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Petersen KK, O'Neill S, Blichfeldt‐Eckhardt MR, Nim C, Arendt‐Nielsen L, Vægter HB. Pain profiles and variability in temporal summation of pain and conditioned pain modulation in pain-free individuals and patients with low back pain, osteoarthritis, and fibromyalgia. Eur J Pain 2025; 29:e4741. [PMID: 39387150 PMCID: PMC11755398 DOI: 10.1002/ejp.4741] [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: 07/09/2024] [Revised: 09/06/2024] [Accepted: 09/24/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND Pain profiles (e.g. pro- and anti-nociceptive) can be developed using quantitative sensory testing (QST) but substantial variability exists. This study describes the variability in temporal summation of pain (TSP) and conditioned pain modulation (CPM) in chronic musculoskeletal pain patients, proposes cut-off values, and explores the association with clinical pain intensity. METHODS This is a secondary analysis in which TSP and CPM were assessed using cuff algometry in pain-free subjects (n = 69), and patients with chronic low back pain (cLBP, n = 267), osteoarthritis (n = 134), and fibromyalgia (n = 101). Using TSP and CPM from the pain-free subjects as a reference, four distinct pain profiles TSP (low/high) and CPM (low/high) were created, and differences in clinical pain between pain profiles were explored. RESULTS Individual data revealed large inter-person variability. High TSP and low CPM were found in fibromyalgia (p < 0.01) and osteoarthritis (p < 0.01) but not cLBP when compared to pain-free subjects. The proportion of patients classified into the distinct pain profiles was significantly different (p < 0.001) with the largest proportion in the high TSP and low CPM group in fibromyalgia (52.5%) and osteoarthritis (41.4%). Clinical pain was not significantly different comparing the pain profiles, and no significant correlations were observed between clinical pain and TSP or CPM. CONCLUSION These results demonstrated substantial inter-person variability in TSP and CPM in patients with different chronic pain conditions and pain-free subjects. The proportion of patients with a pro-nociceptive profile appears larger in fibromyalgia and osteoarthritis, but we found no association to clinical pain. SIGNIFICANT STATEMENT This analysis shows that there is variability when assessing TSP and CPM in both pain-free subjects and patients with chronic pain. A cut-off for determining when a person is pain-sensitive is proposed, and data based on this cut-off approach suggest that significantly more patients with osteoarthritis and fibromyalgia are pain-sensitive (i.e. higher TSP and lower CPM) compared to pain-free subjects. This analysis does not find an association between pain sensitivity and clinical pain.
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Affiliation(s)
- Kristian Kjær‐Staal Petersen
- Department of Materials and Production, Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA)Aalborg UniversityAalborgDenmark
- Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and PainAalborg UniversityAalborgDenmark
| | - Søren O'Neill
- Department of Regional Health ResearchUniversity Hospital of Southern DenmarkOdenseDenmark
- Medical Research Unit, Spine Center of Southern DenmarkUniversity Hospital of Southern DenmarkMiddelfartDenmark
| | - Morten Rune Blichfeldt‐Eckhardt
- Department of Regional Health ResearchUniversity Hospital of Southern DenmarkOdenseDenmark
- Department of Anesthesia, Lillebaelt HospitalUniversity Hospital of Southern DenmarkVejleDenmark
| | - Casper Nim
- Department of Regional Health ResearchUniversity Hospital of Southern DenmarkOdenseDenmark
- Medical Research Unit, Spine Center of Southern DenmarkUniversity Hospital of Southern DenmarkMiddelfartDenmark
- Department of Sports Science and Clinical BiomechanicsCenter for Muscle and Joint HealthOdenseDenmark
| | - Lars Arendt‐Nielsen
- Department of Materials and Production, Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA)Aalborg UniversityAalborgDenmark
- Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and PainAalborg UniversityAalborgDenmark
- Department of Gastroenterology & Hepatology, Mech‐Sense, Clinical InstituteAalborg University HospitalAalborgDenmark
- Steno Diabetes Center North Denmark, Clinical InstituteAalborg University HospitalAalborgDenmark
| | - Henrik Bjarke Vægter
- Department of Clinical Research, Faculty of Health SciencesUniversity of Southern DenmarkDenmark
- Pain Research Group, Pain CenterUniversity Hospital OdenseOdenseDenmark
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Cihan E, Un Yıldırım N, Bakar Y, Bilge O. Can Lymphatic Transport Impaired by Total Knee Arthroplasty be Managed with Manual Lymphatic Drainage? Lymphat Res Biol 2024. [PMID: 39723938 DOI: 10.1089/lrb.2023.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2024] Open
Abstract
Objective: It is known that particles released from the prosthesis due to wear after joint replacement surgery affect the lymphatic system. This study aimed to investigate the effect of the manual lymphatic drainage (MLD) technique on pain, edema, and blood lactate dehydrogenase (LDH) levels in the early period of lymphatic transport affected by total knee arthroplasty (TKA). Method: Twenty-four patients who underwent TKA were randomly allocated (control: 12; MLD: 12). Both groups received postoperative rehabilitation. The MLD group also received MLD in the first 3 days after surgery. Clinical assessment was undertaken on the third day and at the sixth week postoperatively. The Visual Analog Scale (VAS) was used for pain during activity, algometer measurements for pain threshold levels, and the Frustum method for leg volumes. The LDH was recorded using laboratory measurements. Results: A significant difference was found in the VAS activity-related pain scores of the groups according to the assessment time (MLD: χ2 = 47.175; p = 0.000; control; χ2 = 30.995; p < 0.000). The pain threshold significantly increased in the MLD group from postoperative day 2 (2nd day, 3rd day, 6th week, respectively; p = 0.015; p = 0.001; p < 0.000). Leg volume significantly decreased over time in both groups after surgery (p < 0.001); however, there was no significant difference between the groups (first-third postoperative days and sixth week; p = 0.192; p = 0.343; p = 0.453; p = 0.908, respectively). While the LDH significantly decreased after drainage in the MLD group (first-third postoperative days; p = 0.002; p = 0.005; p = 0.006, respectively), it increased with exercise in the control group, first day (p = 0.004) and second day (p = 0.019). Conclusions: MLD added to exercise therapy is more effective than exercise therapy alone in reducing the LDH level, a marker of pain and muscle damage, but is not effective for edema due to surgery.
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Affiliation(s)
- Emine Cihan
- Department of Physiotherapy and Rehabilitation, Selcuk University, Vocational School of Health Sciences, Physiotherapy Program, Konya, Turkey
| | - Necmiye Un Yıldırım
- Gülhane Faculty of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Yeşim Bakar
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, University of Bakırcay, İzmir, Turkey
| | - Onur Bilge
- Meram Faculty of Medicine, Department of Orthopaedics and Traumatology, Necmettin Erbakan University, Konya, Turkey
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Wu F, Liu J, Zheng L, Chen C, Basnet D, Zhang J, Shen C, Feng X, Sun Y, Du X, Zheng JC, Liu J. Preoperative pain sensitivity and its correlation with postoperative acute and chronic pain: a systematic review and meta-analysis. Br J Anaesth 2024; 133:591-604. [PMID: 38879440 DOI: 10.1016/j.bja.2024.05.010] [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: 01/23/2024] [Revised: 04/24/2024] [Accepted: 05/21/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Preoperative pain sensitivity (PPS) can be associated with postsurgical pain. However, estimates of this association are scarce. Confirming this correlation is essential to identifying patients at high risk for severe postoperative pain and for developing analgesic strategy. This systematic review and meta-analysis summarises PPS and assessed its correlation with postoperative pain. METHODS PubMed, Scopus, Cochrane Library, and PsycINFO were searched up to October 1, 2023, for studies reporting the association between PPS and postsurgical pain. Two authors abstracted estimates of the effect of each method independently. A random-effects model was used to combine data. Subgroup analyses were performed to investigate the effect of pain types and surgical procedures on outcomes. RESULTS A total of 70 prospective observational studies were included. A meta-analysis of 50 studies was performed. Postoperative pain was negatively associated with pressure pain threshold (PPT; r=-0.15, 95% confidence interval [CI] -0.23 to -0.07]) and electrical pain threshold (EPT; r=-0.28, 95% CI -0.42 to -0.14), but positively correlated with temporal summation of pain (TSP; r=0.21, 95% CI 0.12-0.30) and Pain Sensitivity Questionnaire (PSQ; r=0.25, 95% CI 0.13-0.37). Subgroup analysis showed that only TSP was associated with acute and chronic postoperative pain, whereas PPT, EPT, and PSQ were only associated with acute pain. A multilevel (three-level) meta-analysis showed that PSQ was not associated with postoperative pain. CONCLUSIONS Lower PPT and EPT, and higher TSP are associated with acute postoperative pain while only TSP is associated with chronic postoperative pain. Patients with abnormal preoperative pain sensitivity should be identified by clinicians to adopt early interventions for effective analgesia. SYSTEMATIC REVIEW PROTOCOL PROSPERO (CRD42023465727).
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Affiliation(s)
- Fan Wu
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Jiehui Liu
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Liang Zheng
- Research Center for Translation Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Changqi Chen
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Diksha Basnet
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Jingya Zhang
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Chaonan Shen
- Research Center for Translation Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuanran Feng
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Yiyan Sun
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Xue Du
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Jialin C Zheng
- Center for Translational Neurodegeneration and Regenerative Therapy, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai, China; Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Jianhui Liu
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China.
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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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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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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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Bruehl S, Milne G, Polkowski G, Shinar A, Anderson S, Mishra P, Larach DB, Martin R, Billings FT. Oxidative stress mediates associations between preoperative psychosocial phenotype and pain-related outcomes at 6 months following total knee arthroplasty: a longitudinal cohort study. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:71-77. [PMID: 37651583 PMCID: PMC10765146 DOI: 10.1093/pm/pnad120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/13/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Greater preoperative depression, anxiety, and pain catastrophizing are associated with more severe long-term pain following total knee arthroplasty (TKA). In a secondary analysis of previously reported data, we tested the hypothesis that these associations are mediated by oxidative stress (OS). DESIGN A mixed between/within-subjects longitudinal cohort design. SETTING A single academic medical center. SUBJECTS Osteoarthritis patients (n = 91; 62.6% female) undergoing unilateral TKA. METHODS We assessed depression, anxiety, and catastrophizing, as well as markers of central sensitization (widespread pain, temporal summation of pain) preoperatively. Blood samples were then obtained immediately prior to intraoperative tourniquet placement for quantification of in vivo biomarkers of systemic OS, F2-isoprostanes and isofurans. Post-TKA pain intensity (numeric rating scale worst pain [NRS], McGill Pain Questionnaire-2 [MPQ-2]) and function (PROMIS Pain Interference) were assessed at 6 months following TKA. RESULTS Greater preoperative depression, catastrophizing, and widespread pain were associated with higher intraoperative combined OS (F2-isoprostanes+isofurans/2), which was in turn associated with higher post-TKA pain intensity and worse function (P < .05). All preoperative phenotype predictors except anxiety were correlated positively with post-TKA pain and/or function (P < .05). Bootstrapped mediation analyses revealed significant (P < .05) indirect (mediated) effects of depression (NRS Worst Pain, MPQ-2, PROMIS Pain Interference), anxiety (MPQ-2, PROMIS Pain Interference), and catastrophizing (PROMIS Pain Interference) on adverse long-term post-TKA outcomes via elevated OS. Central sensitization-related predictors demonstrated only direct effects (P < .05) on post-TKA outcomes that were independent of OS mechanisms. CONCLUSIONS Results suggest that the adverse impact of depression, anxiety, and pain catastrophizing on post-TKA pain and functional outcomes are mediated in part by elevated OS.
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Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37212, United States
| | - Ginger Milne
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37212, United States
| | - Gregory Polkowski
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, United States
| | - Andrew Shinar
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, United States
| | - Sara Anderson
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37212, United States
| | - Puneet Mishra
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37212, United States
| | - Daniel B Larach
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37212, United States
| | - Ryan Martin
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, United States
| | - Frederic T Billings
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37212, United States
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8
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Morris MC, Goodin BR, Bruehl S, Myers H, Rao U, Karlson C, Huber FA, Nag S, Carter C, Kinney K, Dickens H. Adversity type and timing predict temporal summation of pain in African-American adults. J Behav Med 2023; 46:996-1009. [PMID: 37563499 PMCID: PMC10592130 DOI: 10.1007/s10865-023-00440-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
African Americans are disproportionately exposed to adversity across the lifespan, which includes both stressful and traumatic events. Adversity, in turn, is associated with alterations in pain responsiveness. Racial differences in pain responsiveness among healthy adults are well established. However, the extent to which adversity type and timing are associated with alterations in pain responsiveness among healthy African-American adults is not well understood. The present study included 160 healthy African-American adults (98 women), ages 18 to 45. Outcome measures included pain tolerance and temporal summation of pain to evoked thermal pain. Composite scores were created for early-life adversity (childhood trauma, family adversity) and recent adversity (perceived stress, chronic stress burden). A measure of lifetime racial discrimination was also included. Higher levels of recent adversity were associated with higher temporal summation of pain, controlling for gender, age, and education. Neither early-life adversity nor lifetime racial discrimination were associated with temporal summation of pain. The present findings suggest that heightened temporal summation of pain among healthy African-American adults is associated with exposure to recent adversity events. Improved understanding of how recent adversity contributes to heightened temporal summation of pain in African Americans could help to mitigate racial disparities in pain experiences by identifying at-risk individuals who could benefit from early interventions.
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Affiliation(s)
- Matthew C Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA.
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
- , 2525 West End Ave, Nashville, TN, 37206, USA.
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, England
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hector Myers
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Uma Rao
- Department of Psychiatry & Human Behavior and Center for the Neurobiology of Learning and Memory, University of California - Irvine, California, CA, USA
- Children's Hospital of Orange County, Orange, CA, USA
| | - Cynthia Karlson
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Pediatrics, Hematology and Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Felicitas A Huber
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Subodh Nag
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, TN, USA
| | - Chelsea Carter
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, TN, USA
| | - Kerry Kinney
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Harrison Dickens
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
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9
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Riddle DL, Dumenci L. A Latent Change Score Approach to Understanding Chronic Bodily Pain Outcomes Following Knee Arthroplasty: A Secondary Analysis of Longitudinal Data. J Bone Joint Surg Am 2023; 105:1574-1582. [PMID: 37616392 PMCID: PMC10592085 DOI: 10.2106/jbjs.23.00214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND The extent to which chronic bodily pain changes following total knee arthroplasty (TKA) is unknown. We determined the extent of chronic bodily pain changes at 1 year following TKA. METHODS Data from our randomized trial of pain coping skills, which revealed no effect of the studied interventions, were used. The presence and severity of chronic pain in 16 body regions, excluding the surgically treated knee, were determined prior to and 1 year following surgery. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale was used to quantify the extent of surgical knee pain. Latent change score (LCS) models were used to determine the extent to which true chronic bodily pain scores change after TKA. RESULTS The mean age of the sample of 367 participants was 63.4 ± 8.0 years, and 247 (67%) were female. LCS analyses showed significant 20% to 54% reductions in pain in the surgically treated lower limb (not including the surgically treated knee), pain in the non-surgically treated lower limb, and whole body pain. In bivariate LCS analyses, greater improvement in the WOMAC pain score, indicating surgical benefit of TKA, led to greater improvement in all 4 bodily pain areas beyond the surgically treated knee, even after controlling for the latent change in pain catastrophizing. CONCLUSIONS Clinically important chronic bodily pain reductions occurred following TKA and may be causally linked to the surgical procedure. Reduction in chronic bodily pain in sites other than the surgically treated knee is an additional benefit of TKA. LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel L Riddle
- Departments of Physical Therapy, Orthopaedic Surgery, and Rheumatology, Virginia Commonwealth University, Richmond, Virginia
| | - Levent Dumenci
- Department of Epidemiology and Biostatistics, Temple University, Philadelphia, Pennsylvania
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10
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Sluka KA, Wager TD, Sutherland SP, Labosky PA, Balach T, Bayman EO, Berardi G, Brummett CM, Burns J, Buvanendran A, Caffo B, Calhoun VD, Clauw D, Chang A, Coffey CS, Dailey DL, Ecklund D, Fiehn O, Fisch KM, Frey Law LA, Harris RE, Harte SE, Howard TD, Jacobs J, Jacobs JM, Jepsen K, Johnston N, Langefeld CD, Laurent LC, Lenzi R, Lindquist MA, Lokshin A, Kahn A, McCarthy RJ, Olivier M, Porter L, Qian WJ, Sankar CA, Satterlee J, Swensen AC, Vance CG, Waljee J, Wandner LD, Williams DA, Wixson RL, Zhou XJ. Predicting chronic postsurgical pain: current evidence and a novel program to develop predictive biomarker signatures. Pain 2023; 164:1912-1926. [PMID: 37326643 PMCID: PMC10436361 DOI: 10.1097/j.pain.0000000000002938] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 06/17/2023]
Abstract
ABSTRACT Chronic pain affects more than 50 million Americans. Treatments remain inadequate, in large part, because the pathophysiological mechanisms underlying the development of chronic pain remain poorly understood. Pain biomarkers could potentially identify and measure biological pathways and phenotypical expressions that are altered by pain, provide insight into biological treatment targets, and help identify at-risk patients who might benefit from early intervention. Biomarkers are used to diagnose, track, and treat other diseases, but no validated clinical biomarkers exist yet for chronic pain. To address this problem, the National Institutes of Health Common Fund launched the Acute to Chronic Pain Signatures (A2CPS) program to evaluate candidate biomarkers, develop them into biosignatures, and discover novel biomarkers for chronification of pain after surgery. This article discusses candidate biomarkers identified by A2CPS for evaluation, including genomic, proteomic, metabolomic, lipidomic, neuroimaging, psychophysical, psychological, and behavioral measures. Acute to Chronic Pain Signatures will provide the most comprehensive investigation of biomarkers for the transition to chronic postsurgical pain undertaken to date. Data and analytic resources generatedby A2CPS will be shared with the scientific community in hopes that other investigators will extract valuable insights beyond A2CPS's initial findings. This article will review the identified biomarkers and rationale for including them, the current state of the science on biomarkers of the transition from acute to chronic pain, gaps in the literature, and how A2CPS will address these gaps.
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Affiliation(s)
- Kathleen A. Sluka
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Tor D. Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH
| | - Stephani P. Sutherland
- Department of Biostatistics, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD
| | - Patricia A. Labosky
- Office of Strategic Coordination, Division of Program Coordination, Planning and Strategic Initiatives, Office of the Director, National Institutes of Health, Bethesda, MD
| | - Tessa Balach
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago, Chicago, IL
| | - Emine O. Bayman
- Clinical Trials and Data Management Center, Department of Biostatistics, University of Iowa, Iowa City, IA
| | - Giovanni Berardi
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Chad M. Brummett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI
| | - John Burns
- Division of Behavioral Sciences, Rush Medical College, Chicago, IL
| | | | - Brian Caffo
- Department of Biostatistics, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD
| | - Vince D. Calhoun
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State, Georgia Tech, and Emory University, Atlanta, GA
| | - Daniel Clauw
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI
| | - Andrew Chang
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Christopher S. Coffey
- Clinical Trials and Data Management Center, Department of Biostatistics, University of Iowa, Iowa City, IA
| | - Dana L. Dailey
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Dixie Ecklund
- Clinical Trials and Data Management Center, Department of Biostatistics, University of Iowa, Iowa City, IA
| | - Oliver Fiehn
- University of California, Davis, Davis, CA, United States
| | - Kathleen M. Fisch
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, CA, United States
- Center for Computational Biology and Bioinformatics, University of California San Diego, San Diego, CA, United States
| | - Laura A. Frey Law
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Richard E. Harris
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI
| | - Timothy D. Howard
- Department of Biochemistry, Center for Precision Medicine, Wake Forest School of Medicine, Winstom-Salem, NC
- Center for Precision Medicine, Wake Forest School of Medicine, Winstom-Salem, NC
| | - Joshua Jacobs
- Department of Orthopedic Surgery, Rush Medical College, CHicago, IL
| | - Jon M. Jacobs
- Environmental and Molecular Sciences Laboratory, Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA
| | | | | | - Carl D. Langefeld
- Center for Precision Medicine, Wake Forest School of Medicine, Winstom-Salem, NC
- Department of Biostatistics and Data Science, Center for Precision Medicine, Wake Forest School of Medicine, Winstom-Salem, NC
| | - Louise C. Laurent
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, CA, United States
| | - Rebecca Lenzi
- Office of Strategic Coordination, Division of Program Coordination, Planning and Strategic Initiatives, Office of the Director, National Institutes of Health, Bethesda, MD
| | - Martin A. Lindquist
- Department of Biostatistics, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD
| | | | - Ari Kahn
- Texas Advanced Computing Center, University of Texas, AUstin, TX
| | | | - Michael Olivier
- Center for Precision Medicine, Wake Forest School of Medicine, Winstom-Salem, NC
- Department of Internal Medicine, Center for Precision Medicine, Wake Forest School of Medicine, Winstom-Salem, NC
| | - Linda Porter
- National Institute of Neurological Disorders and Stroke, Bethesda, MD
- Office of Pain Policy and Planning National Institutes of Health, Bethesda, MD
| | - Wei-Jun Qian
- Environmental and Molecular Sciences Laboratory, Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA
| | - Cheryse A. Sankar
- National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | | | - Adam C. Swensen
- Environmental and Molecular Sciences Laboratory, Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA
| | - Carol G.T. Vance
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Jennifer Waljee
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Laura D. Wandner
- National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - David A. Williams
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI
| | | | - Xiaohong Joe Zhou
- Center for MR Research and Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois College of Medicine at Chicago, Chicago, IL, United States
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Danielsen AV, Andreasen JJ, Dinesen B, Hansen J, Kjær-Staal Petersen K, Simonsen C, Arendt-Nielsen L. Chronic post-thoracotomy pain after lung cancer surgery: a prospective study of preoperative risk factors. Scand J Pain 2023; 23:501-510. [PMID: 37327358 DOI: 10.1515/sjpain-2023-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/27/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES The objective of this longitudinal cohort study was to investigate if preoperative pain mechanisms, anxiety, and depression increase risk of developing chronic post-thoracotomy pain (CPTP) after lung cancer surgery. METHODS Patients with suspected or confirmed lung cancer undergoing surgery by either video-assisted thoracoscopic surgery or anterior thoracotomy were recruited consecutively. Preoperative assessments were conducted by: quantitative sensory testing (QST) (brush, pinprick, cuff pressure pain detection threshold, cuff pressure tolerance pain threshold, temporal summation and conditioned pain modulation), neuropathic pain symptom inventory (NPSI), and the Hospital Anxiety and Depression Scale (HADS). Clinical parameters in relation to surgery were also collected. Presence of CPTP was determined after six months and defined as pain of any intensity in relation to the operation area on a numeric rating scale form 0 (no pain) to 10 (worst pain imaginable). RESULTS A total of 121 patients (60.2 %) completed follow-up and 56 patients (46.3 %) reported CPTP. Development of CPTP was associated with higher preoperative HADS score (p=0.025), higher preoperative NPSI score (p=0.009) and acute postoperative pain (p=0.042). No differences were observed in relation to preoperative QST assessment by cuff algometry and HADS anxiety and depression sub-scores. CONCLUSIONS High preoperative HADS score preoperative pain, acute postoperative pain intensity, and preoperative neuropathic symptoms were was associated with CPTP after lung cancer surgery. No differences in values of preoperative QST assessments were found. Preoperative assessment and identification of patients at higher risk of postoperative pain will offer opportunity for further exploration and development of preventive measures and individualised pain management depending on patient risk profile.
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Affiliation(s)
- Allan Vestergaard Danielsen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Birthe Dinesen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Laboratory of Welfare Technologies - Digital Health & Rehabilitation, Aalborg, Denmark
| | - John Hansen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, CardioTech Research Group, Aalborg, Denmark
| | - Kristian Kjær-Staal Petersen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg, Denmark
| | - Carsten Simonsen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg, Denmark
- Department of Clinical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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12
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Petersen KKS, Kilic K, Hertel E, Sejersgaard-Jacobsen TH, Jørgensen MK, Troelsen A, Arendt-Nielsen L, Boye Larsen D. Quantitative sensory testing as an assessment tool to predict the response to standard pain treatment in knee osteoarthritis: a systematic review and meta-analysis. Pain Rep 2023; 8:e1079. [PMID: 38699564 PMCID: PMC11065125 DOI: 10.1097/pr9.0000000000001079] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/27/2023] [Accepted: 03/09/2023] [Indexed: 05/05/2024] Open
Abstract
Emerging evidence suggest that quantitative sensory testing (QST) may predict the treatment response to pain-relieving therapies. This systematic review and meta-analysis focus on the predictive value of QST for pain management of knee osteoarthritis (OA). MEDLINE and EMBASE were systematically searched for all studies from year 2000 to 2023 on pretreatment QST and treatment of OA including surgical, pharmaceutical, and nonsurgical and nonpharmaceutical therapies. Preclinical studies and reviews were excluded. The systematic review followed the PRISMA guidelines and was pre-registered on the Open Science Framework website (link: https://osf.io/4FETK/, Identifier: DOI 10.17605/OSF.IO/4FETK). Meta-analysis were conducted to demonstrate the strength of the pre-treatment QST predictions on pain outcomes after OA treatments. Sixteen surgical (all on total knee arthroplasty [TKA], N = 1967), 5 pharmaceutical (4 on non-steroidal anti-inflammatory drugs [NSAIDs], N = 271), and 4 exercise-based therapy studies (N = 232) were identified. Pretreatment QST parameters predicted pain-relieving treatment outcomes in 81% of surgical, 100% of pharmaceutical, and 50% of exercise-based therapy studies. Meta-analyses found pretreatment QST profiles to predicted pain outcomes after TKA (random effects: 0.309, 95% confidence interval [CI]: 0.206-0.405, P < 0.001), NSAIDs (random effects: 0.323, 95% CI: 0.194-0.441, P < 0.001), and exercise-based therapies (random effects: 0.417, 95% CI: 0.138-0.635, P = 0.004). The overall risk of bias for the included studies was low to moderate. This systematic review and meta-analysis demonstrate weak-to-moderate associations between pretreatment QST and pain outcomes after standard OA pain treatments. Based on this work, it is hypothesized that a subset of specific pain sensitive patients with OA exist and that these patients do not respond adequately to standard OA pain treatments.
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Affiliation(s)
- Kristian Kjær-Staal Petersen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School 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
| | - Kübra Kilic
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Emma Hertel
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School 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
| | - Trine Hyttel Sejersgaard-Jacobsen
- Department of Anesthesia, Aalborg University Hospital, Thisted, Denmark
- Department of Orthopedic Anesthesia, Aalborg University Hospital, Aalborg, Denmark
| | - Marlene Kanstrup Jørgensen
- Department of Anesthesia, Aalborg University Hospital, Thisted, Denmark
- Department of Orthopedic Anesthesia, Aalborg University Hospital, Aalborg, Denmark
| | - Anders Troelsen
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School 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
| | - Dennis Boye Larsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
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13
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Corrigan P, Neogi T, Frey-Law L, Jafarzadeh SR, Segal N, Nevitt MC, Lewis CE, Stefanik JJ. Relation of pain sensitization to self-reported and performance-based measures of physical functioning: the Multicenter Osteoarthritis (MOST) study. Osteoarthritis Cartilage 2023; 31:966-975. [PMID: 37003421 PMCID: PMC10330303 DOI: 10.1016/j.joca.2023.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE It is unclear if alterations in nociceptive signaling contribute to poor physical functioning in persons with knee osteoarthritis (OA). We aimed to characterize the relation of pain sensitization to physical functioning in persons with or at risk for knee OA, and determine if knee pain severity mediates these relationships. MATERIALS AND METHODS We used cross-sectional data from the Multicenter Osteoarthritis Study, a cohort study of persons with or at risk for knee OA. Pressure pain thresholds (PPTs) and temporal summation (TS) were assessed with quantitative sensory testing. Self-reported function was quantified with the Western Ontario and McMaster Universities Arthritis Index function subscale (WOMAC-F). Walking speed was determined during a 20-m walk. Knee extension strength was assessed with dynamometry. Relations of PPTs and TS to functional outcomes were examined with linear regression. The mediating role of knee pain severity was assessed with mediation analyses. RESULTS Among 1560 participants (60.5% female, mean age (SD) 67 (8), body mass index (BMI) 30.2 (5.5) kg/m2), lower PPTs and the presence of TS were associated with worse WOMAC-F scores, slower walking speeds, and weaker knee extension. The extent of mediation by knee pain severity was mixed, with the greatest mediation observed for self-report function and only minimally for performance-based function. CONCLUSIONS Heightened pain sensitivity appears to be meaningfully associated with weaker knee extension in individuals with or at risk for knee OA. Relations to self-reported physical function and walking speed do not seem clinically meaningful. Knee pain severity differentially mediated these relationships.
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Affiliation(s)
- P Corrigan
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA; Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, MO, USA.
| | - T Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA.
| | - L Frey-Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA.
| | - S R Jafarzadeh
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA.
| | - N Segal
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
| | - M C Nevitt
- Department of Epidemiology and Biostatistics, University of California - San Francisco, San Francisco, CA, USA.
| | - C E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - J J Stefanik
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA.
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Aoyagi K, Law LF, Carlesso L, Nevitt M, Lewis CE, Wang N, Neogi T. Post-surgical contributors to persistent knee pain following knee replacement: The Multicenter Osteoarthritis Study (MOST). OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100335. [PMID: 36798734 PMCID: PMC9926203 DOI: 10.1016/j.ocarto.2023.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Objective Pain persistence following knee replacement (KR) occurs in ∼20-30% of patients. Although several studies have identified preoperative risk factors for persistent post-KR pain, few have focused on post-KR contributing factors. We sought to determine whether altered nociceptive signaling and other peripheral nociceptive drivers present post-operatively contribute to post-KR pain. Design We included participants from the Multicenter Osteoarthritis Study who were evaluated ∼12 months after KR. We evaluated the relation of measures of pain sensitivity [pressure pain threshold (PPT), temporal summation (TS), and conditioned pain modulation (CPM)] and the number of painful body sites to post-KR WOMAC knee pain, and of the number of painful sites to altered nociceptive signaling using linear or logistic regression models, as appropriate. Results 171 participants (mean age 69 years, 62% female) were included. TS was associated with worse WOMAC pain post-KR (β = 0.77 95% CI:0.19-1.35) and reduced odds of achieving patient acceptable symptom state (aOR = 0.54 95%CI:0.34-0.88). Inefficient CPM was also associated with worse WOMAC pain post-KR (β = 1.43 95% CI:0.15-2.71). In contrast, PPT was not associated with these outcomes. The number of painful body sites present post-KR was associated with TS (β = 0.05, 95% CI:0.01, 0.05). Conclusions Post-KR presence of central sensitization and inefficient descending pain modulation was associated with post-KR pain. We also noted that presence of other painful body sites contributes to altered nociceptive signaling, and this may thus also contribute to the experience of knee pain post-KR. Our findings provide novel insights into central pain mechanisms and other peripheral pain sources contributing to post-KR persistent knee pain.
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Affiliation(s)
- Kosaku Aoyagi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
- Department of Rehabilitation Sciences, University of Texas at El Paso, El Paso, TX, USA
| | | | | | - Michael Nevitt
- University of California San Francisco, San Francisco, CA, USA
| | | | - Na Wang
- Boston University School of Public Health, Boston, MA, USA
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
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Petersen KKS. Predicting pain after standard pain therapy for knee osteoarthritis - the first steps towards personalized mechanistic-based pain medicine in osteoarthritis. Scand J Pain 2023; 23:40-48. [PMID: 35993966 DOI: 10.1515/sjpain-2022-0082] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/01/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The prevalence of osteoarthritis (OA) is rising, and pain is the hallmark symptom of OA. Pain in OA is complicated and can be influenced by multiple joint-related factors and factors related to, e.g., physiological, epigenetic, and pain sensory profiles. Increasing evidence suggests that a subset of patients with OA are pain sensitive. This can be assessed using quantitative sensory testing (QST). Common treatments of OA are total knee arthroplasty (TKA) and administration of 3-weeks of non-steroidal anti-inflammatory drugs (NSAIDs), which provide pain relief to many patients with OA. However, approx. 20% of patients experience chronic postoperative pain after TKA, whereas NSAIDs provide an average pain relief of approx. 25%. The current topical review focuses on the emerging evidence linking pretreatment QST to the treatment response of TKA and NSAID treatments. CONTENT MEDLINE was systematically searched for all studies from 2000 to 2022 on pretreatment QST, TKA, and NSAIDs. Pre-clinical studies, reviews, and meta-analyses were excluded. SUMMARY Currently, 14 studies on TKA and four studies on NSAIDs have been published with the aim to attempt prediction of the treatment response. The QST methodologies in the studies are inconsistent, but 11/14 (79%) studies on TKA and 4/4 (100%) studies on NSAIDs report statistically significant associations between pretreatment QST and chronic postoperative pain after TKA or analgesic effect after NSAID treatment. The strength of the associations remains low-to-moderate. The most consistent pretreatment QST predictors are pressure pain thresholds, temporal summation of pain, and conditioned pain modulation. OUTLOOK The use of QST as predictors of standard OA treatment is interesting, but the predictive strength remains low-to-moderate. A transition of QST from a research-based setting and into the clinic is not advised until the predictive strength has been improved and the methodology has been standardized.
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Affiliation(s)
- Kristian Kjær-Staal Petersen
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Center for Mathematical Modelling of Knee Osteoarthritis, Department of Materials and Production, Aalborg University, Aalborg, Denmark
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16
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Hattori T, Ohga S, Shimo K, Niwa Y, Tokiwa Y, Matsubara T. Predictive Value of Pain Sensitization Associated with Response to Exercise Therapy in Patients with Knee Osteoarthritis: A Prospective Cohort Study. J Pain Res 2022; 15:3537-3546. [PMID: 36394057 PMCID: PMC9653041 DOI: 10.2147/jpr.s385910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/10/2022] [Indexed: 05/01/2024] Open
Abstract
PURPOSE Knee osteoarthritis (KOA) is a degenerative disease with inflammation, becoming persistent as it progresses, resulting in reduced quality of life. Exercise is the recommended treatment for KOA; however, the extent of pain reduction with exercise is heterogeneous and the prognostic implications of baseline factors in patients undergoing exercise are still unknown. This study examined the association between the response to exercise therapy and clinical outcomes, radiologic severity, and pain sensitization, and investigated the optimal predictive value for the effectiveness of exercise. PATIENTS AND METHODS Demographics, radiologic severity, pressure pain threshold (PPT), and temporal summation of pain (TSP) at the knee, tibia, and forearm were assessed at baseline. The pain numeric rating scale (NRS) was assessed before and after 12 weeks of exercise. Patients were divided into responder/non-responder groups according to recommended criteria: responder, ≥30% reduction in pain; non-responder, <30% reduction in pain, and each variable was compared between the groups. The area under the curve (AUC) and cutoff points were determined by receiver operating characteristic curve analysis. RESULTS Sixty-five patients were categorized as responders and 26 as non-responders. In the non-responder group, baseline NRS (P<0.01), pain duration (P<0.01), and TSP at the knee (P<0.001) and tibia (P<0.05) were significantly higher, and PPT at the knee (P<0.001), tibia (P<0.001), and forearm (P<0.001) were significantly lower, than those in the responder group; however, no significant differences between groups were found in other demographics and radiologic severity. The variables that showed moderate or better predictive ability (AUC≥0.7) were PPT at the knee (cutoff points: 241.5 kPa), tibia (307.5 kPa), forearm (318.5 kPa), and TSP at the knee (15.5 mm). CONCLUSION Our findings suggest that pain sensitization is associated with the response to exercise therapy. Furthermore, we provide clinically predictive values for PPT and TSP in predicting the outcome to exercise 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
| | - Yuto Niwa
- Faculty of Rehabilitation, Kobe Gakuin University Graduate School, Kobe, Hyogo, Japan
| | - Yuji Tokiwa
- Faculty of Rehabilitation, Kobe Gakuin University Graduate School, 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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17
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Klasan A, Rice DA, Kluger MT, Borotkanics R, McNair PJ, Lewis GN, Young SW. A combination of high preoperative pain and low radiological grade of arthritis is associated with a greater intensity of persistent pain 12 months after total knee arthroplasty. Bone Joint J 2022; 104-B:1202-1208. [DOI: 10.1302/0301-620x.104b11.bjj-2022-0630.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aims Despite new technologies for total knee arthroplasty (TKA), approximately 20% of patients are dissatisfied. A major reason for dissatisfaction and revision surgery after TKA is persistent pain. The radiological grade of osteoarthritis (OA) preoperatively has been investigated as a predictor of the outcome after TKA, with conflicting results. The aim of this study was to determine if there is a difference in the intensity of pain 12 months after TKA in relation to the preoperative radiological grade of OA alone, and the combination of the intensity of preoperative pain and radiological grade of OA. Methods The preoperative data of 300 patients who underwent primary TKA were collected, including clinical information (age, sex, preoperative pain), psychological variables (depression, anxiety, pain catastrophizing, anticipated pain), and quantitative sensory testing (temporal summation, pressure pain thresholds, conditioned pain modulation). The preoperative radiological severity of OA was graded according to the Kellgren-Lawrence (KL) classification. Persistent pain in the knee was recorded 12 months postoperatively. Generalized linear models explored differences in postoperative pain according to the KL grade, and combined preoperative pain and KL grade. Relative risk models explored which preoperative variables were associated with the high preoperative pain/low KL grade group. Results Pain 12 months after TKA was not associated with the preoperative KL grade alone. Significantly increased pain 12 months after TKA was found in patients with a combination of high preoperative pain and a low KL grade (p = 0.012). Patients in this group were significantly more likely to be male, younger, and have higher preoperative pain catastrophizing, higher depression, and lower anxiety (all p ≤ 0.05). Conclusion Combined high preoperative pain and low radiological grade of OA, but not the radiological grade alone, was associated with a higher intensity of pain 12 months after primary TKA. This group may have a more complex cause of pain that requires additional psychological interventions in order to optimize the outcome of TKA. Cite this article: Bone Joint J 2022;104-B(11):1202–1208.
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Affiliation(s)
- Antonio Klasan
- Kepler University Hospital, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
- Department of Orthopaedic Surgery, Te Whatu Ora Waitematā, Auckland, New Zealand
| | - David A. Rice
- Health and Rehabilitation Research Insitute, Auckland University of Technology, Auckland, New Zealand
- Department of Anaesthesiology and Perioperative Medicine, Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Michal T. Kluger
- Department of Anaesthesiology and Perioperative Medicine, Te Whatu Ora Waitematā, Auckland, New Zealand
- Department of Anaesthesiology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Robert Borotkanics
- Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand
| | - Peter J. McNair
- Health and Rehabilitation Research Insitute, Auckland University of Technology, Auckland, New Zealand
| | - Gwyn N. Lewis
- Health and Rehabilitation Research Insitute, Auckland University of Technology, Auckland, New Zealand
| | - Simon W. Young
- Department of Orthopaedic Surgery, Te Whatu Ora Waitematā, Auckland, New Zealand
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18
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Zhao J, Liang G, Hong K, Pan J, Luo M, Liu J, Huang B. Risk factors for postoperative delirium following total hip or knee arthroplasty: A meta-analysis. Front Psychol 2022; 13:993136. [PMID: 36248575 PMCID: PMC9565976 DOI: 10.3389/fpsyg.2022.993136] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThe purpose of this study was to identify risk factors for delirium after total joint arthroplasty (TJA) and provide theoretical guidance for reducing the incidence of delirium after TJA.MethodsThe protocol for this meta-analysis is registered with PROSPERO (CRD42020170031). We searched PubMed, the Cochrane Library and Embase for observational studies on risk factors for delirium after TJA. Review Manager 5.3 was used to calculate the relative risk (RR) or standard mean difference (SMD) of potential risk factors related to TJA. STATA 14.0 was used for quantitative publication bias evaluation.ResultsIn total, 25 studies including 3,767,761 patients from 9 countries were included. Old age has been widely recognized as a risk factor for delirium. Our results showed that the main risk factors for delirium after TJA were patient factors (alcohol abuse: RR = 1.63; length of education: SMD = −0.93; and MMSE score: SMD = −0.39), comorbidities (hypertension: RR = 1.26; diabetes mellitus: RR = 1.67; myocardial infarction: RR = 17.75; congestive heart failure: RR = 2.54; dementia: RR = 17.75; renal disease: RR = 2.98; history of stroke: RR = 4.83; and history of mental illness: RR = 2.36), surgical factors (transfusion: RR = 1.53; general anesthesia: RR = 1.10; pre-operative albumin: SMD = −0.38; pre-operative hemoglobin: SMD = −0.29; post-operative hemoglobin: SMD = −0.24; total blood loss: SMD = 0.15; duration of surgery: SMD = 0.29; and duration of hospitalization: SMD = 2.00) and drug factors (benzodiazepine use: RR = 2.14; ACEI use: RR = 1.52; and beta-blocker use: RR = 1.62).ConclusionsMultiple risk factors were associated with delirium after TJA. These results may help doctors predict the occurrence of delirium after surgery and determine the correct treatment.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42020170031.
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Affiliation(s)
- Jinlong Zhao
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Guihong Liang
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Kunhao Hong
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
| | - Jianke Pan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Minghui Luo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun Liu
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Jun Liu
| | - Bin Huang
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Bin Huang
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19
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Kirksey MA, Lessard SG, Khan M, Birch GA, Oliver D, Singh P, Rotundo V, Sideris A, Gonzalez Della Valle A, Parks ML, Sculco PK, Otero M. Association of circulating gene expression signatures with stiffness following total knee arthroplasty for osteoarthritis: a pilot study. Sci Rep 2022; 12:12651. [PMID: 35879399 PMCID: PMC9314445 DOI: 10.1038/s41598-022-16868-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/18/2022] [Indexed: 11/22/2022] Open
Abstract
A subset of patients undergoing total knee arthroplasty (TKA) for knee osteoarthritis develop debilitating knee stiffness (reduced range of motion) for poorly understood reasons. Dysregulated inflammatory and immune responses to surgery correlate with reduced surgical outcomes, but the dysregulated gene signatures in patients with stiffness after TKA are poorly defined. As a consequence, we are limited in our ability to identify patients at risk of developing poor surgical outcomes and develop preventative approaches. In this pilot study we aimed to identify perioperative blood gene signatures in patients undergoing TKA for knee osteoarthritis and its association with early surgical outcomes, specifically knee range of motion. To do this, we integrated clinical outcomes collected at 6 weeks after surgery with transcriptomics analyses in blood samples collected immediately before surgery and at 24 h after surgery. We found that patients with stiffness at 6 weeks after surgery have a more variable and attenuated circulating gene expression response immediately after surgery. Our results suggest that patients with stiffness following TKA may have distinct gene expression signatures detectable in peripheral blood in the immediate postoperative period.
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Affiliation(s)
- Meghan A Kirksey
- Hospital for Special Surgery, New York, NY, 10021, USA.,Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, NY, 10021, USA.,Weill Cornell Medical College, New York, NY, 10021, USA
| | - Samantha G Lessard
- Hospital for Special Surgery, New York, NY, 10021, USA.,HSS Research Institute, Hospital for Special Surgery, New York, NY, 10021, USA.,Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Marjan Khan
- Hospital for Special Surgery, New York, NY, 10021, USA.,HSS Research Institute, Hospital for Special Surgery, New York, NY, 10021, USA.,Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY, 10021, USA
| | - George A Birch
- Hospital for Special Surgery, New York, NY, 10021, USA.,Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, NY, 10021, USA
| | - David Oliver
- Hospital for Special Surgery, New York, NY, 10021, USA.,HSS Research Institute, Hospital for Special Surgery, New York, NY, 10021, USA.,The David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Purva Singh
- Hospital for Special Surgery, New York, NY, 10021, USA.,HSS Research Institute, Hospital for Special Surgery, New York, NY, 10021, USA.,Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Valeria Rotundo
- Hospital for Special Surgery, New York, NY, 10021, USA.,Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Alexandra Sideris
- Hospital for Special Surgery, New York, NY, 10021, USA.,Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, NY, 10021, USA
| | | | - Alejandro Gonzalez Della Valle
- Hospital for Special Surgery, New York, NY, 10021, USA.,Weill Cornell Medical College, New York, NY, 10021, USA.,The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Michael L Parks
- Hospital for Special Surgery, New York, NY, 10021, USA.,Weill Cornell Medical College, New York, NY, 10021, USA.,The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Peter K Sculco
- Hospital for Special Surgery, New York, NY, 10021, USA.,Weill Cornell Medical College, New York, NY, 10021, USA.,The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Miguel Otero
- Hospital for Special Surgery, New York, NY, 10021, USA. .,Weill Cornell Medical College, New York, NY, 10021, USA. .,HSS Research Institute, Hospital for Special Surgery, New York, NY, 10021, USA. .,Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY, 10021, USA. .,The David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, NY, 10021, USA.
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20
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Petersen KKS, Drewes AM, Olesen AE, Ammitzbøll N, Bertoli D, Brock C, Arendt-Nielsen L. The Effect of Duloxetine on Mechanistic Pain Profiles, Cognitive Factors, and Clinical Pain in Patients with Painful Knee Osteoarthritis - A Randomized, Double-Blind, Placebo-Controlled, Crossover Study. Eur J Pain 2022; 26:1650-1664. [PMID: 35638317 PMCID: PMC9541875 DOI: 10.1002/ejp.1988] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/03/2022] [Accepted: 05/21/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Duloxetine is indicated in the management of pain in osteoarthritis. Evidence suggests that duloxetine modulate central pain mechanisms and cognitive factors, and these factors are assumed contributing to the analgesic effect. This proof-of-mechanism, randomized, placebo-controlled, crossover, double-blinded trial evaluated the effect of duloxetine on quantitative sensory testing (QST), cognitive factors, and clinical pain in patients with osteoarthritis and to predict the analgesic effect. METHODS Twenty-five patients completed this cross-over study with either 18-weeks duloxetine (maximum 60 mg/daily) followed by placebo or vice-versa. Pressure pain thresholds, temporal summation of pain, and conditioned pain modulation were assessed using cuff algometry. The Hospital Anxiety and Depression Scale and the Pain Catastrophizing Scale evaluated cognitive factors. Clinical pain was assessed using Brief Pain Inventory and Western Ontario and McMaster Universities Osteoarthritis Index. Linear regression models were used to predict the analgesic effect of duloxetine. RESULTS Depending on the clinical pain outcome, 40-68% of patients were classified as responders to duloxetine. Linear regression models predicted the analgesic effect (predictive value of 45-75% depending on clinical pain outcome parameter) using a combination of pre-treatment QST parameters, cognitive factors, and clinical pain. No significant changes were found for QST, cognitive factors, or clinical pain on a group level when comparing duloxetine to placebo. CONCLUSION A combination of pre-treatment QST, cognitive factors, and clinical pain was able to predict the analgesic response of duloxetine. However, in this relatively small study, duloxetine did not selectively modulate QST, cognitive factors, or clinical pain intensity when compared with placebo.
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Affiliation(s)
- Kristian Kjaer-Staal Petersen
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, 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
| | - Nadia Ammitzbøll
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Davide Bertoli
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Christina Brock
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain, 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
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21
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Mechanisms and manifestations in musculoskeletal pain: from experimental to clinical pain settings. Pain 2022; 163:S29-S45. [PMID: 35984370 DOI: 10.1097/j.pain.0000000000002690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/09/2022] [Indexed: 01/18/2023]
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22
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Detection of altered pain facilitatory and inhibitory mechanisms in patients with knee osteoarthritis by using a simple bedside tool kit (QuantiPain). Pain Rep 2022; 7:e998. [PMID: 35392651 PMCID: PMC8984378 DOI: 10.1097/pr9.0000000000000998] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/25/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. A simple bedside quantitative sensory testing tool kit demonstrated acceptable reliability and assessment validity for detecting altered pain facilitatory and inhibitory mechanisms in patients with painful osteoarthritis. Purpose: Altered pain facilitatory and inhibitory mechanisms have been recognized as an important manifestation in patients with chronic pain, and quantitative sensory testing (QST) can act as a proxy for this process. We have recently developed a simple bedside QST tool kit (QuantiPain) for more clinical use. The purpose of this study was to investigate its test–retest reliability and to evaluate its validity compared with the laboratory-based QST protocols in patients with knee osteoarthritis (OA). Methods: QuantiPain consists of 3 items: “pressure algometer” (for pressure pain thresholds [PPTs]), “pinprick” (for temporal summation of pain [TSP]), and “conditioning clamp” (for conditioned pain modulation [CPM]). In experiment-A, intrarater and interrater test–retest reliabilities were investigated in 21 young healthy subjects by using interclass correlation coefficient (ICC). In experiment-B, 40 unilateral painful patients with OA and 40 age-matched, healthy control subjects were included to compare the bedside tool kit against the computerized pressure algometry. Results: In experiment-A, excellent to moderate intrarater and interrater reliabilities were achieved in PPT and TSP (ICC: 0.60–0.92) while the agreements of CPM were good to poor (ICC: 0.37–0.80). In experiment-B, localized and widespread decrease of PPT, facilitated TSP, and impaired CPM was found by using the bedside tool kit in patients with OA compared with controls (P < 0.05). The data were significantly correlated with the established laboratory-based tools (R = 0.281–0.848, P < 0.05). Conclusion: QuantiPain demonstrated acceptable test–retest reliability and assessment validity with the sensitivity to separate patients with painful OA from controls, which has a potential to create more practical approach for quantifying altered pain mechanisms in clinical settings.
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23
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Berardi G, Frey-Law L, Sluka KA, Bayman EO, Coffey CS, Ecklund D, Vance CGT, Dailey DL, Burns J, Buvanendran A, McCarthy RJ, Jacobs J, Zhou XJ, Wixson R, Balach T, Brummett CM, Clauw D, Colquhoun D, Harte SE, Harris RE, Williams DA, Chang AC, Waljee J, Fisch KM, Jepsen K, Laurent LC, Olivier M, Langefeld CD, Howard TD, Fiehn O, Jacobs JM, Dakup P, Qian WJ, Swensen AC, Lokshin A, Lindquist M, Caffo BS, Crainiceanu C, Zeger S, Kahn A, Wager T, Taub M, Ford J, Sutherland SP, Wandner LD. Multi-Site Observational Study to Assess Biomarkers for Susceptibility or Resilience to Chronic Pain: The Acute to Chronic Pain Signatures (A2CPS) Study Protocol. Front Med (Lausanne) 2022; 9:849214. [PMID: 35547202 PMCID: PMC9082267 DOI: 10.3389/fmed.2022.849214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic pain has become a global health problem contributing to years lived with disability and reduced quality of life. Advances in the clinical management of chronic pain have been limited due to incomplete understanding of the multiple risk factors and molecular mechanisms that contribute to the development of chronic pain. The Acute to Chronic Pain Signatures (A2CPS) Program aims to characterize the predictive nature of biomarkers (brain imaging, high-throughput molecular screening techniques, or "omics," quantitative sensory testing, patient-reported outcome assessments and functional assessments) to identify individuals who will develop chronic pain following surgical intervention. The A2CPS is a multisite observational study investigating biomarkers and collective biosignatures (a combination of several individual biomarkers) that predict susceptibility or resilience to the development of chronic pain following knee arthroplasty and thoracic surgery. This manuscript provides an overview of data collection methods and procedures designed to standardize data collection across multiple clinical sites and institutions. Pain-related biomarkers are evaluated before surgery and up to 3 months after surgery for use as predictors of patient reported outcomes 6 months after surgery. The dataset from this prospective observational study will be available for researchers internal and external to the A2CPS Consortium to advance understanding of the transition from acute to chronic postsurgical pain.
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Affiliation(s)
- Giovanni Berardi
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Laura Frey-Law
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Kathleen A. Sluka
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Emine O. Bayman
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, United States
| | - Christopher S. Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, United States
| | - Dixie Ecklund
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, United States
| | - Carol G. T. Vance
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Dana L. Dailey
- Department of Physical Therapy, St. Ambrose University, Davenport, IA, United States
| | - John Burns
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Asokumar Buvanendran
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, United States
| | - Robert J. McCarthy
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, United States
| | - Joshua Jacobs
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Xiaohong Joe Zhou
- Departments of Radiology, Neurosurgery, and Bioengineering, University of Illinois College of Medicine at Chicago, Chicago, IL, United States
| | - Richard Wixson
- NorthShore Orthopaedic and Spine Institute, NorthShore University HealthSystem, Skokie, IL, United States
| | - Tessa Balach
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago, Chicago, IL, United States
| | - Chad M. Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Daniel Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
- Department of Medicine (Rheumatology), University of Michigan, Ann Arbor, MI, United States
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Douglas Colquhoun
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
- Department of Medicine (Rheumatology), University of Michigan, Ann Arbor, MI, United States
| | - Richard E. Harris
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
- Department of Medicine (Rheumatology), University of Michigan, Ann Arbor, MI, United States
| | - David A. Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
- Department of Medicine (Rheumatology), University of Michigan, Ann Arbor, MI, United States
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Department of Psychology, University of Michigan, Ann Arbor, MI, United States
| | - Andrew C. Chang
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer Waljee
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Kathleen M. Fisch
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Kristen Jepsen
- Institute of Genomic Medicine Genomics Center, University of California, San Diego, La Jolla, CA, United States
| | - Louise C. Laurent
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Michael Olivier
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Carl D. Langefeld
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Timothy D. Howard
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Oliver Fiehn
- West Coast Metabolomics Center, University of California, Davis, Davis, CA, United States
| | - Jon M. Jacobs
- Environmental and Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, WA, United States
| | - Panshak Dakup
- Environmental and Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, WA, United States
| | - Wei-Jun Qian
- Environmental and Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, WA, United States
| | - Adam C. Swensen
- Environmental and Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, WA, United States
| | - Anna Lokshin
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Martin Lindquist
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Brian S. Caffo
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ciprian Crainiceanu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Scott Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ari Kahn
- Texas Advanced Computing Center, The University of Texas at Austin, Austin, TX, United States
| | - Tor Wager
- Presidential Cluster in Neuroscience, Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Margaret Taub
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - James Ford
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Stephani P. Sutherland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Laura D. Wandner
- National Institute of Neurological Disorders and Stroke, The National Institutes of Health, Bethesda, MD, United States
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24
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Morris MC, Bruehl S, Stone AL, Garber J, Smith C, Palermo TM, Walker LS. Place and Pain: Association Between Neighborhood SES and Quantitative Sensory Testing Responses in Youth With Functional Abdominal Pain. J Pediatr Psychol 2022; 47:446-455. [PMID: 34757421 PMCID: PMC9308448 DOI: 10.1093/jpepsy/jsab113] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Neighborhood socioeconomic status (SES) is linked to self-reported pain severity and disability but its association with evoked pain responsiveness in individuals with chronic pain remains unclear. The present study examined relations between neighborhood SES, assessed through the area deprivation index (ADI), and static and dynamic pain response indices. It was hypothesized that youth with functional abdominal pain (FAP) living in lower SES neighborhoods would exhibit lower pain threshold, lower pain tolerance, and reduced conditioned pain modulation (CPM) compared to youth living in higher SES neighborhoods. METHODS Participants were 183 youth with FAP and their parents. Youth completed a quantitative sensory testing protocol. Family addresses were used to compute ADI scores. Thermal stimuli for pain threshold and tolerance were delivered to participants' forearms using thermodes. CPM, an index of descending pain inhibition, was determined using a thermode as test stimulus and a hot water bath as conditioning stimulus. RESULTS As hypothesized, youth with FAP living in lower SES neighborhoods exhibited weaker CPM. Contrary to hypotheses, lower neighborhood SES was associated with neither pain thresholds nor with pain tolerance. CONCLUSIONS These findings demonstrated the independent contribution of place of residence-an often neglected component of the biopsychosocial model-to efficiency of descending pain inhibition. Understanding the mechanisms that account for such associations between place and pain could guide the development of public health and policy initiatives designed to mitigate chronic pain risk in underserved and economically marginalized communities.
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Affiliation(s)
- Matthew C Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda L Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Craig Smith
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Lynn S Walker
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
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25
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Edwards RR, Campbell C, Schreiber KL, Meints S, Lazaridou A, Martel MO, Cornelius M, Xu X, Jamison RN, Katz JN, Carriere J, Khanuja HP, Sterling RS, Smith MT, Haythornthwaite JA. Multimodal prediction of pain and functional outcomes 6 months following total knee replacement: a prospective cohort study. BMC Musculoskelet Disord 2022; 23:302. [PMID: 35351066 PMCID: PMC8966339 DOI: 10.1186/s12891-022-05239-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/16/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is among the most common and disabling persistent pain conditions, with increasing prevalence and impact around the globe. In the U.S., the rising prevalence of knee OA has been paralleled by an increase in annual rates of total knee arthroplasty (TKA), a surgical treatment option for late-stage knee OA. While TKA outcomes are generally good, post-operative trajectories of pain and functional status vary substantially; a significant minority of patients report ongoing pain and impaired function following TKA. A number of studies have identified sets of biopsychosocial risk factors for poor post-TKA outcomes (e.g., comorbidities, negative affect, sensory sensitivity), but few prospective studies have systematically evaluated the unique and combined influence of a broad array of factors. METHODS This multi-site longitudinal cohort study investigated predictors of 6-month pain and functional outcomes following TKA. A wide spectrum of relevant biopsychosocial predictors was assessed preoperatively by medical history, patient-reported questionnaire, functional testing, and quantitative sensory testing in 248 patients undergoing TKA, and subsequently examined for their predictive capacity. RESULTS The majority of patients had mild or no pain at 6 months, and minimal pain-related impairment, but approximately 30% reported pain intensity ratings of 3/10 or higher. Reporting greater pain severity and dysfunction at 6 months post-TKA was predicted by higher preoperative levels of negative affect, prior pain history, opioid use, and disrupted sleep. Interestingly, lower levels of resilience-related "positive" psychosocial characteristics (i.e., lower agreeableness, lower social support) were among the strongest, most consistent predictors of poor outcomes in multivariable linear regression models. Maladaptive profiles of pain modulation (e.g., elevated temporal summation of pain), while not robust unique predictors, interacted with psychosocial risk factors such that the TKA patients with the most pain and dysfunction exhibited lower resilience and enhanced temporal summation of pain. CONCLUSIONS This study underscores the importance of considering psychosocial (particularly positively-oriented resilience variables) and sensory profiles, as well as their interaction, in understanding post-surgical pain trajectories.
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Affiliation(s)
- Robert R Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Pain Management Center, 850 Boylston St, MA, 02467, Chestnut Hill, USA.
| | - Claudia Campbell
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Pain Management Center, 850 Boylston St, MA, 02467, Chestnut Hill, USA
| | - Samantha Meints
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Pain Management Center, 850 Boylston St, MA, 02467, Chestnut Hill, USA
| | - Asimina Lazaridou
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Pain Management Center, 850 Boylston St, MA, 02467, Chestnut Hill, USA
| | - Marc O Martel
- Faculties of Dentistry & Medicine, McGill University, Strathcona Anatomy & Dentistry building 3640 University Street, Montreal, Qc, H3A 2B2, Canada
| | - Marise Cornelius
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Pain Management Center, 850 Boylston St, MA, 02467, Chestnut Hill, USA
| | - Xinling Xu
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Pain Management Center, 850 Boylston St, MA, 02467, Chestnut Hill, USA
| | - Robert N Jamison
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Pain Management Center, 850 Boylston St, MA, 02467, Chestnut Hill, USA
| | - Jeffrey N Katz
- Departments of Medicine and Orthopedic Surgery, Orthopedic and Arthritis Center for Outcomes Research, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA
| | | | - Harpal P Khanuja
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert S Sterling
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael T Smith
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer A Haythornthwaite
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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26
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Shohat N, Heller S, Sudya D, Small I, Khawalde K, Khatib M, Yassin M. Mild radiographic osteoarthritis is associated with increased pain and dissatisfaction following total knee arthroplasty when compared with severe osteoarthritis: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:965-981. [PMID: 33604736 DOI: 10.1007/s00167-021-06487-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The association between severity of radiographic osteoarthritis with patient pain, function, and satisfaction following total knee arthroplasty has been disputed. The discrepancies in current literature prompt us to further examine this association in a systematic review and meta-analysis. METHODS The OVID-Medline, Embase, and Web of Science databases were searched from their inception up to Mar 2020. The main independent variable was osteoarthritis severity as defined by preoperative radiographs. The outcomes measured were pain, function and satisfaction following total knee arthroplasty. A minimum of three studies assessing the same patient-reported outcome measures were included in the meta-analysis, as well as those separating patients by chronic pain or dissatisfaction. RESULTS 29 studies were included in this study. Significant heterogeneity was seen between radiographic evaluation and reported outcomes. Patients with only mild radiographic osteoarthritis were more likely to suffer from chronic pain (odds ratio = 2.45, 95% CI = 1.80-3.34, p < 0.001) and dissatisfaction (odds ratio = 2.43, 95% CI = 1.79-3.31, p < 0.001) compared to patients with severe osteoarthritis. A significant association was found between mild radiographic severity and lower total Western Ontario and McMaster Universities Osteoarthritis scores (95% CI = - 0.37-0.06, p = 0.006) as well as Knee Society Scores (CI: - 0.54-0.16, p < 0.001). CONCLUSION Patients with mild radiographic osteoarthritis are anticipated to gain less from total knee arthroplasty compared to those with severe osteoarthritis. They are also at risk for chronic pain and dissatisfaction and should be consulted about this risk prior to surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Noam Shohat
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| | - Snir Heller
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Dan Sudya
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Ilan Small
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Kefah Khawalde
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Muhammad Khatib
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Mustafa Yassin
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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27
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Treister R, Honigman L, Berger A, Cohen B, Asaad I, Kuperman P, Tellem R, Hochberg U, Strauss I. Temporal Summation Predicts De Novo Contralateral Pain After Cordotomy in Patients With Refractory Cancer Pain. Neurosurgery 2022; 90:59-65. [PMID: 34982871 DOI: 10.1227/neu.0000000000001734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Percutaneous cervical cordotomy (PCC), which selectively interrupts ascending nociceptive pathways in the spinal cord, can mitigate severe refractory cancer pain. It has an impressive success rate, with most patients emerging pain-free. Aside from the usual complications of neurosurgical procedures, the risks of PCC include development of contralateral pain, which is less understood. OBJECTIVE To evaluate whether sensory and pain sensitivity, as measured by quantitative sensory testing (QST), are associated with PCC clinical outcomes. METHODS Fourteen palliative care cancer patients with severe chronic refractory pain limited mainly to one side of the body underwent comprehensive quantitative sensory testing assessment pre-PPC and post-PCC. They were also queried about maximal pain during the 24 h precordotomy (0-10 numerical pain scale). RESULTS All 14 patients reported reduced pain postcordotomy, with 7 reporting complete resolution. Four patients reported de novo contralateral pain. Reduced sensitivity in sensory and pain thresholds to heat and mechanical stimuli was recorded on the operated side (P = .028). Sensitivity to mechanical pressure increased on the unaffected side (P = .023), whereas other sensory thresholds were unchanged. The presurgical temporal summation values predicted postoperative contralateral pain (r = 0.582, P = .037). CONCLUSION The development of contralateral pain in patients postcordotomy for cancer pain might be due to central sensitization. Temporal summation could serve as a potential screening tool to identify those who are most likely at risk to develop contralateral pain. Analysis of PCC affords a unique opportunity to investigate how a specific lesion to the nociceptive system affects pain processes.
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Affiliation(s)
- Roi Treister
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Liat Honigman
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Assaf Berger
- Functional Neurosurgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Cohen
- Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Israa Asaad
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Pora Kuperman
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Rotem Tellem
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Palliative Medicine Care Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Uri Hochberg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pain Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Strauss
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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28
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Arant KR, Katz JN, Neogi T. Quantitative sensory testing: identifying pain characteristics in patients with osteoarthritis. Osteoarthritis Cartilage 2022; 30:17-31. [PMID: 34597800 PMCID: PMC8712382 DOI: 10.1016/j.joca.2021.09.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This review outlines the most commonly used quantitative sensory tests to identify pain sensitization. We examine cross-sectional associations between quantitative sensory testing (QST) measures and OA symptoms and severity, along with longitudinal associations between QST findings and response to surgical and non-surgical treatments for OA. DESIGN We conducted a search in PubMed for English language papers including 'osteoarthritis' and 'quantitative sensory testing' as search terms. Papers that did not pertain specifically to OA or QST were excluded. RESULTS Pressure Pain Threshold (PPT), Conditioned Pain Modulation (CPM), and Temporal Summation (TS) are the QST measures used most frequently to identify pain sensitization. Findings indicate that persons with knee OA often exhibit lower PPT thresholds, inefficient CPM, and facilitated TS as compared with controls who do not have OA, supporting the discriminant validity of QST. Pre-treatment QST has shown some success in identifying persons who experience less pain relief from surgical and non-surgical treatments for knee OA. Post-treatment QST has shown that sometimes PPT and CPM can normalize (PPT thresholds increase, and CPM becomes efficient) in patients for whom joint replacement is successful. Recent studies indicate that QST measures are more closely associated with pain severity than OA radiographic severity, suggesting that sensitization may be a trait rather than a state. CONCLUSIONS QST may have a role in identifying persons who are susceptible to chronic pain and may offer an opportunity for personalized, more effective treatment of OA.
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Affiliation(s)
- K R Arant
- The Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA.
| | - J N Katz
- The Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School and Chan Harvard School of Public Health, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
| | - T Neogi
- Section of Rheumatology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
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29
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Ammitzbøll N, Arendt-Nielsen L, Bertoli D, Brock C, Olesen AE, Kappel A, Drewes AM, Petersen KK. A mechanism-based proof of concept study on the effects of duloxetine in patients with painful knee osteoarthritis. Trials 2021; 22:958. [PMID: 34961547 PMCID: PMC8710922 DOI: 10.1186/s13063-021-05941-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/15/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The global burden of osteoarthritis (OA) is steadily increasing due to demographic and lifestyle changes. The nervous system can undergo peripheral and central neuroplastic changes (sensitization) in patients with OA impacting the options to manage the pain adequately. As a result of sensitization, patients with OA show lower pressure pain thresholds (PPTs), facilitated temporal summation of pain (TSP), and impaired conditioned pain modulation (CPM). As traditional analgesics (acetaminophen and non-steroidal anti-inflammatory drugs) are not recommended for long-term use in OA, more fundamental knowledge related to other possible management regimes are needed. Duloxetine is a serotonin-noradrenalin reuptake inhibitor, and analgesic effects are documented in patients with OA although the underlying fundamental mechanisms remain unclear. The descending pain inhibitory control system is believed to be dependent on serotonin and noradrenalin. We hypothesized that the analgesic effect of duloxetine could act through these pathways and consequently indirectly reduce pain and sensitization. The aim of this mechanistic study is to investigate if PPTs, TSP, CPM, and clinical pain parameters are modulated by duloxetine. METHODS This proof of concept study is a randomized, placebo-controlled, double-blinded, crossover trial, which compares PPTs, TSP, and CPM before and after 18 weeks of duloxetine and placebo in forty patients with knee OA. The intervention periods include a titration period (2 weeks), treatment period (60 mg daily for 14 weeks), and a discontinuation period (2 weeks). Intervention periods are separated by 2 weeks. DISCUSSION Duloxetine is recommended for the treatment of chronic pain, but the underlying mechanisms of the analgesic effects are currently unknown. This study will investigate if duloxetine can modify central pain mechanisms and thereby provide insights into the underlying mechanisms of the analgesic effect. TRIAL REGISTRATION ClinicalTrials.gov NCT04224584 . Registered on January 6, 2020. EudraCT 2019-003437-42 . Registered on October 22, 2019. The North Denmark Region Committee on Health Research Ethics N-20190055. Registered on October 31, 2019.
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Affiliation(s)
- Nadia Ammitzbøll
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Davide Bertoli
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Christina Brock
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Anne Estrup Olesen
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark
| | - Andreas Kappel
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Kristian Kjær Petersen
- Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark. .,Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
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30
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Sideris A, Malahias MA, Birch G, Zhong H, Rotundo V, Like BJ, Otero M, Sculco PK, Kirksey M. Identification of biological risk factors for persistent postoperative pain after total knee arthroplasty. Reg Anesth Pain Med 2021; 47:161-166. [PMID: 34921052 DOI: 10.1136/rapm-2021-102953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/18/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is growing evidence that cytokines and adipokines are associated with osteoarthritis (OA) severity, progression, and severity of associated pain. However, the cytokine response to total knee arthroplasty (TKA) and its association with persistent postoperative pain is not well understood. This study aims to describe the perioperative systemic (plasma) and local (synovial fluid) cytokine profiles of patients who do and do not develop persistent pain after TKA. METHODS Patients undergoing primary unilateral TKA for end-stage OA were prospectively enrolled. Demographic and clinical data were gathered preoperatively and postoperatively. Synovial fluid was collected pre arthrotomy and plasma was collected at multiple time points before and after surgery. Persistent postoperative pain (PPP) was defined as Numerical Rating Score≥4 at 6 months. Cytokine levels were measured using the V-Plex Human Cytokine 30-Plex Panel (Mesoscale-Rockville, Maryland, USA). Cytokine levels were compared between PPP and minimal pain groups. Given that the study outcomes are exploratory, no adjustment was performed for multiple testing. RESULTS Incidence of persistent pain at 6 months post TKA was 15/162 (9.3%). Postoperative plasma levels of four cytokines were significantly different in patients who developed persistent postoperative pain: interleukin (IL)-10, IL-1β, vascular endothelial growth factor, and IL12/IL23p40. Significantly lower IL-10 levels in the prearthrotomy synovial fluid were associated with development of postoperative persistent pain. CONCLUSIONS This prospective cohort study described a distinct acute perioperative inflammatory response profile in patients who developed persistent post-TKA pain, characterized by significant differences in four cytokines over the first 2 postoperative days. These results support the growing evidence that the patient-specific biologic response to surgery may influence longer-term clinical outcomes after TKA. TRIAL REGISTRATION NUMBER Clinicaltrials.gov NCT02626533.
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Affiliation(s)
- Alexandra Sideris
- Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Michael-Alexander Malahias
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
| | - George Birch
- Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Haoyan Zhong
- Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Valeria Rotundo
- Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Brian J Like
- Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Miguel Otero
- Orthopedic Soft Tissue Research Program, Weill Cornell Medical College, New York, New York, USA
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
| | - Meghan Kirksey
- Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, New York, USA .,Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
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31
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Boye Larsen D, Laursen M, Simonsen O, Arendt-Nielsen L, Petersen KK. The association between sleep quality, preoperative risk factors for chronic postoperative pain and postoperative pain intensity 12 months after knee and hip arthroplasty. Br J Pain 2021; 15:486-496. [PMID: 34840796 PMCID: PMC8611299 DOI: 10.1177/20494637211005803] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Chronic postoperative pain following total joint replacement (TJA) is a substantial clinical problem, and poor sleep may affect predictive factors for postoperative pain, such as pain catastrophizing. However, the magnitude of these associations is currently unknown. This exploratory study investigated (1) the relationship between preoperative sleep quality, clinical pain intensity, pain catastrophizing, anxiety, and depression and (2) their associations with chronic postoperative pain following TJA. METHODS This secondary analysis from a larger randomized controlled trial included rest pain intensity (preoperative and 12 months postoperative; visual analogue scale, VAS), preoperative Pittsburgh Sleep Quality Index (PSQI), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS) data from 74 knee and 89 hip osteoarthritis (OA) patients scheduled for TJA. Poor sleepers were identified based on preoperative PSQI scores higher than 5. RESULTS Poor sleepers demonstrated higher preoperative VAS, pain catastrophizing, anxiety, and depression compared with good sleepers (all p < 0.003). Preoperative PSQI (β = 0.23, p = 0.006), PCS (β = 0.44, p < 0.005), and anxiety (β = 0.18, p = 0.036) were independent factors for preoperative VAS. Preoperative VAS (β = 0.32, p < 0.005), but not preoperative sleep quality (β = -0.06, p = 0.5), was an independent factor for postoperative VAS. CONCLUSION The OA patients reporting poor preoperative sleep quality show higher preoperative pain, pain catastrophizing, anxiety, and depression. High preoperative pain intensity, but not poor sleep quality, was associated with higher chronic postoperative pain intensity. Future studies are encouraged to explore associations between sleep and chronic postoperative pain.
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Affiliation(s)
- Dennis Boye Larsen
- SMI, Department of Health Science and
Technology, School of Medicine, Aalborg University, Aalborg, Denmark
- Center for Neuroplasticity and Pain
(CNAP), SMI, Department of Health Science and Technology, School of Medicine,
Aalborg University, Aalborg, Denmark
| | - Mogens Laursen
- Orthopaedic Surgery Research Unit,
Aalborg University Hospital, Aalborg, Denmark
| | - Ole Simonsen
- Orthopaedic Surgery Research Unit,
Aalborg University Hospital, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- SMI, Department of Health Science and
Technology, School of Medicine, Aalborg University, Aalborg, Denmark
- Center for Neuroplasticity and Pain
(CNAP), SMI, Department of Health Science and Technology, School of Medicine,
Aalborg University, Aalborg, Denmark
| | - Kristian Kjær Petersen
- SMI, Department of Health Science and
Technology, School of Medicine, Aalborg University, Aalborg, Denmark
- Center for Neuroplasticity and Pain
(CNAP), SMI, Department of Health Science and Technology, School of Medicine,
Aalborg University, Aalborg, Denmark
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32
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Kazarian GS, Anthony CA, Lawrie CM, Barrack RL. The Impact of Psychological Factors and Their Treatment on the Results of Total Knee Arthroplasty. J Bone Joint Surg Am 2021; 103:1744-1756. [PMID: 34252068 DOI: 10.2106/jbjs.20.01479] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ There is a growing body of evidence implicating psychosocial factors, including anxiety, depression, kinesiophobia, central sensitization, and pain catastrophizing, as negative prognostic factors following total knee arthroplasty (TKA). ➤ Symptoms of anxiety and depression likely represent risk factors for negative outcomes in patients undergoing TKA. However, few studies have assessed the impact of preoperative interventions for these conditions on postoperative outcomes. ➤ The Tampa Scale of Kinesiophobia and the Central Sensitization Inventory have demonstrated value in the diagnosis of kinesiophobia and central sensitization. Higher preoperative indices of kinesiophobia and central sensitization predict worse patient-reported outcomes postoperatively. ➤ Although evidence is limited, cognitive-behavioral therapy for kinesiophobia and duloxetine for central sensitization may help to diminish the negative impact of these preoperative comorbidities. It is important to note, however, that outside the realm of TKA, cognitive-behavioral therapy has been recognized as a more effective treatment for central sensitization than medical treatment. ➤ Awareness of these issues will allow surgeons to better prepare patients regarding postoperative expectations in the setting of a comorbid psychosocial risk factor. Further research into the role of preoperative assessment and possible treatment of these conditions in patients undergoing TKA is warranted.
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Affiliation(s)
- Gregory S Kazarian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.,Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Christopher A Anthony
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.,Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles M Lawrie
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
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Morris MC, Bruehl S, Stone AL, Garber J, Smith C, Palermo TM, Walker LS. Does Quantitative Sensory Testing Improve Prediction of Chronic Pain Trajectories? A Longitudinal Study of Youth With Functional Abdominal Pain Participating in a Randomized Controlled Trial of Cognitive Behavioral Treatment. Clin J Pain 2021; 37:648-656. [PMID: 34192714 PMCID: PMC8373792 DOI: 10.1097/ajp.0000000000000956] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/10/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Youth with functional abdominal pain (FAP) experience significant pain-related distress and functional impairment. Although quantitative sensory testing protocols have identified alterations in pain modulatory systems that distinguish youth with FAP from healthy controls, the extent to which evoked pain responses predict subsequent trajectories of pain symptoms and disability over and above established psychosocial risk factors is unclear. METHODS The present study included 183 adolescents with FAP who were enrolled in a randomized controlled trial comparing an 8-week, internet-delivered program of cognitive behavior therapy (n=90) or pain education (n=93). Participants completed a quantitative sensory testing protocol before the intervention and were followed for 12-month posttreatment. RESULTS Whereas adolescents with FAP who exhibited stronger baseline conditioned pain modulation (CPM) reported decreases in pain-related interference over follow-up (b=-0.858, SE=0.396, P=0.032), those with weaker CPM exhibited high, relatively stable levels of pain-related interference over time (b=-0.642, SE=0.400, P=0.110). CPM status predicted changes in pain-related interference after controlling for the effects of treatment condition and psychosocial risk factors. Static measures of pain sensitivity (ie, pain threshold, pain tolerance) and temporal summation of second pain were not associated with changes in measures of abdominal pain, gastrointestinal symptom severity, or pain-related interference over follow-up. DISCUSSION The present findings contribute to a growing literature on the predictive utility of quantitative sensory testing indices and suggest that CPM may complement existing psychosocial risk measures in determining individualized pain-related risk profiles.
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Affiliation(s)
- Matthew C. Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Amanda L. Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN
| | - Craig Smith
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN
| | - Tonya M. Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
| | - Lynn S. Walker
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
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Larsen DB, Laursen M, Edwards RR, Simonsen O, Arendt-Nielsen L, Petersen KK. The Combination of Preoperative Pain, Conditioned Pain Modulation, and Pain Catastrophizing Predicts Postoperative Pain 12 Months After Total Knee Arthroplasty. PAIN MEDICINE 2021; 22:1583-1590. [PMID: 33411890 DOI: 10.1093/pm/pnaa402] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Approximately 20% of knee osteoarthritis patients undergoing total knee arthroplasty (TKA) report chronic postoperative pain. Studies suggest that preoperative variables such as impaired descending pain control, catastrophizing, function, and neuropathic pain-like symptoms may predict postoperative pain 12 months after TKA, but the combined prediction value of these factors has not been tested. The current prospective cohort study aimed to combine preoperative risk factors to investigate the predictive value for postoperative pain 12 months after TKA. DESIGN Prospective cohort with follow-up 12 months after surgery. PATIENTS A consecutive sample of 131 knee osteoarthritis patients undergoing TKA. METHODS Pain intensity, Pain Catastrophizing Scale (PCS) scores, PainDETECT Questionnaire scores, conditioned pain modulation (CPM), and Oxford Knee Score (OKS) were obtained before and 12 months after TKA. RESULTS TKA improved pain (P < 0.001), PCS scores (P < 0.001), PainDETECT Questionnaire scores (P < 0.001), and OKSs (P < 0.001). Preoperative pain correlated with preoperative PCS scores (r = 0.38, P < 0.001), PainDETECT scores (r = 0.53, P < 0.001), and OKSs (r = -0.25, P = 0.001). Preoperative PainDETECT scores were associated with preoperative PCS scores (r = 0.53, P < 0.001) and OKSs (r = -0.25, P = 0.002). Higher postoperative pain was correlated with high preoperative pain (r = 0.424, P < 0.001), PCS scores (r = 0.33, P < 0.001), PainDETECT scores (r = 0.298, P = 0.001), and lower CPM (r = -0.18, P = 0.04). The combination of preoperative pain, PCS score, and CPM explained 20.5% of variance in follow-up pain. PCS scores had a significant effect on pain trajectory when accounting for patient variance (t = 14.41, P < 0.0005). CONCLUSION The combination of high preoperative clinical pain intensity, high levels of pain catastrophizing thoughts, and impaired CPM may predict long-term postoperative pain 12 months after surgery.
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Affiliation(s)
- Dennis Boye Larsen
- SMI, Faculty of Medicine, Department of Health Science and Technology, Aalborg, Denmark.,Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Mogens Laursen
- Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Robert R Edwards
- Pain Management Center, Brigham & Women's Hospital, Chestnut Hill, Massachusetts, USA
| | - Ole Simonsen
- Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- SMI, Faculty of Medicine, Department of Health Science and Technology, Aalborg, Denmark.,Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Kristian Kjær Petersen
- SMI, Faculty of Medicine, Department of Health Science and Technology, Aalborg, Denmark.,Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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35
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Nunes A, Petersen K, Espanha M, Arendt-Nielsen L. Sensitization in office workers with chronic neck pain in different pain conditions and intensities. Scand J Pain 2021; 21:457-473. [PMID: 33641277 DOI: 10.1515/sjpain-2020-0107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 12/12/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Office workers with chronic neck pain demonstrates signs of widespread hyperalgesia, less efficient descending pain modulation, which could indicate sensitization of central pain pathways. No studies have assessed a wide variety of office workers with different chronic neck pain disorders and assessed the impact of pain intensity on assessments of central pain pathways. This study aimed to assessed pressure pain thresholds (PPTs), temporal summation of pain (TSP) and conditioned pain modulation (CPM) and to associate these with pain intensity and disability in subgroups of office workers. METHODS One hundred-and-seventy-one office workers were distributed into groups of asymptomatic and chronic neck pain subjects. Chronic neck pain was categorized as chronic trapezius myalgia and chronic non-specific neck pain and as 'mild-pain' (Visual Analog Scale [VAS]≤3) and 'moderate-pain' (VAS>3) groups. PPTs, TSP, CPM, and Copenhagen Psychosocial Questionnaire II were assessed in all subjects. Neck Disability Index and Pain Catastrophizing Scale were assessed in all the symptomatic office workers. RESULTS PPTs were lower in moderate pain (n=49) and chronic trapezius myalgia (n=56) compared with asymptomatic subjects (n=62, p<0.05). TSP was facilitated in moderate pain group compared with mild pain (n=60, p<0.0001) group and asymptomatic subjects (p<0.0001). No differences were found in CPM comparing the different groups (p<0.05). Multiple regression analysis identified Neck Disability Index and TSP as independent factors for prediction of pain intensity in chronic trapezius myalgia (R2=0.319) and chronic non-specific neck pain (R2=0.208). Somatic stress, stress and sleep as independent factors in chronic non-specific neck pain (R2=0.525), and stress in moderate pain group (R2=0.494) for the prediction of disability. CONCLUSIONS Office workers with chronic trapezius myalgia and moderate pain intensity showed significant signs of widespread pressure hyperalgesia. Moreover, the moderate pain group demonstrated facilitated TSP indicating sensitization of central pain pathways. Neck Disability Index and TSP were independent predictors for pain intensity in pain groups. Sleep and stress were independent predictors for disability.
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Affiliation(s)
- Alexandre Nunes
- Biomechanics and Functional Morphology Laboratory , CIPER , Faculdade de Motricidade Humana da Universidade de Lisboa , Cruz-Quebrada , Portugal.,Escola Superior de Saúde Jean Piaget do Algarve, Silves, Portugal
| | - Kristian Petersen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology , Aalborg University, Aalborg, Denmark
| | - Margarida Espanha
- Biomechanics and Functional Morphology Laboratory , CIPER , Faculdade de Motricidade Humana da Universidade de Lisboa , Cruz-Quebrada , Portugal
| | - Lars Arendt-Nielsen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology , Aalborg University, Aalborg, Denmark
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36
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Paredes AC, Pinto JM, Almeida A, Pinto PR. Predictive value of quantitative sensory testing for acute and chronic postsurgical pain after total joint arthroplasty: a systematic review. Pain 2021; 163:e385-e400. [PMID: 34224493 DOI: 10.1097/j.pain.0000000000002385] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Quantitative sensory testing (QST) can be useful to identify high-risk patients for the development of chronic postsurgical pain. This systematic review aims to assess if presurgical sensory sensitivity measured using QST is associated with acute and chronic postsurgical pain after total joint arthroplasty. A systematic search was performed in September 2020 in PubMed, EMBASE, Web of Science, and Scopus, using terms related to total joint arthroplasty and QST. Prospective studies were included if they reported an association between presurgical QST and postsurgical pain in adults with osteoarthritis undergoing primary unilateral total joint arthroplasty. From 2994 identified studies, 18 met the inclusion criteria (1869 patients). Total knee arthroplasty was the most common surgery (16 studies), and pressure pain threshold was the most common test (11 studies), followed by dynamic measures (9 studies). Postsurgical pain was assessed at acute (5 studies), subacute (2 studies), and chronic (13 studies) time points. Risk of bias was assessed using the Quality in Prognosis Studies tool and evaluated as low to moderate in most domains. Fourteen studies reported at least one statistically significant association between QST and pain (acute: 4 studies, subacute: 1 study, and chronic: 9 studies). Pressure pain threshold was associated with postsurgical pain in 6 studies (of 11, 55%), heat pain threshold in 2 studies (of 6, 33%), conditioned pain modulation in 1 study (of 6, 17%), and temporal summation of pain in 5 studies (of 8, 63%). The predictive role of presurgical QST for postarthroplasty pain remains unclear, mainly because of heterogeneous methodologies and inconsistent results.
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Affiliation(s)
- Ana Cristina Paredes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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37
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Flowers KM, Patton ME, Hruschak VJ, Fields KG, Schwartz E, Zeballos J, Kang JD, Edwards RR, Kaptchuk TJ, Schreiber KL. Conditioned open-label placebo for opioid reduction after spine surgery: a randomized controlled trial. Pain 2021; 162:1828-1839. [PMID: 33449503 PMCID: PMC8378225 DOI: 10.1097/j.pain.0000000000002185] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
ABSTRACT Placebo effects have traditionally involved concealment or deception. However, recent evidence suggests that placebo effects can also be elicited when prescribed transparently as "open-label placebos" (OLPs), and that the pairing of an unconditioned stimulus (eg, opioid analgesic) with a conditioned stimulus (eg, placebo pill) can lead to the conditioned stimulus alone reducing pain. In this randomized control trial, we investigated whether combining conditioning with an OLP (COLP) in the immediate postoperative period could reduce daily opioid use and postsurgical pain among patients recovering from spine surgery. Patients were randomized to COLP or treatment as usual, with both groups receiving unrestricted access to a typical opioid-based postoperative analgesic regimen. The generalized estimating equations method was used to assess the treatment effect of COLP on daily opioid consumption and pain during postoperative period from postoperative day (POD) 1 to POD 17. Patients in the COLP group consumed approximately 30% less daily morphine milligram equivalents compared with patients in the treatment as usual group during POD 1 to 17 (-14.5 daily morphine milligram equivalents; 95% CI: [-26.8, -2.2]). Daily worst pain scores were also lower in the COLP group (-1.0 point on the 10-point scale; 95% CI: [-2.0, -0.1]), although a significant difference was not detected in average daily pain between the groups (-0.8 point; 95% CI: [-1.7, 0.2]). These findings suggest that COLP may serve as a potential adjuvant analgesic therapy to decrease opioid consumption in the early postoperative period, without increasing pain.
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Affiliation(s)
- Kelsey M. Flowers
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Megan E. Patton
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Valerie J. Hruschak
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Kara G. Fields
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Emily Schwartz
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Jose Zeballos
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - James D. Kang
- Departments of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Rob R. Edwards
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Ted J. Kaptchuk
- Program in Placebo Studies and Therapeutic Encounter, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Kristin L. Schreiber
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
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The predictive value of quantitative sensory testing: a systematic review on chronic postoperative pain and the analgesic effect of pharmacological therapies in patients with chronic pain. Pain 2021; 162:31-44. [PMID: 32701654 DOI: 10.1097/j.pain.0000000000002019] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Studies have suggested that quantitative sensory testing (QST) might hold a predictive value for the development of chronic postoperative pain and the response to pharmacological interventions. This review systematically summarizes the current evidence on the predictive value of QST for chronic postoperative pain and the effect of pharmacological interventions. The main outcome measures were posttreatment pain intensity, pain relief, presence of moderate-to-severe postoperative pain, responders of 30% and 50% pain relief, or validated questionnaires on pain and disability. A systematic search of MEDLINE and EMBASE yielded 25 studies on surgical interventions and 11 on pharmacological interventions. Seventeen surgical and 11 pharmacological studies reported an association between preoperative or pretreatment QST and chronic postoperative pain or analgesic effect. The most commonly assessed QST modalities were pressure stimuli (17 studies), temporal summation of pain (TSP, 14 studies), and conditioned pain modulation (CPM, 16 studies). Of those, the dynamic QST parameters TSP (50%) and CPM (44%) were most frequently associated with chronic postoperative pain and analgesic effects. A large heterogeneity in methods for assessing TSP (n = 4) and CPM (n = 7) was found. Overall, most studies demonstrated low-to-moderate levels of risk of bias in study design, attrition, prognostic factors, outcome, and statistical analyses. This systematic review demonstrates that TSP and CPM show the most consistent predictive values for chronic postoperative pain and analgesic effect, but the heterogeneous methodologies reduce the generalizability and hence call for methodological guidelines.
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Lyng KD, Thorsen JBB, Boye Larsen D, Kjær Petersen K. The Modulatory Effect of QST in Shoulder Pain: A Systematic Review and Meta-Analysis. PAIN MEDICINE 2021; 23:733-744. [PMID: 33905508 DOI: 10.1093/pm/pnab155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The underlying mechanisms for shoulder pain (SP) are still widely unknown. Previous reviews report signs of altered pain processing in SP measured using quantitative sensory testing (QST). Evidence suggests that QST might hold predictive value for SP after intervention, yet it is not known whether QST profiles can be modulated in response to different treatments. Therefore, this systematic review and meta-analysis aimed to assess if QST-parameters can be modified by interventions for patients with SP. METHODS Three databases were searched to identify eligible studies. Eligible studies had a prospective design, with at least one QST variable as an outcome in conjunction with an intervention measured before and after intervention. Studies that involved SP caused by spinal or brain injury and studies looking at combined chronic neck/shoulder pain were excluded. RESULTS 19 studies investigating SP were eligible for inclusion for this review. Pressure pain threshold (PPT) was the most frequently used QST-parameter investigating local and widespread hyperalgesia. A meta-analysis was performed with data from 10 studies with a total of 16 interventions. Results demonstrated an overall acute effect (<24 hours after intervention) of interventions in favour of local decreased pain sensitivity and of remote decreased pain sensitivity comparing PPTs before and after interventions. CONCLUSIONS This study demonstrates that interventions such as exercise and manual therapy can modulate PPTs acutely both locally and remotely in patients with shoulder pain. Further research investigating the acute and long-term modulatory ability of these interventions on other QST-parameters is needed in patients with shoulder pain.
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Affiliation(s)
- Kristian Damgaard Lyng
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | | | - Dennis Boye Larsen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Kristian Kjær Petersen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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40
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Levitt AE, Galor A, Small L, Feuer W, Felix ER. Pain sensitivity and autonomic nervous system parameters as predictors of dry eye symptoms after LASIK. Ocul Surf 2021; 19:275-281. [PMID: 33096271 PMCID: PMC7867610 DOI: 10.1016/j.jtos.2020.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Differences in pain processing and autonomic function among patients have been implicated in the development of chronic pain after surgery. This study was designed to evaluate whether pain and autonomic metrics predict severity of chronic dry eye (DE) symptoms after LASIK, as there is increasing evidence that DE symptoms may be manifestations of persistent post-operative ocular pain. METHODS Secondary analysis of prospective randomized clinical trial. Patients were treated with either pregabalin or placebo. As no significant differences in DE symptoms were detected by treatment allocation at six months, all participants were grouped together for the present analyses. Subjects were evaluated pre-LASIK with regard to evoked pain sensitivity (utilizing quantitative sensory testing), autonomic metrics and DE and ocular pain symptoms (via validated questionnaires). Measures of DE and ocular pain were assessed post-LASIK, and the Dry Eye Questionnaire 5 (DEQ5) score 6-months after surgery was the primary outcome of interest. RESULTS 43 individuals were randomized to pregabalin (n = 21) or placebo (n = 22). 42 completed the 6-month visit. Several baseline autonomic metrics correlated with 6-month post-operative DEQ5 scores, including lower systolic (r -0.37, p = 0.02) and diastolic blood pressure (r -0.32, p = 0.04). Ocular pain at 6 months was also negatively correlated with blood pressure (r -0.31, p = 0.047). The presence of painful aftersensations was a significant predictor of chronic DE symptoms at 6 months (mean DEQ5 scores: 8.0 ± 1.9 versus 5.0 ± 5.0, p = 0.009). CONCLUSIONS Heightened parasympathetic tone and prolonged pain sensitivity measured prior to surgery predicted greater DE symptom severity 6 months after LASIK. TRIAL REGISTRATION NCT02701764.
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Affiliation(s)
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL, USA.
| | - Leslie Small
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - William Feuer
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Elizabeth R Felix
- Department of Physical Medicine & Rehabilitation, University of Miami, Miami, FL, USA; Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA
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Hansen S, Dalgaard RC, Mikkelsen PS, Sørensen MB, Petersen KK. Modulation of Exercise-Induced Hypoalgesia Following an Exercise Intervention in Healthy Subjects. PAIN MEDICINE 2020; 21:3556-3566. [PMID: 32984895 DOI: 10.1093/pm/pnaa212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Exercise is recommended to promote and maintain health and as treatment for more than 25 diseases and pain conditions. Exercise-induced hypoalgesia (EIH), a measure of descending pain inhibitory control, has been found to be impaired in some chronic pain conditions, but it is currently unclear if EIH is modifiable. This study investigated whether a long-term exercise intervention could modulate EIH in healthy subjects. METHODS In 38 healthy subjects, EIH was assessed as change in pressure pain threshold (PPT) after a three-minute isometric wall squat within the first week and after approximately seven weeks of military training (MT). Further, temporal summation of pain (TSP) and Knee injury and Osteoarthritis Outcome Score (KOOS) were assessed. Physical performance capacity was assessed using the Endurance 20-m shuttle run fitness test (20MSR). Hypoalgesic (EIH > 0.0 kPa) and hyperalgesic (EIH ≤ 0.0 kPa) subgroups were defined based on baseline EIH. Change in EIH following MT was used as the primary outcome. RESULTS Increased EIH (P = 0.008), PPT (P < 0.003), and 20MSR (P < 0.001) were found following MT, with no changes in TSP and KOOS (P > 0.05). Subjects with a hyperalgesic EIH response at baseline (26% of the participants) presented significantly improved EIH following MT (P = 0.010). Finally, an association between 20MRS change and EIH change was found (r = 0.369, P = 0.023). CONCLUSIONS MT increased EIH, especially in subjects who demonstrated a hyperalgesic response at baseline. Improvement in physical performance capacity was associated with an improvement in EIH, indicating that improvement in physical performance capacity may improve central pain mechanisms.
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Affiliation(s)
- Simon Hansen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | | | | | - Mathias Brandhøj Sørensen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Kristian Kjær Petersen
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain, Aalborg University, Aalborg, Denmark
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42
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Kersch A, Perera P, Mercado M, Gorrie A, Sainsbury D, McGrath T, Aouad P, Sarraf S, Jaaniste T, Champion D. Somatosensory Testing in Pediatric Patients with Chronic Pain: An Exploration of Clinical Utility. CHILDREN-BASEL 2020; 7:children7120275. [PMID: 33291481 PMCID: PMC7762158 DOI: 10.3390/children7120275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/04/2022]
Abstract
We aimed to evaluate the utility of clinical somatosensory testing (SST), an office adaptation of laboratory quantitative sensory testing, in a biopsychosocial assessment of a pediatric chronic somatic pain sample (N = 98, 65 females, 7–18 years). Stimulus–response tests were applied at pain regions and intra-subject control sites to cutaneous stimuli (simple and dynamic touch, punctate pressure and cool) and deep pressure stimuli (using a handheld pressure algometer, and, in a subset, manually inflated cuff). Validated psychological, pain-related and functional measures were administered. Cutaneous allodynia, usually regional, was elicited by at least one stimulus in 81% of cases, most frequently by punctate pressure. Central sensitization, using a composite measure of deep pressure pain threshold and temporal summation of pain, was implied in the majority (59.2%) and associated with worse sleep impairment and psychological functioning. In regression analyses, depressive symptoms were the only significant predictor of pain intensity. Functional interference was statistically predicted by deep pressure pain threshold and depressive symptoms. Manually inflated cuff algometry had comparable sensitivity to handheld pressure algometry for deep pressure pain threshold but not temporal summation of pain. SST complemented standard biopsychosocial assessment of pediatric chronic pain; use of SST may facilitate the understanding of disordered neurobiology.
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Affiliation(s)
- Anna Kersch
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Panchalee Perera
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Melanie Mercado
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Andrew Gorrie
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - David Sainsbury
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
| | - Tara McGrath
- Stollery Children’s Hospital, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Phillip Aouad
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Sara Sarraf
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
| | - Tiina Jaaniste
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - David Champion
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (A.K.); (P.P.); (M.M.); (A.G.); (D.S.); (P.A.); (S.S.); (T.J.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Correspondence:
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Heisler AC, Song J, Muhammad LN, Wohlfahrt A, Marder W, Bolster MB, Bingham CO, Clauw DJ, Dunlop DD, Neogi T, Lee YC. Association of Dysregulated Central Pain Processing and Response to Disease-Modifying Antirheumatic Drug Therapy in Rheumatoid Arthritis. Arthritis Rheumatol 2020; 72:2017-2024. [PMID: 32683800 PMCID: PMC8078061 DOI: 10.1002/art.41440] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 06/14/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine the association between dysregulated central pain processing and treatment response in rheumatoid arthritis (RA). METHODS One hundred eighty-two participants with active RA were followed up for 12 weeks after starting a disease-modifying antirheumatic drug (DMARD). To assess central pain processing, participants underwent quantitative sensory testing (QST), including assessment of pressure pain thresholds (PPTs) at the trapezius muscles, temporal summation, and conditioned pain modulation (CPM). QST measures were categorized as high central dysregulation versus low central dysregulation. The association between baseline central dysregulation and treatment response, as defined by the European League Against Rheumatism (EULAR) response criteria, was assessed using multiple logistic regression adjusted for demographic characteristics, RA-related variables, and psychosocial variables. RESULTS A good EULAR response was achieved in fewer participants with high CPM dysregulation than participants with low CPM dysregulation (22.5% versus 40.3%; P = 0.01). A similar trend, though not significant, was noted when central dysregulation was assessed with PPT and temporal summation. The adjusted odds ratios (ORs) for the association between high central dysregulation and good EULAR response were 0.59 for PPTs (95% confidence interval [95% CI] 0.28-1.23), 0.60 for temporal summation (95% CI 0.27-1.34), and 0.40 for CPM (95% CI 0.19-0.83). In a model examining the combined effects of dysregulated temporal summation and CPM, dysregulation of both measures was associated with lower odds of achieving a good EULAR response (OR 0.23 [95% CI 0.07-0.73]). CONCLUSION Low CPM was significantly associated with lower odds of achieving a good EULAR response, suggesting that inefficient descending inhibitory mechanisms may be a potential treatment target for further study.
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Affiliation(s)
| | - Jing Song
- Northwestern University, Chicago, Illinois
| | | | | | | | | | | | | | | | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
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Årnes AP, Nielsen CS, Stubhaug A, Fjeld MK, Hopstock LA, Horsch A, Johansen A, Morseth B, Wilsgaard T, Steingrímsdóttir ÓA. Physical activity and cold pain tolerance in the general population. Eur J Pain 2020; 25:637-650. [PMID: 33165994 DOI: 10.1002/ejp.1699] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The relationship between habitual physical activity (PA) and experimental pain tolerance has been investigated in small samples of young, healthy and/or single-sex volunteers. We used a large, population-based sample to assess this relationship in men and women with and without chronic pain. METHODS We used data from the sixth and seventh Tromsø Study surveys (2007-2008; 2015-2016), with assessed pain tolerance of participants with the cold pressor test (CPT: dominant hand in circulating cold water at 3°C, maximum test time 106 s), and self-reported total amount of habitual PA in leisure time (n = 19,087), exercise frequency (n = 19,388), exercise intensity (n = 18,393) and exercise duration (n = 18,343). A sub-sample had PA measured by accelerometers (n = 4,922). We used Cox regression to compare CPT tolerance times between self-reported PA levels. For accelerometer-measured PA, we estimated hazard ratios for average daily activity counts, and for average daily minutes of moderate-to-vigorous PA done in bouts lasting 10 min or more. Models were tested for PA-sex, and PA-chronic pain and PA-moderate-to-severe chronic pain interactions. RESULTS Leisure-time PA, exercise intensity and exercise duration were positively associated with CPT tolerance (p < .001; p = .011; p < .001). More PA was associated with higher CPT tolerance. At high levels of leisure-time PA and exercise intensity, men had a significantly higher CPT tolerance than women. Accelerometer-measured PA was not associated with CPT tolerance. CONCLUSIONS This study is one of the first to show that higher self-reported habitual PA was connected to higher experimental pain tolerance in a population-based sample, especially for men. This was not found for accelerometer-measured PA. SIGNIFICANCE This study finds that higher level of self-reported leisure-time physical activity is associated with increased cold pressor pain tolerance in a large population-based sample. Though present in both sexes, the association is strongest among men. Despite the robust dose-response relationship between pain tolerance and self-reported activity level, no such relationship was found for accelerometer-measured activity, reflecting a possible discrepancy in the aspect of physical activity measured. Though the study design does not permit causal conclusions, the findings suggest that increasing physical activity may increase pain tolerance in the general population.
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Affiliation(s)
- Anders P Årnes
- Department of Pain, Department of Community Medicine, University Hospital of North Norway, Tromsø, Norway.,Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Christopher S Nielsen
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Audun Stubhaug
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mats K Fjeld
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Laila A Hopstock
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Alexander Horsch
- Department of Computer Science, UiT The Arctic University of Norway, Tromsø, Norway
| | - Aslak Johansen
- Department of Pain, Department of Community Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Bente Morseth
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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van Helmond N, Aarts HM, Timmerman H, Olesen SS, Drewes AM, Wilder-Smith OH, Steegers MA, Vissers KC. Is Preoperative Quantitative Sensory Testing Related to Persistent Postsurgical Pain? A Systematic Literature Review. Anesth Analg 2020; 131:1146-1155. [PMID: 32925335 DOI: 10.1213/ane.0000000000004871] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Persistent postsurgical pain (PPSP) is a common complication of surgery that significantly affects quality of life. A better understanding of which patients are likely to develop PPSP would help to identify when perioperative and postoperative pain management may require specific attention. Quantitative sensory testing (QST) of a patient's preoperative pain perception is associated with acute postoperative pain, and acute postoperative pain is a risk factor for PPSP. The direct association between preoperative QST and PPSP has not been reviewed to date. In this systematic review, we assessed the relationship of preoperative QST to PPSP. We searched databases with components related to (1) preoperative QST; (2) association testing; and (3) PPSP. Two authors reviewed all titles and abstracts for inclusion. Inclusion criteria were as follows: (1) QST performed before surgery; (2) PPSP assessed ≥3 months postoperatively; and (3) the association between QST measures and PPSP is investigated. The search retrieved 905 articles; 24 studies with 2732 subjects met inclusion criteria. Most studies (22/24) had moderate to high risk of bias in multiple quality domains. Fourteen (58%) studies reported a significant association between preoperative QST and PPSP. Preoperative temporal summation of pain (4 studies), conditioned pain modulation (3 studies), and pressure pain threshold (3 studies) showed the most frequent association with PPSP. The strength of the association between preoperative QST and PPSP varied from weak to strong. Preoperative QST is variably associated with PPSP. Measurements related to central processing of pain may be most consistently associated with PPSP.
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Affiliation(s)
- Noud van Helmond
- From the Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, New Jersey
| | - Hugo M Aarts
- Department of Cardiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Hans Timmerman
- From the Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Søren S Olesen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Asbjørn M Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Oliver H Wilder-Smith
- From the Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Monique A Steegers
- From the Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Anesthesiology, Vrije Universiteit (VU) Medical Center, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Kris C Vissers
- From the Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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46
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Meints SM, Edwards RR, Gilligan C, Schreiber KL. Behavioral, Psychological, Neurophysiological, and Neuroanatomic Determinants of Pain. J Bone Joint Surg Am 2020; 102 Suppl 1:21-27. [PMID: 32251127 PMCID: PMC8272523 DOI: 10.2106/jbjs.20.00082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Samantha M. Meints
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher Gilligan
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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O'Brien AT, El-Hagrassy MM, Rafferty H, Sanchez P, Huerta R, Chaudhari S, Conde S, Rosa G, Fregni F. Impact of Therapeutic Interventions on Pain Intensity and Endogenous Pain Modulation in Knee Osteoarthritis: A Systematic Review and Meta-analysis. PAIN MEDICINE 2020; 20:1000-1011. [PMID: 30615173 DOI: 10.1093/pm/pny261] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To study the impact of therapeutic interventions on pain analgesia and endogenous pain modulation in knee osteoarthritis (KOA). DESIGN Systematic review and meta-analysis. METHODS We searched for KOA randomized clinical trials and observational studies with data on therapeutic interventions comparing pain intensity, temporal summation (TS), and conditioned pain modulation (CPM) scores relative to control. These data were pooled as Hedge's g. To study the relationship between pain intensity and TS/CPM, we performed metaregression with 10,000 Monte-Carlo permutations. RESULTS We reviewed 11 studies (559 participants). On studying all the interventions together, we found no significant changes in pain modulation, TS, or CPM. Our findings show that this lack of difference is likely because surgical and nonsurgical interventions resulted in contrary effects. Metaregression significantly correlated pain reduction with normalization of TS and CPM. CONCLUSIONS We demonstrate an association between pain reduction and TS/CPM normalization. Though we cannot directly compare these interventions, the results allow us to draw hypotheses on potential practice schemas. Recovering defective endogenous pain modulation mechanisms may help establish long-term analgesia. However, to validate these paradigms as robust clinical biomarkers, further investigation into their mechanisms would be necessary. The registration number for this review is CRD42017072066.
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Affiliation(s)
- Anthony Terrence O'Brien
- Department of Physical Medicine and Rehabilitation, Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan Public School of Health, Boston, Massachusetts, USA
| | - Mirret M El-Hagrassy
- Department of Physical Medicine and Rehabilitation, Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Haley Rafferty
- Department of Physical Medicine and Rehabilitation, Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paula Sanchez
- Department of Physical Medicine and Rehabilitation, Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rodrigo Huerta
- Department of Physical Medicine and Rehabilitation, Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan Public School of Health, Boston, Massachusetts, USA
| | - Swapnali Chaudhari
- Department of Physical Medicine and Rehabilitation, Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sonia Conde
- Department of Physical Medicine and Rehabilitation, Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gleysson Rosa
- Department of Physical Medicine and Rehabilitation, Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Felipe Fregni
- Department of Physical Medicine and Rehabilitation, Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan Public School of Health, Boston, Massachusetts, USA
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48
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Investigating the Effect of Perioperative Chlorzoxazone on Acute Postoperative Pain After Total Hip and Knee Replacement Surgery. Clin J Pain 2020; 36:352-358. [DOI: 10.1097/ajp.0000000000000805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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49
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Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis. J Clin Med 2019; 8:jcm8111769. [PMID: 31652929 PMCID: PMC6912819 DOI: 10.3390/jcm8111769] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) is a leading cause of chronic pain and disability in older adults, which most commonly affects the joints of the knee, hip, and hand. To date, there are no established disease modifying interventions that can halt or reverse OA progression. Therefore, treatment is focused on alleviating pain and maintaining or improving physical and psychological function. Rehabilitation is widely recommended as first-line treatment for OA as, in many cases, it is safer and more effective than the best-established pharmacological interventions. In this article, we describe the presentation of OA pain and give an overview of its peripheral and central mechanisms. We then provide a state-of-the-art review of rehabilitation for OA pain—including self-management programs, exercise, weight loss, cognitive behavioral therapy, adjunct therapies, and the use of aids and devices. Next, we explore several promising directions for clinical practice, including novel education strategies to target unhelpful illness and treatment beliefs, methods to enhance the efficacy of exercise interventions, and innovative, brain-directed treatments. Finally, we discuss potential future research in areas, such as treatment adherence and personalized rehabilitation for OA pain.
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Affiliation(s)
- David Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
- Waitemata Pain Service, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland 1142, New Zealand.
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
| | - Eva Huysmans
- Pain in Motion International Research Group.
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussel, Belgium.
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
- I-CHER, Interuniversity Center for Health Economics Research, 1090 Brussels, Belgium.
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium.
| | - Janelle Letzen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
| | - Patrick Finan
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
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50
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Pretreatment Exercise-induced Hypoalgesia is Associated With Change in Pain and Function After Standardized Exercise Therapy in Painful Knee Osteoarthritis. Clin J Pain 2019; 36:16-24. [DOI: 10.1097/ajp.0000000000000771] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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