of abnormalities in the static and dynamic FNCs, which provided a reference for the identification of potential central nervous therapeutic targets for KOA treatment and might shed light on the other musculoskeletal pain neuroimaging studies.
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Affiliation(s)
- Shirui Cheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Key Laboratory of Acupuncture for Senile Disease (Chengdu University of TCM), Ministry of Education, Chengdu 611137, China
| | - Fang Zeng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Key Laboratory of Acupuncture for Senile Disease (Chengdu University of TCM), Ministry of Education, Chengdu 611137, China
| | - Jun Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Xiaohui Dong
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Weihua Yang
- Dali Bai Autonomous Prefecture Chinese Medicine Hospital, Dali 671000, China
| | - Tao Yin
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Key Laboratory of Acupuncture for Senile Disease (Chengdu University of TCM), Ministry of Education, Chengdu 611137, China
| | - Kama Huang
- College of Electronics and Information Engineering, Sichuan University, Chengdu 610064, China
| | - Fanrong Liang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Key Laboratory of Acupuncture for Senile Disease (Chengdu University of TCM), Ministry of Education, Chengdu 611137, China.
| | - Zhengjie Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Key Laboratory of Acupuncture for Senile Disease (Chengdu University of TCM), Ministry of Education, Chengdu 611137, China.
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19
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Liebano RE, Sluka KA, Roy J, Savinelli M, Dailey DL, Riley SP. Effects of transcutaneous electrical nerve stimulation on pain, function, and descending inhibition in people with non-specific chronic low-back pain: a study protocol for a randomized crossover trial. Trials 2024; 25:242. [PMID: 38582874 PMCID: PMC10998305 DOI: 10.1186/s13063-024-08089-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 04/02/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is a significant public health problem, is very prevalent, and is often characterized by the persistence of symptoms. Transcutaneous electrical nerve stimulation (TENS) may benefit people with chronic LBP because it can activate descending inhibitory pathways and inhibit central excitability. However, previous studies that have investigated the effects of TENS on pain in people with LBP have failed to use proper intensities of current, and the timing of the assessment of pain was not performed during the peak of the analgesic response or functional activities. Therefore, the present study aims to assess the effects of TENS on measures of pain, function, and descending inhibition using the maximal tolerable intensity of TENS in participants with LBP. METHODS/DESIGN This study will be a randomized crossover trial. The participants for this study will be recruited from various places, including the University of Hartford, physical therapy clinics, and local businesses in the Hartford area, as well as online websites geared towards clinical trial recruitment. A total of 34 participants will receive all three treatments: active TENS, placebo TENS, and no treatment control. The treatment order will be randomized using a website-based randomization tool. For active TENS, a modulating frequency of 2-125 Hz will be applied with a variable pulse duration and maximal tolerable intensity for 30 min. The TENS will be left on for post-treatment testing to assess the effects during its maximally effective period for a total of 50 to 60 min. Furthermore, the intensity may be turned down if muscle twitching is present to ensure blinding of the evaluator. For placebo TENS, the unit will deliver current for 45 s, ramping to 0 in the last 15 s. The primary outcome will be pain intensity at rest and with movement, determined using the numerical pain rating scale. The secondary outcomes will be pressure pain threshold, heat pain threshold, temporal summation of pain, conditioned pain modulation, sit-to-stand test, and repeated trunk flexion. The assessments will be performed immediately before and after treatment. Statistical analysis of the data obtained will consider a significance level of p < 0.05. DISCUSSION This study will provide evidence concerning the effects and mechanisms of TENS treatment in participants with chronic non-specific low back pain. The outcomes, including pain, function, and descending inhibition, will help us gain a greater understanding of how TENS can be used for these participants. TRIAL REGISTRATION ClinicalTrials.gov NCT05812885. Registered on 24th May 2023.
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Affiliation(s)
- Richard E Liebano
- Department of Rehabilitation Sciences, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT 06117, USA.
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, 1-242 MEB, University of Iowa, Iowa City, IA 52242, USA
| | - Joshua Roy
- Department of Rehabilitation Sciences, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT 06117, USA
| | - Meghan Savinelli
- Department of Rehabilitation Sciences, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT 06117, USA
| | - Dana L Dailey
- Department of Physical Therapy and Rehabilitation Science, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Physical Therapy, St. Ambrose University, Davenport, IA 52803, USA
| | - Sean P Riley
- Hartford Healthcare Rehabilitation Network, 330 Western Blvd #101, Glastonbury, CT, 06033, USA
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20
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Monteiro BP, Otis C, Nitulescu R, Troncy E. Quantitative sensory testing in canine musculoskeletal pain: Findings from a systematic review, meta-analysis feasibility assessment, and limitations. Vet J 2024; 304:106102. [PMID: 38492631 DOI: 10.1016/j.tvjl.2024.106102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
Quantitative sensory testing (QST) allows the study of pain mechanisms, patient phenotyping, and response to therapy. The goals of this study were to conduct a systematic review of the use of QST in dogs with musculoskeletal disease including osteoarthritis (OA), and to assess, by means of a meta-analysis, the ability of QST to differentiate affected dogs from healthy controls. The study protocol was registered; three bibliographic databases were screened. Studies involving QST in healthy dogs and those with musculoskeletal disease were included. Data were extracted using a standardized form. Assessment of quality and risk of bias were performed using the CAMARADES critical assessment tool. Twenty-nine articles met the inclusion criteria [systematic review (n = 11); meta-analysis (n = 28)]. In the systematic review, ten studies performed static QST: mechanical [punctate tactile (n = 6); mechanical pressure (n = 5)]; thermal [cold (n = 3); hot (n = 4)]; electrical (n = 1); and one study performed dynamic QST [conditioned pain modulation (n = 1)]. Most studies were of good scientific quality and showed low to moderate risk of bias. A meta-analysis was not possible due to numerous and severe issues of heterogeneity of data among studies. Methods to reduce risk of bias and use of reporting guidelines are some of the most needed improvements in QST research in dogs. Standardization of QST methodology is urgently needed in future studies to allow for data synthesis and a clear understanding of the sensory phenotype of dogs with and without chronic pain including OA.
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Affiliation(s)
- B P Monteiro
- Research Group in Animal Pharmacology of Quebec (GREPAQ), Université de Montréal, Saint-Hyacinthe, Québec J2S 2M2, Canada
| | - C Otis
- Research Group in Animal Pharmacology of Quebec (GREPAQ), Université de Montréal, Saint-Hyacinthe, Québec J2S 2M2, Canada
| | - R Nitulescu
- University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec H2X 0A9, Canada; Centre d'intégration et d'analyse des données médicales (CITADEL) du Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec H2X 0A9, Canada
| | - E Troncy
- Research Group in Animal Pharmacology of Quebec (GREPAQ), Université de Montréal, Saint-Hyacinthe, Québec J2S 2M2, Canada; University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec H2X 0A9, Canada.
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21
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Amodeo G, Magni G, Galimberti G, Riboldi B, Franchi S, Sacerdote P, Ceruti S. Neuroinflammation in osteoarthritis: From pain to mood disorders. Biochem Pharmacol 2024:116182. [PMID: 38556026 DOI: 10.1016/j.bcp.2024.116182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/19/2024] [Accepted: 03/28/2024] [Indexed: 04/02/2024]
Abstract
Osteoarthritis (OA) is the most common form of musculoskeletal disease, and its prevalence is increasing due to the aging of the population. Chronic pain is the most burdensome symptom of OA that significantly lowers patients' quality of life, also due to its frequent association with emotional comorbidities, such as anxiety and depression. In recent years, both chronic pain and mood alterations have been linked to the development of neuroinflammation in the peripheral nervous system, spinal cord and supraspinal brain areas. Thus, mechanisms at the basis of the development of the neuroinflammatory process may indicate promising targets for novel treatment for pain and affective comorbidities that accompany OA. In order to assess the key role of neuroinflammation in the maintenance of chronic pain and its potential involvement in development of psychiatric components, the monoiodoacetate (MIA) model of OA in rodents has been used and validated. In the present commentary article, we aim to summarize up-to-date results achieved in this experimental model of OA, focusing on glia activation and cytokine production in the sciatic nerve, dorsal root ganglia (DRGs), spinal cord and brain areas. The association of a neuroinflammatory state with the development of pain and anxiety- and depression-like behaviors are discussed. Results suggest that cells and molecules involved in neuroinflammation may represent novel targets for innovative pharmacological treatments of OA pain and mood comorbidities.
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Affiliation(s)
- Giada Amodeo
- Laboratory of Pain Therapy and Neuroimmunology, Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via Balzaretti, 9 -20133 Milan (IT), Italy
| | - Giulia Magni
- Laboratory of Pain Therapy and Neuroimmunology, Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via Balzaretti, 9 -20133 Milan (IT), Italy
| | - Giulia Galimberti
- Laboratory of Pain Therapy and Neuroimmunology, Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via Balzaretti, 9 -20133 Milan (IT), Italy
| | - Benedetta Riboldi
- Laboratory of Pain Therapy and Neuroimmunology, Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via Balzaretti, 9 -20133 Milan (IT), Italy
| | - Silvia Franchi
- Laboratory of Pain Therapy and Neuroimmunology, Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via Balzaretti, 9 -20133 Milan (IT), Italy
| | - Paola Sacerdote
- Laboratory of Pain Therapy and Neuroimmunology, Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via Balzaretti, 9 -20133 Milan (IT), Italy
| | - Stefania Ceruti
- Laboratory of Pain Therapy and Neuroimmunology, Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via Balzaretti, 9 -20133 Milan (IT), Italy.
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22
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Smith M, Murrell JC, Mendl M. Spatial working memory in a disappearing object task is impaired in female but not male dogs with chronic osteoarthritis. Anim Cogn 2024; 27:13. [PMID: 38429533 PMCID: PMC10907419 DOI: 10.1007/s10071-024-01845-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/31/2023] [Accepted: 11/18/2023] [Indexed: 03/03/2024]
Abstract
Chronic pain in humans is associated with impaired working memory but it is not known whether this is the case in long-lived companion animals, such as dogs, who are especially vulnerable to developing age-related chronic pain conditions. Pain-related impairment of cognitive function could have detrimental effects on an animal's ability to engage with its owners and environment or to respond to training or novel situations, which may in turn affect its quality of life. This study compared the performance of 20 dogs with chronic pain from osteoarthritis and 21 healthy control dogs in a disappearing object task of spatial working memory. Female neutered osteoarthritic dogs, but not male neutered osteoarthritic dogs, were found to have lower predicted probabilities of successfully performing the task compared to control dogs of the same sex. In addition, as memory retention interval in the task increased, osteoarthritic dogs showed a steeper decline in working memory performance than control dogs. This suggests that the effects of osteoarthritis, and potentially other pain-related conditions, on cognitive function are more clearly revealed in tasks that present a greater cognitive load. Our finding that chronic pain from osteoarthritis may be associated with impaired working memory in dogs parallels results from studies of human chronic pain disorders. That female dogs may be particularly prone to these effects warrants further investigation.
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Affiliation(s)
- Melissa Smith
- Bristol Veterinary School, University of Bristol, Langford House, Langford, BS40 5DU, UK
| | - Joanna C Murrell
- Bristol Veterinary School, University of Bristol, Langford House, Langford, BS40 5DU, UK
- Highcroft Veterinary Referrals, 615 Wells Rd, Whitchurch, Bristol, BS14 9BE, UK
| | - Michael Mendl
- Bristol Veterinary School, University of Bristol, Langford House, Langford, BS40 5DU, UK.
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23
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Malek N, Mlost J, Kostrzewa M, Rajca J, Starowicz K. Description of Novel Molecular Factors in Lumbar DRGs and Spinal Cord Factors Underlying Development of Neuropathic Pain Component in the Animal Model of Osteoarthritis. Mol Neurobiol 2024; 61:1580-1592. [PMID: 37731080 PMCID: PMC10896862 DOI: 10.1007/s12035-023-03619-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023]
Abstract
Osteoarthritis (OA) is one of the most common joint disorder, with pain accompanied by functional impairment, as the most pronounced clinical symptom. Currently used pharmacotherapy involves symptomatic treatment that do not always provide adequate pain relief. This may be due to concomitance of central sensitization and development of neuropathic features in OA patients. Here we performed studies in the animal model of OA to investigate of the neuropathic component. Intraarticular injection of monoiodoacetate (MIA, 1 mg) was used to induce OA in Wistar male rats. Development of pain phenotype was assessed by behavioral testing (PAM test and von Frey's test), while corresponding changes in dorsal root ganglia (DRGs L3-L5) and spinal cord (SC) gene expression were assessed by means of qRT-PCR technique. We also performed microtomography of OA-affected knee joints to correlate the level of bone degradation with observed behavioral and molecular changes. We observed gradually developing remote allodynia after MIA treatment, indicating the presence of neuropathic component. Our results showed that, among DRGs innervating knee joint, development of central sensitization is most likely due to peripheral input of stimuli through DRG L5. In SC, development of secondary hypersensitivity correlated with increased expression of TAC1 and NPY. Our studies provided molecular records on abnormal activation of pain transmission markers in DRG and SC during development of OA that are responsible for the manifestation of neuropathic features. The obtained results increase insight into molecular changes occurring in the neuronal tissue during OA development and may contribute to readdressing treatment paradigms.
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Affiliation(s)
- Natalia Malek
- Department of Neurochemistry, Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland.
- Department of Chemical Biology and Bioimaging, Faculty of Chemistry, Wroclaw University of Science and Technology, Wroclaw, Poland.
| | - Jakub Mlost
- Department of Neurochemistry, Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland
| | - Magdalena Kostrzewa
- Department of Neurochemistry, Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland
| | - Jolanta Rajca
- Galen Orthopaedics, Bierun, Poland
- Galen Lab, Bierun, Poland
| | - Katarzyna Starowicz
- Department of Neurochemistry, Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland
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24
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Di Antonio S, Arendt-Nielsen L, Ponzano M, Bovis F, Torelli P, Elisa P, Finocchi C, Castaldo M. Profiling migraine patients according to clinical and psychophysical characteristics: clinical validity of distinct migraine clusters. Neurol Sci 2024; 45:1185-1200. [PMID: 37833507 PMCID: PMC10858147 DOI: 10.1007/s10072-023-07118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023]
Abstract
AIMS Investigate if different clinical and psychophysical bedside tools can differentiate between district migraine phenotypes in ictal/perictal (cohort 1) and interictal (cohort 2) phases. METHOD This observational study included two independent samples in which patients were subgrouped into distinct clusters using standardized bedside assessment tools (headache frequency, disability, cervical active range of motion, pressure pain threshold in different areas): (A) cohort 1-ictal/perictal migraine patients were subgrouped, based on previous studies, into two clusters, i.e., Cluster-1.1 No Psychophysical Impairments (NPI) and Cluster-1.2 Increased Pain Sensitivity and Cervical Musculoskeletal Dysfunction (IPS-CMD); (B) cohort 2-interictal migraine patients were subgrouped into three clusters, i.e., Cluster-2.1 NPI, Cluster-2.2 IPS, and Cluster-2.3 IPS-CMD. Clinical characteristics (multiple questionnaires), somatosensory function (comprehensive quantitative sensory testing (QST)), and cervical musculoskeletal impairments (cervical musculoskeletal assessment) were assessed and compared across headache clusters and a group of 56 healthy controls matched for sex and age. RESULTS Cohort 1: A total of 156 subjects were included. Cluster-1.2 (IPS-CMD) had higher headache intensity (p = 0.048), worse headache-related (p = 0.003) and neck-related disability (p = 0.005), worse quality of life (p = 0.003), and higher symptoms related to sensitization (p = 0.001) and psychological burden (p = 0.005) vs. Cluster-1.1(NPI). Furthermore, Cluster-1.2 (IPS-CMD) had (1) reduced cervical active and passive range of motion (p < 0.023), reduced functionality of deep cervical flexors (p < 0.001), and reduced values in all QST(p < 0.001) vs. controls, and (2) reduced active mobility in flexion, left/right lateral flexion (p < 0.045), and reduced values in QST (p < 0.001) vs. Cluster-1.1 (NPI). Cohort 2: A total of 154 subjects were included. Cluster-2.3 (IPS-CMD) had (1) longer disease duration (p = 0.006), higher headache frequency (p = 0.006), disability (p < 0.001), and psychological burden (p = 0.027) vs. Cluster-2.2 (IPS) and (2) higher headache-related disability (p = 0.010), neck-related disability (p = 0.009), and higher symptoms of sensitization (p = 0.018) vs. Cluster-2.1 (NPI). Cluster-2.3(IPS-CMD) had reduced cervical active and passive range of motion (p < 0.034), and reduced functionality of deep cervical flexors (p < 0.001), vs. controls, Custer-2.1 (NPI), and Cluster-2.2 (IPS). Cluster-2.2 (IPS) and 2.3 (IPS-CMD) had reduced QST values vs. controls (p < 0.001) and Cluster-2.1 (p < 0.039). CONCLUSION A battery of patient-related outcome measures (PROMs) and quantitative bedside tools can separate migraine clusters with different clinical characteristics, somatosensory functions, and cervical musculoskeletal impairments. This confirms the existence of distinct migraine phenotypes and emphasizes the importance of migraine phases of which the characteristics are assessed. This may have implications for responders and non-responders to anti-migraine medications.
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Affiliation(s)
- Stefano Di Antonio
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), School of Medicine, SMI, Aalborg University, Aalborg, Denmark
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, Genoa, Italy
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), School of Medicine, SMI, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology & Hepatology, Mech-Sense, Clinical Institute, Aalborg University Hospital, 9000, Aalborg, Denmark
- Clinical Institute, Steno Diabetes Center North Denmark, Aalborg University Hospital, 9000, Aalborg, Denmark
| | - Marta Ponzano
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Francesca Bovis
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Paola Torelli
- Headache Centre, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Pelosin Elisa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, Genoa, Italy
- IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Matteo Castaldo
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), School of Medicine, SMI, Aalborg University, Aalborg, Denmark.
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25
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Larsen JB, Madeleine P, Sørensen LB, Sachau J, Otto JC, Baron R, Arendt-Nielsen L. Subgrouping of facilitatory or inhibitory conditioned pain modulation responses in patients with chronic knee pain. Explorative analysis from a multicentre trial. Eur J Pain 2024; 28:335-351. [PMID: 37746845 DOI: 10.1002/ejp.2185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 07/07/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Facilitatory and inhibitory conditioned pain modulation (CPM) responses are observed in healthy volunteers and chronic pain patients, but the clinical implications for phenotyping are unknown. This study aimed to subgroup and compare chronic knee pain patients according to their CPM responses. METHODS This explorative, cross-sectional study included 127 patients with chronic knee pain (osteoarthritis or following total knee arthroplasty). Individual CPM responses were categorized as facilitatory (test stimuli pain intensity increased when conditioning stimuli were applied), as inhibitory (test stimuli pain intensity decreased) or as no change (defined as less than 5.3% change in pain intensity). Outcomes were clinical pain intensities, temporal summation, widespread pain, self-reported physical function, PainDETECT questionnaire and Pain Quality Assessment Scale. Data were analysed as comparisons between the inhibitory and the facilitatory groups and using multivariate linear regression models. RESULTS Fifty-four patients had facilitatory CPM responses, 49 had inhibitory CPM responses, and 24 showed no change in CPM response. A between-group difference was observed for self-reported physical function, with the facilitatory CPM group reporting better function (54.4 vs. 46.0, p = 0.028) and the facilitatory CPM group reported more deep pain sensations (3.2 vs. 2.0, p = 0.021). The remaining outcomes showed no between-group differences. Higher clinical pain intensity and facilitated temporal summation were associated in the facilitated CPM group but not in the inhibitory CPM group. CONCLUSION These explorative findings indicated that quantitative clinical and experimental differences exist between facilitatory or inhibitory CPM responses in a chronic knee pain patient population. Differences in patients' CPM responses should be further investigated to unravel possible clinical importance. SIGNIFICANCE Our findings confirm that conditioned pain modulation consist of inhibitory and facilitatory responders among a patient population with chronic knee pain. This explorative study indicates that patients with either facilitatory or inhibitory conditioned pain modulation could exhibit differences in pain outcomes. Subgrouping of chronic pain patients depending on individual conditioned pain modulation responses could be considered in phenotyping patients prior to inclusion in clinical trials or used for personalizing the management regime.
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Affiliation(s)
- J B Larsen
- Musculoskeltal Health and Implementation, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - P Madeleine
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - L B Sørensen
- Musculoskeltal Health and Implementation, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - J Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - J C Otto
- Ameos Clinic Eutin, Eutin, Germany
| | - R Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - L Arendt-Nielsen
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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26
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Liu ZF, Zhang Y, Liu J, Wang YY, Chen M, Liu EY, Guo JM, Wang YH, Weng ZW, Liu CX, Yu CH, Wang XY. Effect of Traditional Chinese Non-Pharmacological Therapies on Knee Osteoarthritis: A Narrative Review of Clinical Application and Mechanism. Orthop Res Rev 2024; 16:21-33. [PMID: 38292459 PMCID: PMC10826518 DOI: 10.2147/orr.s442025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024] Open
Abstract
Knee osteoarthritis (KOA) stands as a degenerative ailment with a substantial and escalating prevalence. The practice of traditional Chinese non-pharmacological therapy has become a prevalent complementary and adjunctive approach. A mounting body of evidence suggests its efficacy in addressing KOA. Recent investigations have delved into its underlying mechanism, yielding some headway. Consequently, this comprehensive analysis seeks to encapsulate the clinical application and molecular mechanism of traditional Chinese non-pharmacological therapy in KOA treatment. The review reveals that various therapies, such as acupuncture, electroacupuncture, warm needle acupuncture, tuina, and acupotomy, primarily target localized knee components like cartilage, subchondral bone, and synovium. Moreover, their impact extends to the central nervous system and intestinal flora. More perfect experimental design and more comprehensive research remain a promising avenue in the future.
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Affiliation(s)
- Zhi-Feng Liu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Yang Zhang
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Jing Liu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Yu-Yan Wang
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Mo Chen
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Er-Yang Liu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Jun-Ming Guo
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Yan-Hua Wang
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Zhi-Wen Weng
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Chang-Xin Liu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Chang-He Yu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Xi-You Wang
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
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Vigotsky AD, Cong O, Pinto CB, Barroso J, Perez J, Petersen KK, Arendt-Nielsen L, Hardt K, Manning D, Apkarian AV, Branco P. Mechanical hyperalgesia and neuropathic pain qualities impart risk for chronic postoperative pain after total knee replacement. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.16.24301372. [PMID: 38293074 PMCID: PMC10827245 DOI: 10.1101/2024.01.16.24301372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Total knee replacement (TKR) is the gold-standard treatment for end-stage chronic osteoarthritis pain, yet many patients report chronic postoperative pain after TKR. The search for preoperative predictors for chronic postoperative pain following TKR has been studied with inconsistent findings. This study investigates the predictive value of quantitative sensory testing (QST) and PainDETECT for postoperative pain 3, 6, and 12 months post-TKR. We assessed baseline and postoperative (3- and 6-months) QST measures in 77 patients with knee OA (KOA) and 41 healthy controls, along with neuropathic pain scores in patients (PainDETECT). QST parameters included pressure pain pressure threshold (PPT), pain tolerance threshold (PTT), conditioned pain modulation (CPM), and temporal summation (TS) using cuff algometry, alongside mechanical hyperalgesia, and mechanical temporal summation to repeated pinprick stimulation. Compared to healthy controls, KOA patients at baseline demonstrated hyperalgesia to pinprick stimulation at the medial OA-affected knee and cuff pressure on the ipsilateral calf. Lower cuff algometry PTT and mechanical pinprick hyperalgesia were associated with baseline KOA pain intensity. Moreover, baseline pinprick pain hyperalgesia explained 25% of variance in pain intensity 12 months post-TKR and preoperative neuropathic pain scores also captured 30% and 20% of the variance in postoperative pain at 6- and 12-months, respectively. A decrease in mechanical pinprick hyperalgesia from before surgery to 3 months after TKR was associated with lower postoperative pain at the 12 months post-TKR follow-up, and vice-versa. Our findings suggest that preoperative pinprick hyperalgesia and PainDETECT neuropathic-like pain symptoms show predictive value for the development of chronic post-TKR pain.
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Affiliation(s)
- Andrew D. Vigotsky
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
- Departments of Biomedical Engineering and Statistics, Northwestern University, Evanston, IL. 60208, USA
| | - Olivia Cong
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
| | - Camila B Pinto
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
| | - Joana Barroso
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
| | - Jennifer Perez
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
| | - Kristian Kjaer Petersen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Department of Material and Production, Faculty of Engineering and Science, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Department of Material and Production, Faculty of Engineering and Science, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Kevin Hardt
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine. Chicago, IL. 60611, USA
| | - David Manning
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine. Chicago, IL. 60611, USA
| | - A. Vania Apkarian
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
| | - Paulo Branco
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine. Chicago, IL. 60610, USA
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O'Neill S, Nim CG, Chang NHS. Validation of a spring loaded probe for single and repeat pressure pain testing, including public domain specifications for design and manufacture. PLoS One 2024; 19:e0292809. [PMID: 38215173 DOI: 10.1371/journal.pone.0292809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/28/2023] [Indexed: 01/14/2024] Open
Abstract
Temporal summation of pressure pain is technically more challenging than simple pressure pain thresholds. The current study describes the design, manufacture and validation of a simple mechanical test apparatus to assess the temporal summation of deep pressure pain. We release design details into the public domain with the intention of providing free access for researchers especially in low income countries. Utility and validity of the probes were assessed by pressure application in three different experimental setups: A. Identifying potential issues which needed to be addressed to ensure a reliable test procedure (189 tests with 24 testers using four different probes). B. Selecting the most reliable target force curve (one tester conducted 20 tests). C. Estimating classic inter and intra-examiner reliability and comparing probe measures to other QST measures (repeated measures study with counterbalancing). We make recommendations on best use of the probes. Pressure pain thresholds assessed using probes were affected by anatomical test site and testing tool, but not by tester, day or session. Temporal summation of pressure pain was significantly greater than that of a single pressure application. We found no correlation between temporal summation using the probes on the Infra-Spinatus muscle and temporal summation using a pneumatic cuff on the lower leg. The probe was a useful tool for assessing pain intensity and temporal summation of pressure pain intensity, but not for pain thresholds. A number of caveats need to be considered when using the probe, including but not limited to audio cues and target ideal wave function.
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Affiliation(s)
- Søren O'Neill
- Medical Spinal Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Casper Glissmann Nim
- Medical Spinal Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Natalie Hong Siu Chang
- Medical Spinal Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
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Beckwée D, Nijs J, Bierma-Zeinstra SMA, Leemans L, Leysen L, Puts S, Rice D, Schiphof D, Bautmans I. Exercise therapy for knee osteoarthritis pain: how does it work? A study protocol for a randomised controlled trial. BMJ Open 2024; 14:e074258. [PMID: 38199628 PMCID: PMC10806725 DOI: 10.1136/bmjopen-2023-074258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Muscle strengthening training (MST) and behavioural graded activity (BGA) show comparable effects on knee osteoarthritic (KOA) pain, but the mechanisms of action remain unclear. Both exercise-induced anti-inflammation and central sensitisation are promising pathways for pain relief in response to exercise therapy in patients with KOA: MST has the potential to decrease inflammation and BGA has the potential to decrease central sensitisation. Hence, this study aims to examine inflammation and central sensitisation as mediators for the effect of MST and/or BGA on pain in patients with KOA. METHODS AND ANALYSIS The Knee OsteoArthritis PAIN trial started on 10 January 2020 (anticipated end: April 2024). The three-arm clinical trial aims to recruit 90 KOA patients who will be randomly allocated to 12 weeks of (1) MST, (2) BGA or (3) care as usual. Assessments will be performed at baseline, 13 and 52 weeks after finishing the intervention. Outcomes, including pain (Knee injury and Osteoarthritis Outcome Score), were chosen in line with the OARSI recommendations for clinical trials of rehabilitation interventions for OA and the IMMPACT/OMERACT recommendations for the assessment of physical function in chronic pain clinical trials. Inflammation as well as features of central sensitisation (including conditioned pain modulation, offset analgesia, temporal summation of pain and event-related potentials following electrical stimulation), will be considered as treatment mediators. A multiple mediators model will be estimated with a path-analysis using structural equation models. In July 2023, all 90 KOA patients have been included and 42 participants already finished the study. ETHICS AND DISSEMINATION This study obtained ethics approval (B.U.N. 143201941843). Unravelling the mechanisms of action of exercise therapy in KOA will not only be extremely valuable for researchers, but also for exercise immunology and pain scientists and clinicians. TRIAL REGISTRATION NUMBER NCT04362618.
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Affiliation(s)
- David Beckwée
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Movement Antwerp (MOVANT) research group, Universiteit Antwerpen, Antwerpen, Belgium
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussel, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Goteborg, Sweden
- University Hospital Brussels, Brussels, Belgium
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, Netherlands
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lynn Leemans
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Laurence Leysen
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Sofie Puts
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussel, Belgium
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - David Rice
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- Department of Anaesthesiology and Perioperative Medicine, Waitematā Pain Service, Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Ivan Bautmans
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussel, Belgium
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Cazzaniga S, Real G, Finazzi S, Lorini LF, Forget P, Bugada D. How to Modulate Peripheral and Central Nervous System to Treat Acute Postoperative Pain and Prevent Pain Persistence. Curr Neuropharmacol 2024; 22:23-37. [PMID: 37563811 DOI: 10.2174/1570159x21666230810103508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 08/12/2023] Open
Abstract
Chronic postoperative pain (CPSP) is a major issue after surgery, which may impact on patient's quality of life. Traditionally, CPSP is believed to rely on maladaptive hyperalgesia and risk factors have been identified that predispose to CPSP, including acute postoperative pain. Despite new models of prediction are emerging, acute pain is still a modifiable factor that can be challenged with perioperative analgesic strategies. In this review we present the issue of CPSP, focusing on molecular mechanism underlying the development of acute and chronic hyperalgesia. Also, we focus on how perioperative strategies can impact directly or indirectly (by reducing postoperative pain intensity) on the development of CPSP.
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Affiliation(s)
- Sara Cazzaniga
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
| | - Giovanni Real
- Department of Health Sciences, University of Milan, 20122, Milan, Italy
| | - Simone Finazzi
- Department of Health Sciences, University of Milan, 20122, Milan, Italy
| | - Luca F Lorini
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
| | - Patrice Forget
- School of Medicine, Medical Sciences and Nutrition, Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Scotland, United Kingdom
- Department of Anaesthesia, NHS Grampian, Aberdeen AB25 2ZD, Scotland, United Kingdom
| | - Dario Bugada
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
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Curatolo M. Central Sensitization and Pain: Pathophysiologic and Clinical Insights. Curr Neuropharmacol 2024; 22:15-22. [PMID: 36237158 DOI: 10.2174/1570159x20666221012112725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 11/22/2022] Open
Abstract
Central sensitization is an increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input. AIM To explain how the notion of central sensitization has changed our understanding of pain conditions, discuss how this knowledge can be used to improve the management of pain, and highlight knowledge gaps that future research needs to address. METHODS Overview of definitions, assessment methods, and clinical implications. RESULTS Human pain models, and functional and molecular imaging have provided converging evidence that central sensitization occurs and is clinically relevant. Measures to assess central sensitization in patients are available; however, their ability to discriminate sensitization of central from peripheral neurons is unclear. Treatments that attenuate central sensitization are available, but the limited understanding of molecular and functional mechanisms hampers the development of target-specific treatments. The origin of central sensitization in human pain conditions that are not associated with tissue damage remains unclear. CONCLUSION The knowledge of central sensitization has revolutionized our neurobiological understanding of pain. Despite the limitations of clinical assessment in identifying central sensitization, it is appropriate to use the available tools to guide clinical decisions towards treatments that attenuate central sensitization. Future research that elucidates the causes, molecular and functional mechanisms of central sensitization would provide crucial progress towards the development of treatments that target specific mechanisms of central sensitization.
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Affiliation(s)
- Michele Curatolo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
- The University of Washington Clinical Learning, Evidence and Research (CLEAR), University of Washington, WAI, USA
- Center for Sensory-Motor Interaction, University of Aalborg, Aalborg, Denmark
- Center for Musculoskeletal Disorders, Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
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Hattori T, Ohga S, Shimo K, Matsubara T. Pathology of knee osteoarthritis pain: contribution of joint structural changes and pain sensitization to movement-evoked pain in knee osteoarthritis. Pain Rep 2024; 9:e1124. [PMID: 38274197 PMCID: PMC10810602 DOI: 10.1097/pr9.0000000000001124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/17/2023] [Accepted: 11/25/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Movement-evoked pain (MEP) is the primary symptom in patients with knee osteoarthritis (KOA). Objectives This study aimed to investigate the contribution of joint structural changes and pain sensitization to the mechanisms of MEP in patients with KOA. Methods A total of 86 patients were assessed for demographic characteristics, osteoarthritis severity, Whole-Organ Magnetic Resonance Imaging Score-Hoffa synovitis and bone marrow lesions, pressure pain threshold and temporal summation of pain at the knee and forearm, Central Sensitization Inventory-9, and MEP. In measure of MEP, knee pain was scored using a numerical rating scale (NRS, 0-10) before and every minute during a 6-minute walking test (6MWT), and the MEP index was defined as the change in NRS pain score from baseline to the sixth minute of walking. Result On average, pain during 6MWT increased by 1.4 ± 1.5 points on the NRS relative to baseline, with 30.2% of patients showing an increase of 2 points or more. The hierarchical linear regression analysis revealed that Hoffa synovitis, pressure pain threshold at the forearm, and temporal summation of pain at the knee were associated with the MEP index. Conclusion The findings of this study suggest that both synovitis and neural mechanisms, such as pain sensitization, play a role in the development of MEP in KOA.
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Affiliation(s)
- Takafumi Hattori
- Faculty of Rehabilitation, Kobe Gakuin University Graduate School, Kobe, Hyogo, Japan
- Department of Rehabilitation, Maehara Orthopedics Rehabilitation Clinic, Obu, Aichi, Japan
| | - Satoshi Ohga
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Hyogo, Japan
| | - Kazuhiro Shimo
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Hyogo, Japan
| | - Takako Matsubara
- Faculty of Rehabilitation, Kobe Gakuin University Graduate School, Kobe, Hyogo, Japan
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Hyogo, Japan
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Colonna S, Borghi C. Rhizarthrosis Part I: A Literature Review. Cureus 2024; 16:e52932. [PMID: 38406032 PMCID: PMC10893956 DOI: 10.7759/cureus.52932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Rhizarthrosis (RA), or trapeziometacarpal osteoarthritis, is an arthritic degenerative process that affects the first joint of the thumb. The objective of this work is to provide therapists with an overview of the fundamental issues related to the therapeutic management of trapeziometacarpal joint instability. Prevalent in females, especially post-menopause, and linked to age, RA involves ligament and muscle structures, with causes ranging from hormonal influences to mechanical factors. Understanding the biomechanics, stability, and factors contributing to RA is crucial for effective intervention. This study explores the role of ligaments, muscles, and anatomical variants in thumb joint degeneration, emphasizing the importance of stability and congruence. RA manifests as pain at the base of the thumb, limiting grip strength and hindering everyday tasks. Pain initially occurs during specific movements but can progress to constant discomfort, affecting sleep. Chronic RA leads to joint stiffness, deformities like the "Z thumb," and muscle atrophy, impacting daily functions. Clinical evaluation involves pain assessment, joint mobility examination, and palpation. Diagnostic tests like the grind test and lever test aid in confirming RA. Radiographic examination reveals joint space degeneration and osteophytes and helps classify RA stages using the Eaton-Littler classification. Conservative treatment aims to alleviate pain, reduce joint stress, and enhance function. Orthoses help stabilize the joint. Therapeutic exercises, emphasizing muscle strength and dynamic stability, prove beneficial. Manual therapies like neurodynamic, Kaltenborn, Mulligan, and Maitland techniques target pain reduction and improve joint mechanics. The studies on conservative approaches provide evidence that a multimodal intervention consisting of joint mobilization, neural mobilization, and exercise is beneficial in reducing pain in patients with RA. When conservative therapy fails, surgical intervention is indicated.
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Affiliation(s)
- Saverio Colonna
- Osteopathic Spine Center Education (OSCE), Spine Center, Bologna, ITA
| | - Corrado Borghi
- Osteopathic Spine Center Education (OSCE), Spine Center, Bologna, ITA
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Prent JM, van der Wurff P, Scholten-Peeters GG. Lifestyle factors and psychological factors are associated with central pain processing in service members with persistent low-back pain: A cross-sectional exploratory study. Medicine (Baltimore) 2023; 102:e36741. [PMID: 38134068 PMCID: PMC10735071 DOI: 10.1097/md.0000000000036741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Persistent low-back pain (LBP) is highly prevalent in the military. Altered central pain processing is one of the mechanisms found to underlie persistent LBP. Our aim was to explore which factors are associated with altered pain processing in Dutch service members with persistent LBP. This knowledge may guide clinicians in what factors to address in the treatment of dysfunctional pain processing in service members with persistent LBP. Twenty-one service members with persistent LBP (mean age 34.0 years, 18 males) were included in this cross-sectional exploratory study. Participants completed questionnaires regarding lifestyle and psychological factors. Altered central pain processing was measured by temporal summation of pain to examine the function of the pain facilitatory system and by conditioned pain modulation to examine the pain inhibitory function. Univariable and multivariable linear regression analyses were performed. A higher local temporal summation of pain was associated with a longer sitting time, a higher level of physical activity and a higher level of pain catastrophizing. A higher local conditioned pain modulation was associated with a higher level of pain catastrophizing, anxiety and depression symptoms, and with a lower sleep quality. A higher remote conditioned pain modulation effect was associated with a higher level of physical activity, a higher body mass index and a shorter sitting time. This study succeeded in identifying lifestyle and psychological factors associated with altered pain processing in service members with persistent LBP. Prospective studies are needed to examine causality in these relationships.
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Affiliation(s)
- Julia M. Prent
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, Amsterdam, The Netherlands
- Research and Development, Military Rehabilitation Centre “Aardenburg”, Doorn, The Netherlands
| | - Peter van der Wurff
- Research and Development, Military Rehabilitation Centre “Aardenburg”, Doorn, The Netherlands
| | - Gwendolyne G.M. Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, Amsterdam, The Netherlands
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Deere R, Chowdhury E, Tabor A, Thompson D, Bilzon JLJ. The effects of upper- vs. lower-body aerobic exercise on perceived pain in individuals with chronic knee pain: a randomised crossover trial. FRONTIERS IN PAIN RESEARCH 2023; 4:1277482. [PMID: 38124706 PMCID: PMC10731310 DOI: 10.3389/fpain.2023.1277482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Background and objectives Some patients with chronic knee pain experience an increase in knee pain following a single bout of exercise involving their knee joint, which can negatively affect exercise adherence and thus result in reduced overall health and lack of disease management. We want to determine whether a single bout of upper-body (UB) aerobic arm-ergometry exercise is effective in reducing the experience of pain in those with chronic knee pain compared with lower-body (LB) aerobic leg ergometry exercise. Methods A total of 19 individuals (women = 11, men = 8; age = 63 ± 8 years; body mass index = 24 ± 3 kg/m2) who suffered from chronic knee pain for ≥3 months took part in this study. Arm-ergometry and cycle-ergometry exercises were performed for 30 min at a moderate intensity, separated by 7 days. Pain intensity was assessed by means of a visual analogue scale (VAS) pre- and post-exercise and for 7 days post-exercise. Pressure pain threshold (PPT) and mechanical detection threshold (MDT) were measured pre- and post-exercise at both local and distal anatomical sites. Data are presented as mean ± SD. Results VAS pain was significantly reduced (p = 0.035) at 1 day post-exercise following the UB exercise trial (-1.4 ± 0.8) when compared with the LB exercise trial (+0.1 ± 2.1). Both UB and LB exercises were effective in reducing local and distal PPT. MDT responses were heterogeneous, and no differences between the UB and LB exercise conditions were noted. Conclusion An acute bout of upper-body aerobic arm-ergometry exercise evoked a significant decrease in the affected knee joint pain in individuals with chronic knee pain of up to 24 h/1 day post-exercise compared with lower-body aerobic exercise. While the exact mechanisms remain unclear, upper-body exercise may offer a viable, novel therapeutic treatment for patients with chronic knee pain.
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Affiliation(s)
- Rachel Deere
- Centre for Clinical Rehabilitation and Exercise Medicine (CREM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for Nutrition and Exercise Metabolism (CNEM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications (CAMERA), University of Bath, Bath, United Kingdom
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Enhad Chowdhury
- Centre for Clinical Rehabilitation and Exercise Medicine (CREM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for Nutrition and Exercise Metabolism (CNEM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications (CAMERA), University of Bath, Bath, United Kingdom
| | - Abby Tabor
- Faculty of Health and Applied Sciences, University of West England, Bristol, United Kingdom
| | - Dylan Thompson
- Centre for Clinical Rehabilitation and Exercise Medicine (CREM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for Nutrition and Exercise Metabolism (CNEM), Department for Health, University of Bath, Bath, United Kingdom
| | - James L. J. Bilzon
- Centre for Clinical Rehabilitation and Exercise Medicine (CREM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for Nutrition and Exercise Metabolism (CNEM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications (CAMERA), University of Bath, Bath, United Kingdom
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De Schoenmacker I, Sirucek L, Scheuren PS, Lütolf R, Gorrell LM, Brunner F, Curt A, Rosner J, Schweinhardt P, Hubli M. Sensory phenotypes in complex regional pain syndrome and chronic low back pain-indication of common underlying pathomechanisms. Pain Rep 2023; 8:e1110. [PMID: 38027464 PMCID: PMC10653599 DOI: 10.1097/pr9.0000000000001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction First-line pain treatment is unsatisfactory in more than 50% of chronic pain patients, likely because of the heterogeneity of mechanisms underlying pain chronification. Objectives This cross-sectional study aimed to better understand pathomechanisms across different chronic pain cohorts, regardless of their diagnoses, by identifying distinct sensory phenotypes through a cluster analysis. Methods We recruited 81 chronic pain patients and 63 age-matched and sex-matched healthy controls (HC). Two distinct chronic pain cohorts were recruited, ie, complex regional pain syndrome (N = 20) and low back pain (N = 61). Quantitative sensory testing (QST) was performed in the most painful body area to investigate somatosensory changes related to clinical pain. Furthermore, QST was conducted in a pain-free area to identify remote sensory alterations, indicating more widespread changes in somatosensory processing. Results Two clusters were identified based on the QST measures in the painful area, which did not represent the 2 distinct pain diagnoses but contained patients from both cohorts. Cluster 1 showed increased pain sensitivities in the painful and control area, indicating central sensitization as a potential pathomechanism. Cluster 2 showed a similar sensory profile as HC in both tested areas. Hence, either QST was not sensitive enough and more objective measures are needed to detect sensitization within the nociceptive neuraxis or cluster 2 may not have pain primarily because of sensitization, but other factors such as psychosocial ones are involved. Conclusion These findings support the notion of shared pathomechanisms irrespective of the pain diagnosis. Conversely, different mechanisms might contribute to the pain of patients with the same diagnosis.
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Affiliation(s)
- Iara De Schoenmacker
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Laura Sirucek
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
- Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Paulina S. Scheuren
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Robin Lütolf
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lindsay M. Gorrell
- Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Florian Brunner
- Physical Medicine and Rheumatology, Balgrist University Hospital, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jan Rosner
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Alan Edward Center for Research on Pain, McGill University, Montreal, QC, Canada
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Perruccio AV, Badley EM, Antflek D, Power JD, Baltzer H. Frequency of multisite non-hand joint involvement in patients with thumb-base osteoarthritis, and associations with functional and patient-reported outcomes. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100397. [PMID: 37609061 PMCID: PMC10440563 DOI: 10.1016/j.ocarto.2023.100397] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
Purpose In OA studies, the focus often is on an index-joint; other affected joint sites are often overlooked. In this thumb-base OA study, we documented the frequency of symptomatic non-hand joint sites and investigated whether their count was associated with thumb-specific functional and patient-reported outcome measures. Design Patients seeking care for thumb-base OA (conservative or surgical) were included. A patient-completed questionnaire captured sociodemographic and health characteristics, symptomatic hand and non-hand joint sites, and outcome measures (thumb-base pain intensity, symptoms and disability (TASD) and upper-extremity disability/symptoms (quickDASH)). Grip and pinch strength were measured. Linear regressions examined the association between each outcome and symptomatic joint site count, adjusted for several covariates. Results The mean age of the 145 patients was 62 years, 72% were female. Mean symptomatic non-hand joint site count was 3.6. Ten percent reported only their hands as symptomatic; 30% reported 2-3 other symptomatic sites, and 49% reported 4+. From cross-sectional multivariable analyses, a higher symptomatic non-hand joint site count was associated with worse scores for all patient-reported outcomes and grip strength. Every unit increase in joint site count (49% had a 4+ count) was associated with a 2.1-3.3 unit increase (worse) in patient-reported outcome scores (all p < 0.02). Conclusions In this sample, nearly 80% of patients had 2+ symptomatic non-hand joint sites. These symptoms were associated with worse thumb- and hand-specific outcomes, suggesting a need for awareness of whole body OA burden, with implications for outcome score interpretations, study designs, and provision of care in thumb-base OA.
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Affiliation(s)
- Anthony V. Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Canada
- Arthritis Community Research and Epidemiology Unit (ACREU), Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Canada
| | - Elizabeth M. Badley
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Canada
- Arthritis Community Research and Epidemiology Unit (ACREU), Canada
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Daniel Antflek
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Canada
| | - J Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Canada
| | - Heather Baltzer
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Canada
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Chen Q, Bharadwaj V, Irvine KA, Clark JD. Mechanisms and treatments of chronic pain after traumatic brain injury. Neurochem Int 2023; 171:105630. [PMID: 37865340 DOI: 10.1016/j.neuint.2023.105630] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023]
Abstract
While pain after trauma generally resolves, some trauma patients experience pain for months to years after injury. An example, relevant to both combat and civilian settings, is chronic pain after traumatic brain injury (TBI). Headache as well as pain in the back and extremities are common locations for TBI-related chronic pain to be experienced. TBI-related pain can exist alone or can exacerbate pain from other injuries long after healing has occurred. Consequences of chronic pain in these settings include increased suffering, higher levels of disability, serious emotional problems, and worsened cognitive deficits. The current review will examine recent evidence regarding dysfunction of endogenous pain modulatory mechanisms, neuroplastic changes in the trigeminal circuitry and alterations in spinal nociceptive processing as contributors to TBI-related chronic pain. Key pain modulatory centers including the locus coeruleus, periaqueductal grey matter, and rostroventromedial medulla are vulnerable to TBI. Both the rationales and existing evidence for the use of monoamine reuptake inhibitors, CGRP antagonists, CXCR2 chemokine receptor antagonists, and interventional therapies will be presented. While consensus guidelines for the management of chronic post-traumatic TBI-related pain are lacking, several approaches to this clinically challenging situation deserve focused evaluation and may prove to be viable therapeutic options.
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Affiliation(s)
- QiLiang Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, CA, 94305, USA
| | - Vimala Bharadwaj
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, CA, 94305, USA
| | - Karen-Amanda Irvine
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, CA, 94305, USA; Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (E4-220), Palo Alto, CA, 94304, USA
| | - J David Clark
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, School of Medicine, Stanford, CA, 94305, USA; Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (E4-220), Palo Alto, CA, 94304, USA.
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Park EH, Seo J, Lee Y, Park K, Kim KR, Kim S, Mobasheri A, Choi H. TissueGene-C induces long-term analgesic effects through regulation of pain mediators and neuronal sensitization in a rat monoiodoacetate-induced model of osteoarthritis pain. Osteoarthritis Cartilage 2023; 31:1567-1580. [PMID: 37544583 DOI: 10.1016/j.joca.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/21/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE TissueGene-C (TG-C), a combination of human allogeneic chondrocytes and irradiated GP2-293 cells engineered to overexpress transforming growth factor-β1 (TGF-β1), has been developed as a novel cell-based gene therapy and a candidate for disease modifying osteoarthritis drug (DMOAD). We aim to investigate analgesic mechanism of TG-C in a pre-clinical animal model with monoiodoacetate (MIA)-induced pain. DESIGN We used a rat MIA model of osteoarthritis (OA) pain. We examined that TG-C can regulate pain by inhibiting the upregulation of various pain mediators in both knee joint tissue and dorsal root ganglia (DRG) (n = 112) and alleviating pain behavior (n = 41) and neuronal hyperexcitability in DRG (n = 60), afferent nerve fiber (n = 24), and spinal cord (n = 35). RESULTS TG-C significantly alleviated pain-related behavior by restoring altered dynamic weight bearing and reduced mechanical threshold of the affected hindlimb. TG-C significantly suppressed the expression of nerve growth factor (NGF) and calcitonin gene-related peptide (CGRP) in inflamed joint tissue. TG-C significantly suppressed the upregulation of tropomyosin receptor kinase A (TrkA) and nerve injury/regeneration protein (GAP43) and activation of Iba1-positive microglial cells in DRG. TG-C significantly recovered neuronal hyperexcitability by restoring RMP and firing threshold and frequency of DRG neurons, attenuating firing rates of mechanosensitive C- or Aδ-nerve fiber innervating knee joint, and lowering increased miniature and evoked excitatory postsynaptic currents (mEPSCs and eEPSCs) in the spinal cord. CONCLUSION Our results demonstrated that TG-C exerted potent analgesic effects in a rat MIA model of OA pain by inhibiting the upregulation of pain mediators and modulating neuronal sensitization.
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Affiliation(s)
- Eui Ho Park
- Department of Physiology, College of Medicine and Neuroscience Research Institute, Korea University, Seoul, South Korea
| | - Jinwon Seo
- Institute of BioInnovation Research, Kolon Life Science, Inc., Magok-dong, Gangseo-gu, Seoul, South Korea
| | - Yunsin Lee
- Institute of BioInnovation Research, Kolon Life Science, Inc., Magok-dong, Gangseo-gu, Seoul, South Korea
| | - Kiwon Park
- Institute of BioInnovation Research, Kolon Life Science, Inc., Magok-dong, Gangseo-gu, Seoul, South Korea
| | - Kyung-Ran Kim
- Institute of BioInnovation Research, Kolon Life Science, Inc., Magok-dong, Gangseo-gu, Seoul, South Korea
| | - Sujeong Kim
- Institute of BioInnovation Research, Kolon Life Science, Inc., Magok-dong, Gangseo-gu, Seoul, South Korea
| | - Ali Mobasheri
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Regenerative Medicine, State Research Institute Center for Innovative Medicine, Vilnius, Lithuania; World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging, Université de Liège, Liège, Belgium; Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Heonsik Choi
- Healthcare Research Institute, Kolon Advanced Research Cluster, Magok-dong, Gangseo-gu, Seoul, South Korea.
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Lee S, Neogi T, Costello KE, Senderling B, Stefanik JJ, Frey-Law L, Kumar D. Association of mechanical temporal summation of pain with muscle co-contraction during walking in people with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2023; 110:106105. [PMID: 37778085 PMCID: PMC10841902 DOI: 10.1016/j.clinbiomech.2023.106105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND People with knee osteoarthritis walk with excessive muscle co-contraction that can accelerate disease progression. Central pain sensitization is common in people with knee osteoarthritis and may be related to walking patterns. The objective of this study was to examine the relation of central pain sensitization with muscle co-contraction during walking in people with knee osteoarthritis. METHODS This study reports secondary analysis from baseline data of two clinical trials (n = 90 participants with knee osteoarthritis). The presence of central pain sensitization was measured by mechanical temporal summation at the patella and the wrist. Quadriceps and hamstrings activation was assessed using surface electromyography during walking at self-selected and fast paces. Muscle co-contraction indices for vastus medialis-medial hamstrings and vastus lateralis-lateral hamstrings muscle pairs were calculated during stance phases. Co-contraction outcomes were compared between people with and without mechanical temporal summation at each site, adjusting for age, sex, and body mass index. FINDINGS People with mechanical temporal summation at the knee had greater vastus lateralis-lateral hamstrings co-contraction while walking at a fast pace (P = 0.04). None of the other differences was statistically significant, but the overall trends and effect sizes indicated greater co-contraction in people with temporal summation at the knee irrespective of gait phase, walking speed, or muscle pairs. INTERPRETATION Central pain sensitization, assessed as mechanical temporal summation at the knee, is related to greater knee muscle co-contraction during fast walking in people with knee osteoarthritis. Thus, mitigating central sensitization may be an interventional target to reduce muscle co-contraction for people with knee osteoarthritis.
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Affiliation(s)
- Soyoung Lee
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Kerry E Costello
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA
| | | | - Joshua J Stefanik
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Laura Frey-Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Deepak Kumar
- Department of Physical Therapy, Boston University, Boston, MA, USA; Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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Wang D, Moosa S, Ishaque M, Finan P, Quigg M, Jeffrey Elias W, Liu CC. Painful Cutaneous Laser Stimulation for Temporal Summation of Pain Assessment. THE JOURNAL OF PAIN 2023; 24:2283-2293. [PMID: 37468022 DOI: 10.1016/j.jpain.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
Variability in pain sensitivity arises not only from the differences in peripheral sensory receptors but also from the differences in central nervous system (CNS) pain inhibition and facilitation mechanisms. Temporal summation of pain (TSP) is an experimental protocol commonly used in human studies of pain facilitation but is susceptible to confounding when elicited with the skin-contact thermode, which adds the responses of touch-related Aβ low-threshold mechanoreceptors to nociceptive receptors. In the present study, we evaluate an alternative method involving the use of a contactless cutaneous laser for TSP assessment. We show that repetitive laser stimulations with a one second inter-stimulus interval evoked reliable TSP responses in a significant proportion of healthy subjects (N = 36). Female subjects (N = 18) reported greater TSP responses than male subjects confirming earlier studies of sex differences in central nociceptive excitability. Furthermore, repetitive laser stimulations during TSP induction elicited increased time-frequency electroencephalography (EEG) responses. The present study demonstrates that repetitive laser stimulation may be an alternative to skin-contact methods for TSP assessment in patients and healthy controls. PERSPECTIVE: Temporal summation of pain (TSP) is an experimental protocol commonly used in human studies of pain facilitation. We show that contactless cutaneous laser stimulation is a reliable alternative to the skin contact approaches during TSP assessment.
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Affiliation(s)
- Dan Wang
- Departments of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Shayan Moosa
- Departments of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Mariam Ishaque
- Departments of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Patrick Finan
- Departments of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Mark Quigg
- Departments of Neurology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - W Jeffrey Elias
- Departments of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Chang-Chia Liu
- Departments of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
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Matsuda S, Igawa Y, Uchisawa H, Iki S, Osumi M. Thermal Grill Illusion in Post-Stroke Patients: Analysis of Clinical Features and Lesion Areas. J Pain Res 2023; 16:3895-3904. [PMID: 38026455 PMCID: PMC10656876 DOI: 10.2147/jpr.s433309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose In the thermal grill illusion, participants experience a feeling similar to burning pain. The illusion is induced by simultaneously touching warm and cool stimuli in alternating positions. In post-stroke pain, central sensitization is caused by a variety of factors, including damage to the spinothalamic tract and shoulder pain. Because the thermal grill illusion depends on central mechanisms, it has recently been suggested that it may be a useful indicator of central sensitization. Therefore, we hypothesized that post-stroke patients who are more likely to experience central sensitization may also be more likely to experience a thermal grill sensation of pain and discomfort than the likelihood among those who are less likely to experience central sensitization. However, the effects of the thermal grill illusion in post-stroke patients have not yet been reported. In this pilot study, we conducted the thermal grill illusion procedure in post-stroke patients and analyzed the relationship between clinical somatosensory functions and thermal grill sensations. We also conducted brain imaging analysis to identify brain lesion areas that were associated with thermal grill sensations. Patients and Methods Twenty patients (65.7 ± 11.9 years old) with post-stroke patients participated in this study. The thermal grill illusion procedure was performed as follows: patients simultaneously touched eight water-filled copper bars, with the water temperature adjusted to provide alternate warm (40°C) and cold (20°C) stimuli. Results Thermal grill sensation of pain and discomfort tended to be associated with the wind-up phenomenon in bedside quantitative sensory testing and thermal grill sensation of discomfort was also related to damage to the thalamic lateral nucleus. Conclusion These findings suggest that the thermal grill illusion might measure central sensitization, and that secondary brain hyperactivity might lead to increased thermal grill sensations.
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Affiliation(s)
| | - Yuki Igawa
- Graduate School of Health Sciences, Kio University, Nara, Japan
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Hidekazu Uchisawa
- Graduate School of Health Sciences, Kio University, Nara, Japan
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Shinya Iki
- Department of Rehabilitation, Kawaguchi Neurosurgery Rehabilitation Clinic, Osaka, Japan
| | - Michihiro Osumi
- Graduate School of Health Sciences, Kio University, Nara, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
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Dahmani D, Taik FZ, Berrichi I, Fourtassi M, Abourazzak FE. Impact of central sensitization on pain, disability and psychological distress in patients with knee osteoarthritis and chronic low back pain. BMC Musculoskelet Disord 2023; 24:877. [PMID: 37950225 PMCID: PMC10636971 DOI: 10.1186/s12891-023-07019-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Central sensitization (CS) is becoming increasingly recognized as a significant factor in many chronic pain conditions, including knee osteoarthritis (KOA) and chronic low back pain (CLBP). Yet it presently remains unclear how strong is the involvement of CS in KOA and CLBP and which factors are involved in CS in these two chronic disabling diseases. METHODS This is a cross-sectional study in which included a total of 178 patients with KOA and 118 patients with CLBP. Inclusion criteria for eligible participants for the KOA group were a confirmed diagnosis of KOA according to the American College of Rheumatology criteria, and for the CLBP group a chronic low back pain for more than 3 months. Subjects were excluded if they presented with a diagnosed psychiatric disorder or if they lacked the capacity to provide informed consent, understand study questionnaires or perform physical performance tests. In each group, were assessed; CS-related symptoms using the Central Sentization Inventory (CSI); demographic and clinical characteristics such as disease duration, pain intensity on a visual analog scale, self-reported function using the Lequesne index for KOA patients and the Oswestry Disability index for CLBP patients, and physical performance with the 6 minutes' walk test; as well as psychosocial risk factors using the Patient Health Questionnaire for depression (PHQ-9), the Generalized Anxiety Disorder (GAD-7) and the Pain Catastrophizing Scale (PCS). RESULTS CSI scores significantly correlated with pain intensity and disability in KOA and CLBP patients, and were highly correlated with self-reported symptoms of depression, anxiety and pain catastrophizing. Depression significantly predicted the CSI score in both groups. CONCLUSION These findings provide further evidence for the impact of CS on pain, function and physical performance in KOA and CLBP patients. Psychosocial symptoms such as pain catastrophizing, anxiety and depression should also be considered as they are also associated with CS.
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Affiliation(s)
- Doha Dahmani
- Rheumatology Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Abdelmalek Essaadi University, Tangier, Morocco.
| | - Fatima Zahrae Taik
- Rheumatology Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Abdelmalek Essaadi University, Tangier, Morocco
- Laboratory of Life and Health Sciences, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Imane Berrichi
- Rheumatology Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Abdelmalek Essaadi University, Tangier, Morocco
| | - Maryam Fourtassi
- Laboratory of Life and Health Sciences, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Fatima Ezzahra Abourazzak
- Rheumatology Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Abdelmalek Essaadi University, Tangier, Morocco
- Laboratory of Life and Health Sciences, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
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Amorim D, Fonseca-Rodrigues D, David-Pereira A, Costa O, Lima AP, Nogueira R, Cruz R, Martins AS, Sousa L, Oliveira F, Pereira H, Pirraco R, Pertovaara A, Almeida A, Pinto-Ribeiro F. Injection of kaolin/carrageenan in the rat knee joint induces progressive experimental knee osteoarthritis. Pain 2023; 164:2477-2490. [PMID: 37390363 DOI: 10.1097/j.pain.0000000000002954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/25/2023] [Indexed: 07/02/2023]
Abstract
ABSTRACT Osteoarthritis (OA), the most common joint disorder worldwide, is characterized by progressive degeneration of articular and periarticular structures, leading to physical and emotional impairments that greatly affect the quality of life of patients. Unfortunately, no therapy has been able to halt the progression of the disease. Owing to the complexity of OA, most animal models are only able to mimic a specific stage or feature of the human disorder. In this work, we demonstrate the intraarticular injection of kaolin or carrageenan leads to the progressive degeneration of the rat's knee joint, accompanied by mechanical hyperalgesia and allodynia, gait impairments (reduced contact area of the affected limb), and radiological and histopathological findings concomitant with the development of human grade 4 OA. In addition, animals also display emotional impairments 4 weeks after induction, namely, anxious and depressive-like behaviour, important and common comorbidities of human OA patients. Overall, prolonging kaolin or carrageenan-induced monoarthritis mimics several important physical and psychological features of human OA in both male and female rodents and could be further applied in long-term studies of OA-associated chronic pain.
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Affiliation(s)
- Diana Amorim
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Institute of Biomedicine/Physiology, University of Helsinki, Helsinki, Finland
| | - Diana Fonseca-Rodrigues
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ana David-Pereira
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Wolfson CARD, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
| | - Octávia Costa
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Antónia Palhares Lima
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rosete Nogueira
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rute Cruz
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ana Sofia Martins
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Liliana Sousa
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Hélder Pereira
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Minho University, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
| | - Rogério Pirraco
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Minho University, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
| | - Antti Pertovaara
- Institute of Biomedicine/Physiology, University of Helsinki, Helsinki, Finland
| | - Armando Almeida
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Filipa Pinto-Ribeiro
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Pontes-Silva A, Dibai-Filho AV, de Melo TS, Santos LM, de Souza MC, DeSantana JM, Avila MA. Effects of progressive intensity resistance training on the impact of fibromyalgia: protocol for a blinded randomized controlled trial. BMC Musculoskelet Disord 2023; 24:816. [PMID: 37838712 PMCID: PMC10576880 DOI: 10.1186/s12891-023-06952-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/10/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Fibromyalgia guidelines indicate that exercise is critical in the management of fibromyalgia, and there is evidence that patients with fibromyalgia can perform resistance training at moderate and high intensities. However, despite the biological plausibility that progression of intensity provides greater benefit to individuals, no studies have compared different intensities (progressive versus constant intensities) of the same exercise in this population. OBJECTIVE To compare the effect of 24 sessions of resistance training (progressive vs. constant intensity) on impact of fibromyalgia, sleep quality, anxiety, depression, pain, walking ability, and musculoskeletal capacity. METHODS A protocol for a blinded randomized controlled trial. The sample will be randomized into three groups: group 1 (progressive intensity, experimental), group 2 (constant intensity, control A), and group 3 (walking, control B). Group 1 will perform resistance training at moderate intensity (50% of maximum dynamic strength), previously determined by the 1 repetition maximum (1-RM) test in the proposed exercises. The strength of each individual will be reassessed every 4 weeks (by 1-RM) and the intensity of each exercise will be positively adjusted by 20% of the value observed in kg (i.e., first month 50%; second month 70%; third month 90% of the maximum dynamic strength). Group 2 will perform the same procedure, but the intensity will be maintained at 50% of the maximum dynamic strength throughout the treatment (i.e., constant intensity from the first to the third month). Group 3 will perform a 40-minute treadmill walk at low intensity, defined by a walking speed corresponding to 60-70% of the maximum heart rate, which we will control with a heart rate monitor. All groups will receive a 45-minute pain education session prior to the exercise program, covering the pathophysiologic mechanisms of chronic pain, strategies for coping with pain, avoiding hypervigilance, and deconstructing beliefs and myths about chronic pain. DISCUSSION The results of the present study may help health care professionals adjust the intensity of resistance training and thus plan the most effective intervention (progressive or constant intensity) to reduce the impact of fibromyalgia on patients' lives. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-9pbq9fg, date of registration: October 06, 2022.
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Affiliation(s)
- André Pontes-Silva
- Physical Therapy Postgraduate Program, Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Almir Vieira Dibai-Filho
- Physical Education Postgraduate Program, Physical Education Department, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | - Thayná Soares de Melo
- Physical Therapy Postgraduate Program, Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, Brazil
| | | | - Marcelo Cardoso de Souza
- Postgraduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Josimari Melo DeSantana
- Laboratory of Research on Neuroscience (LAPENE), Physical Therapy Department, Graduate Program in Health Science, Graduate Program in Physiological Science, Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil
| | - Mariana Arias Avila
- Physical Therapy Postgraduate Program, Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil.
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, Brazil.
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Bashekah KA, Zagzoug ME, Banaja AW, Alghamdi AA, Mishiming OS, Jan MA, Kemawi OA, Alharbi BA, Althagafi AA, Aljifri SM. Prevalence and Characteristics of Knee Osteoarthritis Among the General Public in Saudi Arabia. Cureus 2023; 15:e47666. [PMID: 38021677 PMCID: PMC10670982 DOI: 10.7759/cureus.47666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Knee osteoarthritis (OA) is a chronic and progressive knee joint condition that is influenced by multiple factors. This research aims to examine the prevalence and characteristics of knee OA among the general public in Saudi Arabia. Methodology This cross-sectional online survey was conducted in September 2023 in Saudi Arabia. This research used a previously developed questionnaire to validate the diagnosis of OA, which was performed in accordance with the diagnostic criteria established by the American College of Rheumatology (ACR). The Western Ontario and McMaster Universities Arthritis Index questionnaire (WOMAC) was used to examine the severity and characteristics of knee OA patients. A binary logistic regression analysis was conducted to determine the variables that influence the severity of knee OA and the likelihood of developing OA. Results A total of 1,019 individuals participated in this study. Around one-third of the participants (34.5%) fulfilled the ACR criteria for knee OA diagnosis. Overall, the mean WOMAC score was 34.1 (18.8) out of 96, which represents 35.5% of the maximum obtainable score and demonstrates a low degree of knee OA severity. The mean pain sub-scale score was 7.4 (3.8) out of 20, which represents 37.0% of the maximum obtainable score and demonstrates a low level of pain intensity. The mean stiffness sub-scale score was 2.7 (1.8) out of 8, which represents 33.8% of the maximum obtainable score and demonstrates a low degree of stiffness in joints. The mean physical function sub-scale score was 24.0 (14.0) out of 68, which represents 35.3% of the maximum obtainable score and demonstrates a low level of physical function difficulty. Females, older participants (above 40 years), those with high body mass index (28.8 kg/cm2 and higher), non-smokers, those with comorbidities, those who did not practice daily physical activity, those who had a family history of knee OA, and those who suffered from flat feet, rheumatoid arthritis, gout, lupus, or back or hip pain were more likely to develop knee OA and have severe OA (p < 0.05). Conclusions The findings of this study demonstrated a significant prevalence rate of knee OA and highlighted a discrepancy between the rates obtained by diagnostic criteria and those determined through clinical diagnosis. Several significant factors that contribute to the development of OA encompass lifestyle choices such as food and exercise, familial predisposition, genetic influences, and the presence of comorbidities. To effectively tackle this intricate matter, it is imperative to adopt a patient-centered strategy and prioritize early intervention.
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Foubert A, Chantrain VA, Meeus M, Maes P, Haenen V, Lobet S, Lambert C, Hermans C, Roussel N. Psychophysical assessment of pain in adults with moderate and severe haemophilia: A cross-sectional study. Haemophilia 2023; 29:1243-1258. [PMID: 37528565 DOI: 10.1111/hae.14830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/19/2023] [Accepted: 07/14/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Joint pain is the hallmark of haemophilia; therefore it seems clinically rather a musculoskeletal than a bleeding disorder. Although joint pain in people with haemophilia (PwH) is a complex and multidimensional problem, pain assessment remains primarily focused on the structural evaluation of their joints. Whereas, only few data are available on the potential implication of psychophysical and psychological factors. OBJECTIVE This study aimed to perform a psychophysical pain assessment including quantitative sensory testing (QST) and an evaluation of psychological factors in a large sample of PwH, to get insight into the individuals' pain system. METHODS Ninety-nine adults (36.9 ± 13.5 years) with moderate/severe haemophilia A/B and 46 healthy controls filled in self-reported pain and psychological questionnaires and underwent a QST evaluation including static and dynamic tests. Static tests focused on the determination of thermal detection and pain thresholds and mechanical pressure pain thresholds. Dynamic tests evaluated pain facilitation and the efficacy of endogenous pain inhibition. Besides comparing PwH and healthy controls, between-subgroup differences were studied in PwH based on their pain distribution. RESULTS The study revealed increased thermal and mechanical pain sensitivity and the presence of unhelpful psychological factors such as anxiety/depression in PwH. Among the subgroups, especially PwH with widespread pain showed altered somatosensory functioning. Enhanced pain facilitation and impaired efficacy of endogenous pain inhibition in PwH could not be observed. CONCLUSION Altered somatosensory functioning and unhelpful psychological factors, appear to play an important role in the pathophysiology of pain in PwH, especially in PwH with widespread pain.
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Affiliation(s)
- Anthe Foubert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion, International Research Group, www.paininmotion.be
- Faculté des Sciences de la Motricité, Université catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Valérie-Anne Chantrain
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion, International Research Group, www.paininmotion.be
- Faculté des Sciences de la Motricité, Université catholique de Louvain, Louvain-La-Neuve, Belgium
- Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion, International Research Group, www.paininmotion.be
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Philip Maes
- Department of Paediatrics, University Hospital Antwerp, Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Vincent Haenen
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion, International Research Group, www.paininmotion.be
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Sébastien Lobet
- Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- Haemostasis and Thrombosis Unit, Division of Hematology, Clinique universitaires Saint-Luc, Brussels, Belgium
- Secteur de kinésithérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Catherine Lambert
- Haemostasis and Thrombosis Unit, Division of Hematology, Clinique universitaires Saint-Luc, Brussels, Belgium
| | - Cédric Hermans
- Haemostasis and Thrombosis Unit, Division of Hematology, Clinique universitaires Saint-Luc, Brussels, Belgium
| | - Nathalie Roussel
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
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Hollis D, Mendis MD, Ng SK, Thomas M, Marks D, Lewis J, Hides J, Bisset L. Are clinical outcomes associated with baseline sensory profiles in people with musculoskeletal shoulder pain? Protocol for a prospective longitudinal observational study. Musculoskeletal Care 2023; 21:895-907. [PMID: 37139704 DOI: 10.1002/msc.1770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/10/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Musculoskeletal shoulder pain is a common problem and its symptoms often become persistent. The experience of pain is multidimensional, and therefore, a range of patient characteristics may influence treatment response. An altered sensory processing has been associated with persistent musculoskeletal pain states and may contribute to outcomes in patients with musculoskeletal shoulder pain. The presence and potential impact of altered sensory processing in this patient cohort is not currently known. The aim of this prospective longitudinal cohort study is to investigate if baseline sensory characteristics are associated with clinical outcomes in patients presenting to a tertiary hospital with persistent musculoskeletal shoulder pain. If found, a relationship between sensory characteristics and outcome may lead to the creation of more effective treatment strategies and improvements in risk adjustment and prognosis. METHODS This is a single-centre prospective cohort study with 6-, 12- and 24-month follow-up. A total of 120 participants aged ≥18 years with persistent musculoskeletal shoulder pain (≥3 months) will be recruited from an Australian public tertiary hospital orthopaedic department. Baseline assessments, including quantitative sensory tests and a standardised physical examination, will be performed. In addition, information will be obtained from patient interviews, self-report questionnaires and medical records. Follow-up outcome measures will comprise information from the Shoulder Pain and Disability Index and a six-point Global Rating of Change scale. ANALYSIS Descriptive statistics will be used to report baseline characteristics and outcome measures over time. Change in outcome measures at the primary endpoint of six months from baseline will be calculated using paired t-tests. Associations between baseline characteristics and outcomes at a 6-month follow-up will be reported using multivariable linear and logistic regression models. DISCUSSION Understanding the relationship between sensory profile and the variable response to treatment in people with persistent musculoskeletal shoulder pain may enhance our understanding of the mechanisms contributing to the presentation. In addition, through better understanding of the contributing factors, the results of this study may contribute to the development of an individualised, patient-centred approach to treatment for people with this highly prevalent and debilitating condition.
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Affiliation(s)
- Danielle Hollis
- School of Health Sciences and Social Work, Griffith University, Nathan, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - M Dilani Mendis
- School of Health Sciences and Social Work, Griffith University, Nathan, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Physiotherapy Department, Mater Health, South Brisbane, Queensland, Australia
| | - Shu-Kay Ng
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Michael Thomas
- Orthopaedic Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Darryn Marks
- Orthopaedic Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Department of Physiotherapy, Bond University, Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Gold Coast, Queensland, Australia
| | - Jeremy Lewis
- Therapy Department, Central London Community Healthcare National Health Service Trust, Finchley Memorial Hospital, London, UK
- Musculoskeletal Research, Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Julie Hides
- School of Health Sciences and Social Work, Griffith University, Nathan, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Physiotherapy Department, Mater Health, South Brisbane, Queensland, Australia
| | - Leanne Bisset
- School of Health Sciences and Social Work, Griffith University, Nathan, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
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Iio R, Manaka T, Nakazawa K, Hirakawa Y, Ito Y, Ogura A, Nakamura H. Assessment of Prevalence and Risk Factors for Central Sensitization Related to Shoulder Osteoarthritis and Rotator Cuff Tears Using the Central Sensitization Inventory: A Cross-Sectional Study in Shoulder Surgery Patients. J Clin Med 2023; 12:5633. [PMID: 37685700 PMCID: PMC10488326 DOI: 10.3390/jcm12175633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/08/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Shoulder disorders occasionally cause intractable pain. Central sensitization (CS) may be involved in such pain. Identifying risk factors associated with CS is crucial for effective pain control. This study aimed to determine the effects of shoulder osteoarthritis and rotator cuff tears (RCT) on CS and associated factors. This study included patients evaluated for CS using the Central Sensitization Inventory (CSI) before surgery for shoulder osteoarthritis, RCT, or cuff tear arthropathy. Patients with a CSI score of 40 or higher were defined as having CS. The relationships between glenohumeral osteoarthritis (GHOA), RCT size, and CS were statistically analyzed. Multiple regression analysis was performed to examine the factors affecting CSI scores. Subjects included 167 patients: 131 patients had RCT without GHOA, 23 had GHOA with RCT, and 13 had GHOA without RCT. The GHOA group had a significantly higher CSI score (27.5 [10.8-40.5] vs. 18.0 [10.0-27.5]) and CS prevalence (27.8% vs. 8.4%) than the RCT without GHOA group. There was no significant correlation between RCT size and CSI scores. Multiple regression analysis showed that female sex, severe pain, and long pain duration were associated with higher CSI scores. Considering the risk factors for CS might be helpful in shoulder treatment.
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Affiliation(s)
- Ryosuke Iio
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (R.I.); (K.N.)
| | - Tomoya Manaka
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (Y.H.); (H.N.)
| | - Katsumasa Nakazawa
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (R.I.); (K.N.)
| | - Yoshihiro Hirakawa
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (Y.H.); (H.N.)
| | - Yoichi Ito
- Ito Clinic, Osaka Shoulder Center, Osaka 580-0016, Japan; (Y.I.); (A.O.)
| | - Ayako Ogura
- Ito Clinic, Osaka Shoulder Center, Osaka 580-0016, Japan; (Y.I.); (A.O.)
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (Y.H.); (H.N.)
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Simis M, Pacheco-Barrios K, Vasquez-Avila K, Rebello-Sanchez I, Parente J, Castelo-Branco L, Marduy A, de Melo PS, Imamura M, Battistella L, Fregni F. Functional and Neural Correlates Associated with Conditioned Pain Modulation in Patients with Chronic Knee Osteoarthritis Pain: A Cross-Sectional Study. Life (Basel) 2023; 13:1697. [PMID: 37629554 PMCID: PMC10455308 DOI: 10.3390/life13081697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/23/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Background: In this study, we aimed to assess the factors that predict a dysfunctional conditioned pain modulation (CPM) in chronic knee OA. Methods: This is a cross-sectional analysis of patients with chronic knee OA from a prospective cohort study in Brazil (n = 85). We performed linear and logistic multivariate regression models using the purposeful selection approach to test the relationship between the CPM in both knees (average) as a dependent variable and demographics, clinical, and neurophysiological as independent variables. Results: A significant negative association between WOMAC pain scores and CPM (β: -0.13) was found. This association was modified by the subjects' race, being stronger in the non-white subjects. In our logistic regression models, pain intensity indexed with the WOMAC pain scale remained a significant association with dichotomized CPM. Furthermore, a significant CPM association with balance, indexed with the Berg Balance score, was evidenced (β: 0.04). Neurophysiological variables showed a significant negative relationship with CPM, such as the relative power of delta oscillations in the frontal area (β: -3.11) and central area (β: -3.23). There was no significant relationship between CPM and the following domains: cognitive, emotion, sleep, opioid receptor polymorphisms, and intrinsic variables of OA disease. There was no association of CPM with TMS-indexed inhibitory markers. Conclusions: These results may indicate that less function of the pain descending inhibitory system in patients with OA is correlated with higher activity-related pain (WOMAC), less balance, and cortical plasticity especially with increased low-frequency (delta) brain oscillations. These associations seem modified by race.
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Affiliation(s)
- Marcel Simis
- Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo 01002, Brazil; (M.S.); (M.I.); (L.B.)
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA; (K.P.-B.); (K.V.-A.); (I.R.-S.); (J.P.); (L.C.-B.); (A.M.); (P.S.d.M.)
- Unidad de Investigación para la Generación y Síntesis de Evidencia en Salud, Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Lima 15026, Peru
| | - Karen Vasquez-Avila
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA; (K.P.-B.); (K.V.-A.); (I.R.-S.); (J.P.); (L.C.-B.); (A.M.); (P.S.d.M.)
| | - Ingrid Rebello-Sanchez
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA; (K.P.-B.); (K.V.-A.); (I.R.-S.); (J.P.); (L.C.-B.); (A.M.); (P.S.d.M.)
| | - Joao Parente
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA; (K.P.-B.); (K.V.-A.); (I.R.-S.); (J.P.); (L.C.-B.); (A.M.); (P.S.d.M.)
| | - Luis Castelo-Branco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA; (K.P.-B.); (K.V.-A.); (I.R.-S.); (J.P.); (L.C.-B.); (A.M.); (P.S.d.M.)
| | - Anna Marduy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA; (K.P.-B.); (K.V.-A.); (I.R.-S.); (J.P.); (L.C.-B.); (A.M.); (P.S.d.M.)
| | - Paulo S. de Melo
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA; (K.P.-B.); (K.V.-A.); (I.R.-S.); (J.P.); (L.C.-B.); (A.M.); (P.S.d.M.)
| | - Marta Imamura
- Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo 01002, Brazil; (M.S.); (M.I.); (L.B.)
| | - Linamara Battistella
- Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo 01002, Brazil; (M.S.); (M.I.); (L.B.)
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA; (K.P.-B.); (K.V.-A.); (I.R.-S.); (J.P.); (L.C.-B.); (A.M.); (P.S.d.M.)
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