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Tomić M, Nastić K, Dinić M, Brdarić E, Kotur-Stevuljević J, Pecikoza U, Pavićević D, Micov A, Milenković D, Jovanović A, Stepanović-Petrović R. Vortioxetine reduces the development of pain-related behaviour in a knee osteoarthritis model in rats: Involvement of nerve growth factor (NGF) down-regulation. Br J Pharmacol 2024. [PMID: 39299793 DOI: 10.1111/bph.17342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/31/2024] [Accepted: 08/04/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND AND PURPOSE Vortioxetine, a multimodal-acting antidepressant, has recently shown analgesic properties. We aimed to investigate its prophylactic effect in the osteoarthritis (OA) model and gain insights into the underlying molecular mechanisms. Duloxetine was studied as a reference. EXPERIMENTAL APPROACH In the monoiodoacetate (MIA)-induced rat model of knee OA, pain-related behaviour was assessed in weight-bearing and Von Frey tests. Antidepressants were administered orally once daily for 28 days. Gene expression of pain-related mediators (Ngf, Il-1β, Tnf-α, Bdnf, and Tac1 encoding substance P) and oxidative stress parameters were determined after completion of the treatment/behavioural testing protocol. KEY RESULTS Vortioxetine and duloxetine dose dependently reduced weight-bearing asymmetry and mechanical hyperalgesia of the paw ipsilateral to the MIA-injected knee. Vortioxetine reduced the increased Ngf mRNA expression in the MIA-injected knees to the level in sham-injected counterparts. It reduced oxidative stress parameters in the affected knees, more effectively in females than males. Duloxetine showed no effect on Ngf mRNA expression and oxidative stress. Both antidepressants decreased mRNA expression of pain-related mediators in the lumbar L3-L5 ipsilateral DRGs and spinal cords, which were up-regulated in MIA-injected rats. This effect was male-specific. CONCLUSION AND IMPLICATIONS Vortioxetine may be effective against the development of chronic pain in OA. Its antihyperalgesic effect may be mediated, at least in part, by normalization of NGF expression in the affected joint. Decrease of localized oxidative stress and of expression of pain-related mediators that contribute to central sensitization are also involved in vortioxetine's antihyperalgesic effect, in a sex-specific pattern.
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Affiliation(s)
- Maja Tomić
- Department of Pharmacology, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
| | - Katarina Nastić
- Department of Pharmacology, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
| | - Miroslav Dinić
- Group for Probiotics and Microbiota-Host Interaction, Institute of Molecular Genetics and Genetic Engineering (IMGGE), University of Belgrade, Belgrade, Serbia
| | - Emilija Brdarić
- Group for Probiotics and Microbiota-Host Interaction, Institute of Molecular Genetics and Genetic Engineering (IMGGE), University of Belgrade, Belgrade, Serbia
| | - Jelena Kotur-Stevuljević
- Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
| | - Uroš Pecikoza
- Department of Pharmacology, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
| | - David Pavićević
- Department of Pharmacology, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
| | - Ana Micov
- Department of Pharmacology, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
| | - Danijela Milenković
- Department of Physics and Mathematics, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
| | - Aleksandar Jovanović
- Department of Basic and Clinical Sciences, University of Nicosia - Medical School, Nicosia, Cyprus
- Center for Neuroscience and Integrative Brain Research (CENIBRE), University of Nicosia - Medical School, Nicosia, Cyprus
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Lane CY, Thoma LM, Alvarez C, Givens DL, Nelson AE, Goode AP, Foucher KC, Golightly YM. Diminished vibration perception and greater pressure pain sensitivity are associated with worse knee osteoarthritis outcomes across sex and race. Osteoarthritis Cartilage 2024; 32:1163-1171. [PMID: 38880428 DOI: 10.1016/j.joca.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 05/03/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To examine associations of vibration sensitivity and pressure pain sensitivity with knee osteoarthritis (OA) outcomes across sex and race, which may relate to known sex and race disparities in clinical outcomes. DESIGN Data were from the 2013-2015 visit of the Johnston County Osteoarthritis Project. Exposures were vibration perception threshold (VPT) measured at the bilateral medial femoral condyle (MFC) and first metatarsophalangeal joint (MTP), and pressure pain threshold (PPT) measured at the bilateral upper trapezius. Outcomes were knee pain severity and presence of knee symptoms, radiographic knee OA, and symptomatic knee OA in each knee. Cross-sectional associations of the exposures with the outcomes were examined using logistic regression models, overall and separately by sex and race. RESULTS In the VPT and PPT analyses, 851 and 862 participants (mean age 71 years, 68% female, 33% Black, body mass index 31 kg/m2) and 1585 and 1660 knees were included, respectively. Higher VPT (lower vibration sensitivity) at the MFC and first MTP joint was associated with all outcomes. Lower PPT (greater pressure pain sensitivity) was associated with greater knee pain severity. Associations of VPT and PPT with all outcomes were similar among females and males and Black and White individuals. CONCLUSIONS Diminished vibration perception and greater pressure pain sensitivity were cross-sectionally associated with worse knee OA outcomes. Despite differences in VPT and PPT among females and males and Black and White adults, associations with knee OA outcomes did not differ by sex or race, suggesting neurophysiological differences do not relate to established disparities.
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Affiliation(s)
- Chris Y Lane
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Louise M Thoma
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Deborah L Givens
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Adam P Goode
- Department of Orthopedic Surgery, Duke University, Durham, NC, United States.
| | - Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States.
| | - Yvonne M Golightly
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, United States.
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Lee S, Neogi T, McGinley B, Wang N, Frey Law L, Torabian KA, Aoyagi K, Stefanik JJ, Carlesso LC, Hausdorff JM, Gazit E, Segal NA, Lewis CE, Nevitt MC, Kumar D. Associations of pain sensitivity and conditioned pain modulation with physical activity: findings from the Multicenter Osteoarthritis Study (MOST). Osteoarthritis Cartilage 2024; 32:982-989. [PMID: 38763431 PMCID: PMC11254545 DOI: 10.1016/j.joca.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE Individuals with chronic pain due to knee osteoarthritis (OA) are insufficiently physically active, and alterations of facilitatory and inhibitory nociceptive signaling are common in this population. Our objective was to examine the association of these alterations in nociceptive signaling with objective accelerometer-based measures of physical activity in a large observational cohort. DESIGN We used data from the Multicenter Osteoarthritis Study. Measures of peripheral and central pain sensitivity included pressure pain threshold at the knee and mechanical temporal summation at the wrist, respectively. The presence of descending pain inhibition was assessed by conditioned pain modulation (CPM). Physical activity was quantitatively assessed over 7 days using a lower back-worn activity monitor. Summary metrics included steps/day, activity intensity, and sedentary time. Linear regression analyses were used to evaluate the association of pain sensitivity and the presence of descending pain inhibition with physical activity measures. RESULTS Data from 1873 participants was analyzed (55.9% female, age = 62.8 ± 10.0 years). People having greater peripheral and central sensitivity showed lower step counts. CPM was not significantly related to any of the physical activity measures, and none of the exposures were significantly related to sedentary time. CONCLUSIONS In this cohort, greater peripheral and central sensitivity were associated with reduced levels of objectively-assessed daily step counts. Further research may investigate ways to modify or treat heightened pain sensitivity as a means to increase physical activity in older adults with knee OA.
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Affiliation(s)
- Soyoung Lee
- Department of Physical Therapy, Boston University, Boston, MA, USA.
| | - Tuhina Neogi
- Division of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Brooke McGinley
- School of Public Health, Boston University, Boston, MA, USA.
| | - Na Wang
- School of Public Health, Boston University, Boston, MA, USA.
| | - Laura Frey Law
- Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, IA, USA.
| | - Kaveh A Torabian
- Department of Physical Therapy, Boston University, Boston, MA, USA.
| | - Kosaku Aoyagi
- Division of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Joshua J Stefanik
- Division of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Department of Physical Therapy, Northeastern University, Boston, MA, USA.
| | - Lisa C Carlesso
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
| | - Jeffrey M Hausdorff
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Rush University Medical Center, Chicago, IL, USA.
| | - Eran Gazit
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Neil A Segal
- Department of Rehabilitation Medicine, University of Kansas, Kansas City, KS, USA.
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Michael C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Deepak Kumar
- Department of Physical Therapy, Boston University, Boston, MA, USA; Division of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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Tong B, Chen H, Wang C, Zeng W, Li D, Liu P, Liu M, Jin X, Shang S. Clinical prediction models for knee pain in patients with knee osteoarthritis: a systematic review. Skeletal Radiol 2024; 53:1045-1059. [PMID: 38265451 DOI: 10.1007/s00256-024-04590-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To identify and describe existing models for predicting knee pain in patients with knee osteoarthritis. METHODS The electronic databases PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library were searched from their inception to May 2023 for any studies to develop and validate a prediction model for predicting knee pain in patients with knee osteoarthritis. Two reviewers independently screened titles, abstracts, and full-text qualifications, and extracted data. Risk of bias was assessed using the PROBAST. Data extraction of eligible articles was extracted by a data extraction form based on CHARMS. The quality of evidence was graded according to GRADE. The results were summarized with descriptive statistics. RESULTS The search identified 2693 records. Sixteen articles reporting on 26 prediction models were included targeting occurrence (n = 9), others (n = 7), progression (n = 5), persistent (n = 2), incident (n = 1), frequent (n = 1), and flares (n = 1) of knee pain. Most of the studies (94%) were at high risk of bias. Model discrimination was assessed by the AUROC ranging from 0.62 to 0.81. The most common predictors were age, BMI, gender, baseline pain, and joint space width. Only frequent knee pain had a moderate quality of evidence; all other types of knee pain had a low quality of evidence. CONCLUSION There are many prediction models for knee pain in patients with knee osteoarthritis that do show promise. However, the clinical extensibility, applicability, and interpretability of predictive tools should be considered during model development.
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Affiliation(s)
- Beibei Tong
- School of Nursing, Peking University, Beijing, China
| | - Hongbo Chen
- Nursing Department of Peking University Third Hospital, Beijing, China
| | - Cui Wang
- School of Nursing, Peking University, Beijing, China
| | - Wen Zeng
- School of Nursing, Peking University, Beijing, China
| | - Dan Li
- School of Nursing, Peking University, Beijing, China
| | - Peiyuan Liu
- School of Nursing, Peking University, Beijing, China
| | - Ming Liu
- Macao Polytechnic University, Macao, China
| | | | - Shaomei Shang
- School of Nursing, Peking University, Beijing, China.
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Sethi V, Anand C, Della Pasqua O. Clinical Assessment of Osteoarthritis Pain: Contemporary Scenario, Challenges, and Future Perspectives. Pain Ther 2024; 13:391-408. [PMID: 38662319 PMCID: PMC11111648 DOI: 10.1007/s40122-024-00592-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/06/2024] [Indexed: 04/26/2024] Open
Abstract
The multifaceted nature of osteoarthritis (OA) pain presents a challenge in understanding and managing the condition. The diverse pain experiences, progression rates, individual responses to treatments, and complex disease mechanisms contribute to heterogeneity in the clinical studies outcomes. The lack of a standardized methodology for assessing and classifying OA pain challenges healthcare practitioners. This complicates the establishment of universally applicable protocols or standardized guidelines for treatment. This article explores the heterogeneity observed in clinical studies evaluating OA pain treatments, highlighting the necessity for refined methodologies, personalized patient categorization, and consistent outcome measures. It discusses the role of the multidimensional nature of OA pain, underlying pain mechanisms, and other contributing factors to the heterogeneity in outcome measures. Addressing these variations is crucial to establishing a more consistent framework for evidence-based treatments and advancing care of the patient with OA pain.
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Affiliation(s)
- Vidhu Sethi
- Haleon (Formerly GSK Consumer Healthcare), GSK Asia House, Rochester Park, Singapore, 139234, Singapore.
| | - Chetan Anand
- Advanced Pain Management Centre, Hackettstown, NJ, USA
| | - Oscar Della Pasqua
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Brentford, UK
- Clinical Pharmacology and Therapeutics Group, University College London, BMA House, Tavistock Square, London, UK
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Mathew J, Adhia DB, Hall M, De Ridder D, Mani R. EEG-Based Cortical Alterations in Individuals With Chronic Knee Pain Secondary to Osteoarthritis: A Cross-sectional Investigation. THE JOURNAL OF PAIN 2024; 25:104429. [PMID: 37989404 DOI: 10.1016/j.jpain.2023.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 11/05/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
Chronic painful knee osteoarthritis (OA) is a disabling physical health condition. Alterations in brain responses to arthritic changes in the knee may explain persistent pain. This study investigated source localized, resting-state electroencephalography activity and functional connectivity in people with knee OA, compared to healthy controls. Adults aged 44 to 85 years with knee OA (n = 37) and healthy control (n = 39) were recruited. Resting-state electroencephalography was collected for 10 minutes and decomposed into infraslow frequency (ISF) to gamma frequency bands. Standard low-resolution electromagnetic brain tomography statistical nonparametric maps were conducted, current densities of regions of interest were compared between groups and correlation analyses were performed between electroencephalography (EEG) measures and clinical pain and functional outcomes in the knee OA group. Standard low-resolution electromagnetic brain tomography nonparametric maps revealed higher (P = .006) gamma band activity over the right insula (RIns) in the knee OA group. A significant (P < .0001) reduction in ISF band activity at the pregenual anterior cingulate cortex, whereas higher theta, alpha, beta, and gamma band activity at the dorsal anterior cingulate cortex, pregenual anterior cingulate cortex, the somatosensory cortex, and RIns in the knee OA group were identified. ISF activity of the dorsal anterior cingulate cortex was positively correlated with pain measures and psychological distress scores. Theta and alpha activity of RIns were negatively correlated with pain interference. In conclusion, aberrations in infraslow and faster frequency EEG oscillations at sensory discriminative, motivational-affective, and descending inhibitory cortical regions were demonstrated in people with chronic painful knee OA. Moreover, EEG oscillations were correlated with pain and functional outcome measures. PERSPECTIVE: This study confirms alterations in the rsEEG oscillations and its relationship with pain experience in people with knee OA. The study provides potential cortical targets and the EEG frequency bands for neuromodulatory interventions for managing chronic pain experience in knee OA.
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Affiliation(s)
- Jerin Mathew
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand; Department of Anatomy, School of Biomedical Sciences, University of Otago, New Zealand; Pain@Otago Research Theme, University of Otago, New Zealand
| | - Divya B Adhia
- Pain@Otago Research Theme, University of Otago, New Zealand; Division of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand
| | - Matthew Hall
- Division of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand
| | - Dirk De Ridder
- Pain@Otago Research Theme, University of Otago, New Zealand; Division of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand; Pain@Otago Research Theme, University of Otago, New Zealand
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Vincent TL, Miller RE. Molecular pathogenesis of OA pain: Past, present, and future. Osteoarthritis Cartilage 2024; 32:398-405. [PMID: 38244717 PMCID: PMC10984780 DOI: 10.1016/j.joca.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/05/2024] [Accepted: 01/16/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To provide a historical perspective and narrative review on research into the molecular pathogenesis of osteoarthritis pain. DESIGN PubMed databases were searched for combinations of "osteoarthritis", "pain" and "animal models" for papers that represented key phases in the history of osteoarthritis pain discovery research including epidemiology, pathology, imaging, preclinical modeling and clinical trials. RESULTS The possible anatomical sources of osteoarthritis pain were identified over 50 years ago, but relatively slow progress has been made in understanding the apparent disconnect between structural changes captured by radiography and symptom severity. Translationally relevant animal models of osteoarthritis have aided in our understanding of the structural and molecular drivers of osteoarthritis pain, including molecules such as nerve growth factor and C-C motif chemokine ligand 2. Events leading to persistent osteoarthritis pain appear to involve a two-step process involving changes in joint innervation, including neo-innervation of the articular cartilage, as well as sensitization at the level of the joint, dorsal root ganglion and central nervous system. CONCLUSIONS There remains a great need for the development of treatments to reduce osteoarthritis pain in patients. Harnessing all that we have learned over the past several decades is helping us to appreciate the important interaction between structural disease and pain, and this is likely to facilitate development of new disease modifying therapies in the future.
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Affiliation(s)
- Tonia L Vincent
- Centre for OA Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, University of Oxford, Roosevelt Drive, OX3 7FY Oxford, UK.
| | - Rachel E Miller
- Division of Rheumatology and Chicago Center on Musculoskeletal Pain, Rush University Medical Center, Chicago, IL, USA.
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Sofat N, Lambarth A. Can we achieve pain stratification in musculoskeletal conditions? Implications for clinical practice. FRONTIERS IN PAIN RESEARCH 2024; 5:1362757. [PMID: 38524267 PMCID: PMC10958789 DOI: 10.3389/fpain.2024.1362757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
In the last few years there has been an increased appreciation that pain perception in rheumatic and musculoskeletal diseases (RMDs) has several mechanisms which include nociceptive, inflammatory, nociplastic and neuropathic components. Studies in specific patient groups have also demonstrated that the pain experienced by people with specific diagnoses can present with distinctive components over time. For example, the pain observed in rheumatoid arthritis has been widely accepted to be caused by the activation of nociceptors, potentiated by the release of inflammatory mediators, including prostaglandins, leukotrienes and cytokine networks in the joint environment. However, people with RA may also experience nociplastic and neuropathic pain components, particularly when treatments with disease modifying anti-rheumatic drugs (DMARDs) have been implemented and are insufficient to control pain symptoms. In other RMDs, the concept of pain sensitisation or nociplastic pain in driving ongoing pain symptoms e.g. osteoarthritis and fibromyalgia, is becoming increasingly recognised. In this review, we explore the hypothesis that pain has distinct modalities based on clinical, pathophysiological, imaging and genetic factors. The concept of pain stratification in RMD is explored and implications for future management are also discussed.
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Affiliation(s)
- Nidhi Sofat
- Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
- Department of Rheumatology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Andrew Lambarth
- Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
- Department of Rheumatology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
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Sturgeon JA, Cooley C, Minhas D. Practical approaches for clinicians in chronic pain management: Strategies and solutions. Best Pract Res Clin Rheumatol 2024; 38:101934. [PMID: 38341332 DOI: 10.1016/j.berh.2024.101934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
Effective management of chronic pain necessitates multidisciplinary approaches including medical treatment, physical therapy, lifestyle interventions, and behavioral or mental health therapy. Medical providers regularly report high levels of stress and challenge when treating patients with chronic pain, which recur in part due to improper education on contributors to pain and misalignment in patient and provider goals and expectations for treatment. The current paper reviews common challenges and misconceptions in the setting of chronic pain management as well as strategies for effective patient education and goal setting related to these issues. The paper also outlines key aspects of provider burnout, its relevance for medical providers in chronic pain management, and recommendations for burnout prevention in navigating issues of patient education and treatment planning.
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Affiliation(s)
- John A Sturgeon
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Corinne Cooley
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, USA; Department of Pain Management and Rehabilitation Services, Stanford Health Care, Redwood City, CA, USA.
| | - Deeba Minhas
- Department of Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA.
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Aoyagi K, Jafarzadeh SR, Carlesso L, Law LF, Lewis CE, Nevitt M, Neogi T. Mediating Effect of Pain Sensitization on the Paradoxical Relation of Taking Opioids to Pain Severity in Knee Osteoarthritis: The Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken) 2024; 76:403-408. [PMID: 37750238 PMCID: PMC10922135 DOI: 10.1002/acr.25244] [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: 03/28/2023] [Revised: 08/16/2023] [Accepted: 11/21/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE One of the less understood adverse effects while taking opioids is the paradoxical increase in pain, known as opioid-induced hyperalgesia (OIH). We sought to determine whether pain sensitization mediates the relation of taking an opioid to pain severity in people with knee osteoarthritis (OA). METHODS We included participants in a National Institutes of Health-funded cohort study of people with or at risk of knee OA. Participants were categorized into opioid and nonopioid analgesic groups at baseline. Western Ontario McMaster Universities OA Index (WOMAC) pain two years later was assessed as the outcome. We used causal mediation analysis to assess the mediating role of pain sensitization, quantified by changes in pressure pain threshold (PPT) at the wrist and patella over two years, on the effect of taking an opioid on WOMAC pain two years later. RESULTS We included 296 participants who took opioids and 1,070 participants who took nonopioid analgesics. Compared with taking nonopioid analgesics, taking opioids was associated with greater pain two years later. This relation was mediated by 0.05- and 0.08-unit changes in wrist PPT (95% confidence interval [CI] 0.01-0.10) and patellar PPT (95% CI 0.02-0.14), respectively. When we assessed any worsening in WOMAC pain score over two years, taking opioids, compared with taking nonopioid analgesics, had 2% and 5% higher odds of experiencing any worsening pain mediated by changes in wrist PPT (95% CI 0.99-1.04) and patellar PPT (95% CI 1.01-1.09), respectively. CONCLUSION Pain sensitization had small mediating effects on the paradoxical phenomenon of OIH, suggesting that pain sensitization may not play a major role and/or that PPT is an inadequate tool to assess OIH.
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Affiliation(s)
- Kosaku Aoyagi
- University of Texas at El Paso, El Paso, TX, USA
- Boston University School of Medicine, Boston, MA, USA
| | | | | | | | | | - Michael Nevitt
- University of California San Francisco, San Francisco, CA, USA
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, MA, USA
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Saxer F, Hollinger A, Bjurström M, Conaghan P, Neogi T, Schieker M, Berenbaum F. Pain-phenotyping in osteoarthritis: Current concepts, evidence, and considerations towards a comprehensive framework for assessment and treatment. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100433. [PMID: 38225987 PMCID: PMC10788802 DOI: 10.1016/j.ocarto.2023.100433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/30/2023] [Indexed: 01/17/2024] Open
Abstract
Objectives Pain as central symptom of osteoarthritis (OA) needs to be addressed as part of successful treatment. The assessment of pain as feature of disease or outcome in clinical practice and drug development remains a challenge due to its multidimensionality and the plethora of confounders. This article aims at providing insights into our understanding of OA pain-phenotypes and suggests a framework for systematic and comprehensive assessments. Methods This narrative review is based on a search of current literature for various combinations of the search terms "pain-phenotype" and "knee OA" and summarizes current knowledge on OA pain-phenotypes, putting OA pain and its assessment into perspective of current research efforts. Results Pain is a complex phenomenon, not necessarily associated with tissue damage. Various pain-phenotypes have been described in knee OA. Among those, a phenotype with high pain levels not necessarily matching structural changes and a phenotype with low pain levels and impact are relatively consistent. Further subgroups can be differentiated based on patient reported outcome measures, assessments of comorbidities, anxiety and depression, sleep, activity and objective measures such as quantitative sensory testing. Conclusions The complexity of both OA as disease and pain in OA prompt the definition of a set of variables that facilitate assessments comparable across studies to maximize our understanding of pain, as central concern for the patient.
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Affiliation(s)
- F. Saxer
- Novartis Biomedical Research, Novartis Campus, 4002, Basel, Switzerland
- Medical Faculty, University of Basel, 4002, Basel, Switzerland
| | - A. Hollinger
- Novartis Biomedical Research, Novartis Campus, 4002, Basel, Switzerland
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - M.F. Bjurström
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - P.G. Conaghan
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, UK
| | - T. Neogi
- Clinical Epidemiology Research and Training Unit and Rheumatology, Boston University School of Medicine Epidemiology, Boston University School of Public Health, United States
| | - M. Schieker
- Novartis Biomedical Research, Novartis Campus, 4002, Basel, Switzerland
- Medical Faculty, Ludwig-Maximilians-University, Munich, 80336, Germany
| | - F. Berenbaum
- Department of Rheumatology, Sorbonne Université, INSERM CRSA, AP-HP Hopital Saint Antoine, Paris, France
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Mani R, Adhia DB, Awatere S, Gray AR, Mathew J, Wilson LC, Still A, Jackson D, Hudson B, Zeidan F, Fillingim R, De Ridder D. Self-regulation training for people with knee osteoarthritis: a protocol for a feasibility randomised control trial (MiNT trial). FRONTIERS IN PAIN RESEARCH 2024; 4:1271839. [PMID: 38269396 PMCID: PMC10806808 DOI: 10.3389/fpain.2023.1271839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/07/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Knee osteoarthritis (OA) is a chronic secondary musculoskeletal pain condition resulting in disability, reduced quality of life, and high societal costs. Pain associated with knee OA is linked to increased sensitivity in sensory, cognitive, and emotional areas of the brain. Self-regulation training targeting brain functioning related to pain experience could reduce pain and its associated disability. Self-regulatory treatments such as mindfulness meditation (MM) and electroencephalography neurofeedback (EEG-NF) training improve clinical outcomes in people with knee OA. A feasibility clinical trial can address factors that could inform the design of the full trial investigating the effectiveness of self-regulation training programmes in people with knee OA. This clinical trial will evaluate the feasibility, safety, acceptability, experience and perceptions of the self-regulatory training programmes. Methods The proposed feasibility trial is based on a double-blind (outcome assessor and investigators), three-arm (MM usual care, EEG-NF + usual care and usual care control group) randomised controlled parallel clinical trial. Participants with knee OA will be recruited from the community and healthcare practices. A research assistant (RA) will administer both interventions (20-min sessions, four sessions each week, and 12 sessions over three successive weeks). Feasibility measures (participant recruitment rate, adherence to interventions, retention rate), safety, and acceptability of interventions will be recorded. An RA blinded to the group allocation will record secondary outcomes at baseline, immediately post-intervention (4th week), and 3 months post-intervention. The quantitative outcome measures will be descriptively summarised. The qualitative interviews will evaluate the participants' experiences and perceptions regarding various aspects of the trial, which includes identifying the barriers and facilitators in participating in the trial, evaluating their opinions on the research procedures, such as their preferences for the study site, and determining the level of acceptability of the interventions as potential clinical treatments for managing knee OA. Māori participant perceptions of how assessment and training practices could be acceptable to a Māori worldview will be explored. The interviews will be audio-recorded and analysed thematically. Discussion This trial will provide evidence on the feasibility, safety, and acceptability of the MM and EEG-NF training in people with knee OA, thus informing the design of a full randomised clinical control trial.
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Affiliation(s)
- Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Divya Bharatkumar Adhia
- Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Sharon Awatere
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
- The Health Boutique, Napier, New Zealand
| | | | - Jerin Mathew
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | | | - Amanda Still
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - David Jackson
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ben Hudson
- Department of General Practice, University of Otago, Christchurch, New Zealand
| | - Fadel Zeidan
- Department of Anesthesiology, School of Medicine, University of California, San Diego, CA, United States
| | - Roger Fillingim
- Pain Research and Intervention Center of Excellence, Clinical and Translational Science Institute, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Dirk De Ridder
- Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
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Jochimsen KN, Kramer E, Van Wyngaarden J, Noehren B, Samaan MA, Duncan ST, Mattacola CG, Jacobs CA. Preoperative Temporal Summation is Associated with Impaired Recovery Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome . THE ARCHIVES OF BONE AND JOINT SURGERY 2024; 12:580-586. [PMID: 39211569 PMCID: PMC11353151 DOI: 10.22038/abjs.2024.78368.3607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/23/2024] [Indexed: 09/04/2024]
Abstract
Objectives Chronic pain is a risk factor for worse outcomes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Pain sensitization involves the central nervous system perceiving previously innocuous stimuli as noxious. Temporal summation can provide a surrogate measure of sensitization, and may be a clinical tool to identify patients at a higher risk for poor post-hip arthroscopy outcomes. Therefore, we aimed to 1) identify the prevalence of temporal summation in patients undergoing hip arthroscopy for FAIS, 2) determine if there a difference in postoperative improvement between individuals with and without preoperative temporal summation, and 3) examine preoperative predictors of poor postoperative recovery. Methods 51 participants undergoing hip arthroscopy for FAIS underwent preoperative temporal summation testing. Three months postoperatively, 38 participants completed the 12-item International Hip Outcome Tool (iHOT-12) and reported their overall symptomatic improvement (0% to 100%, with 100% being normal). Participants were categorized on the presence ( Numeric Pain Rating Scale; NPRS 2) or absence ( NPRS < 2) of temporal summation. A Mann-Whitney U test was used to determine the difference in improvement between groups (temporal summation: temporal summation (TS), no temporal summation (NTS), and a linear regression was used to explore predictors of improvement. Results 23 (45.1%) of 51 participants displayed preoperative temporal summation. In participants with postoperative data, those with temporal summation reported less improvement than those without (TS: 62.8% 29.7%; NTS: 82.7% 13.9%; p = 0.01; Cohen's d = -0.86). Temporal summation (Beta = -0.48; 95% CI -36.6, -8.7) and mental health disorder (Beta = -0.30; 95% CI -28.0, -0.48) predicted 28.1% of the variance in postoperative improvement (p = 0.002). Conclusion The presence of preoperative temporal summation is common and related to worse postoperative recovery after hip arthroscopy for FAIS.
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Affiliation(s)
- Kate N. Jochimsen
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Emilie Kramer
- West Virginia University School of Medicine, Morgantown, WV, USA
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Aydemir B, Muhammad LN, Song J, Chang AH, Dunlop DD, Chang RW, Lee YC. Modifiable physical and behavioural factors associated with widespread pain in older adults with radiographic evidence of knee osteoarthritis. Musculoskeletal Care 2023; 21:1090-1097. [PMID: 37271894 PMCID: PMC10714439 DOI: 10.1002/msc.1789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To identify modifiable physical and behavioural factors associated with widespread pain (WSP) in older adults with radiographic evidence of knee osteoarthritis (OA). METHODS Cross-sectional initial visit data of participants with radiographic knee OA (Kellgren-Lawrence grade of ≥2) from the Osteoarthritis Initiative Study were analysed. WSP was defined as pain on both sides of the body, above and below the waist, and in the axial skeleton. Time (hrs/d) spent participating in sitting and moderate-strenuous physical activities were calculated from the Physical Activity Scale for the Elderly questionnaire. Physical function was quantified using gait speed and the chair stand test. Restless sleep was assessed using an item on the CES-D Scale. Logistic regression models were constructed to examine the strength of the associations between primary exposures and WSP in unadjusted and adjusted analyses. RESULTS Among the 2637 participants (mean age 62.6 years, 58.6% female), 16.8% met the criteria for WSP. All primary measures of interest were related to WSP in unadjusted analyses. In adjusted multivariable analysis, slow gait speed (adjusted odds ratio [aOR] 1.43; 95% CI 1.01, 2.02), lower chair stand rate (aOR 0.98; 95% CI 0.97-0.99), and restless sleep (aOR 1.61; 95% CI 1.25-2.08) maintained significant associations with WSP. CONCLUSION Poor sleep behaviours and low physical function capacity are associated with WSP in adults with radiographic knee OA. These findings highlight the importance of assessing sleep, physical function, and pain distribution in this population. Interventions to improve physical function and sleep behaviours should be investigated as potential strategies to mitigate WSP.
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Affiliation(s)
- Burcu Aydemir
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lutfiyya N. Muhammad
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jing Song
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alison H. Chang
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dorothy D. Dunlop
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rowland W. Chang
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yvonne C. Lee
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Lee S, Neogi T, Costello KE, Senderling B, Stefanik JJ, Frey-Law L, Kumar D. Association of mechanical temporal summation of pain with muscle co-contraction during walking in people with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2023; 110:106105. [PMID: 37778085 PMCID: PMC10841902 DOI: 10.1016/j.clinbiomech.2023.106105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND People with knee osteoarthritis walk with excessive muscle co-contraction that can accelerate disease progression. Central pain sensitization is common in people with knee osteoarthritis and may be related to walking patterns. The objective of this study was to examine the relation of central pain sensitization with muscle co-contraction during walking in people with knee osteoarthritis. METHODS This study reports secondary analysis from baseline data of two clinical trials (n = 90 participants with knee osteoarthritis). The presence of central pain sensitization was measured by mechanical temporal summation at the patella and the wrist. Quadriceps and hamstrings activation was assessed using surface electromyography during walking at self-selected and fast paces. Muscle co-contraction indices for vastus medialis-medial hamstrings and vastus lateralis-lateral hamstrings muscle pairs were calculated during stance phases. Co-contraction outcomes were compared between people with and without mechanical temporal summation at each site, adjusting for age, sex, and body mass index. FINDINGS People with mechanical temporal summation at the knee had greater vastus lateralis-lateral hamstrings co-contraction while walking at a fast pace (P = 0.04). None of the other differences was statistically significant, but the overall trends and effect sizes indicated greater co-contraction in people with temporal summation at the knee irrespective of gait phase, walking speed, or muscle pairs. INTERPRETATION Central pain sensitization, assessed as mechanical temporal summation at the knee, is related to greater knee muscle co-contraction during fast walking in people with knee osteoarthritis. Thus, mitigating central sensitization may be an interventional target to reduce muscle co-contraction for people with knee osteoarthritis.
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Affiliation(s)
- Soyoung Lee
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Kerry E Costello
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA
| | | | - Joshua J Stefanik
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Laura Frey-Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Deepak Kumar
- Department of Physical Therapy, Boston University, Boston, MA, USA; Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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Modarresi S, Pearson N, Madden K, Bennell KL, Fahnestock M, Neogi T, Carlesso LC. Pain Informed Movement for people with knee osteoarthritis: Protocol for a pilot randomized controlled trial. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100402. [PMID: 37664870 PMCID: PMC10469070 DOI: 10.1016/j.ocarto.2023.100402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/09/2023] [Indexed: 09/05/2023] Open
Abstract
Objective Conservative pain management strategies for knee osteoarthritis (KOA) have limited effectiveness and do not employ a pain-mechanism informed approach. Pain Informed Movement is a novel intervention combining mind-body techniques with neuromuscular exercise and pain neuroscience education (PNE), aimed at improving endogenous pain modulation. While the feasibility and acceptability of this program has been previously established, it now requires further evaluation in comparison to standard KOA care. Design This protocol describes the design of a pilot two-arm randomized controlled trial (RCT) with an embedded qualitative component. The primary outcome is complete follow-up rate. With an allocation ratio of 1:1, 66 participants (33/arm) (age ≥40 years, KOA diagnosis or meeting KOA NICE criteria, and pain intensity ≥3/10), will be randomly allocated to two groups that will both receive 8 weeks of twice weekly in-person exercise sessions. Those randomized to Pain Informed Movement will receive PNE and mind-body technique instruction provided initially as videos and integrated into exercise sessions. The control arm will receive neuromuscular exercise and standard OA education. Assessment will include clinical questionnaires, physical and psychophysical tests, and blood draws at baseline and program completion. Secondary outcomes are program acceptability, burden, rate of recruitment, compliance and adherence, and adverse events. Participants will be invited to an online focus group at program completion. Conclusion The results of this pilot RCT will serve as the basis for a larger multi-site RCT aimed at determining the program's effectiveness with the primary outcome of assessing the mediating effects of descending modulation on changes in pain.
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Affiliation(s)
- Shirin Modarresi
- Michael DeGroote Institute for Pain Research and Care (IPRC), McMaster University, Hamilton, ON, Canada
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada
| | - Neil Pearson
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Kim Madden
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Research Institute of St. Joe's, Hamilton, ON, Canada
| | - Kim L. Bennell
- Centre for Health Exercise and Sports Medicine | Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Margaret Fahnestock
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Lisa C. Carlesso
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada
- Research Institute of St. Joe's, Hamilton, ON, Canada
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Dahmani D, Taik FZ, Berrichi I, Fourtassi M, Abourazzak FE. Impact of central sensitization on pain, disability and psychological distress in patients with knee osteoarthritis and chronic low back pain. BMC Musculoskelet Disord 2023; 24:877. [PMID: 37950225 PMCID: PMC10636971 DOI: 10.1186/s12891-023-07019-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Central sensitization (CS) is becoming increasingly recognized as a significant factor in many chronic pain conditions, including knee osteoarthritis (KOA) and chronic low back pain (CLBP). Yet it presently remains unclear how strong is the involvement of CS in KOA and CLBP and which factors are involved in CS in these two chronic disabling diseases. METHODS This is a cross-sectional study in which included a total of 178 patients with KOA and 118 patients with CLBP. Inclusion criteria for eligible participants for the KOA group were a confirmed diagnosis of KOA according to the American College of Rheumatology criteria, and for the CLBP group a chronic low back pain for more than 3 months. Subjects were excluded if they presented with a diagnosed psychiatric disorder or if they lacked the capacity to provide informed consent, understand study questionnaires or perform physical performance tests. In each group, were assessed; CS-related symptoms using the Central Sentization Inventory (CSI); demographic and clinical characteristics such as disease duration, pain intensity on a visual analog scale, self-reported function using the Lequesne index for KOA patients and the Oswestry Disability index for CLBP patients, and physical performance with the 6 minutes' walk test; as well as psychosocial risk factors using the Patient Health Questionnaire for depression (PHQ-9), the Generalized Anxiety Disorder (GAD-7) and the Pain Catastrophizing Scale (PCS). RESULTS CSI scores significantly correlated with pain intensity and disability in KOA and CLBP patients, and were highly correlated with self-reported symptoms of depression, anxiety and pain catastrophizing. Depression significantly predicted the CSI score in both groups. CONCLUSION These findings provide further evidence for the impact of CS on pain, function and physical performance in KOA and CLBP patients. Psychosocial symptoms such as pain catastrophizing, anxiety and depression should also be considered as they are also associated with CS.
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Affiliation(s)
- Doha Dahmani
- Rheumatology Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Abdelmalek Essaadi University, Tangier, Morocco.
| | - Fatima Zahrae Taik
- Rheumatology Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Abdelmalek Essaadi University, Tangier, Morocco
- Laboratory of Life and Health Sciences, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Imane Berrichi
- Rheumatology Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Abdelmalek Essaadi University, Tangier, Morocco
| | - Maryam Fourtassi
- Laboratory of Life and Health Sciences, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Fatima Ezzahra Abourazzak
- Rheumatology Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Abdelmalek Essaadi University, Tangier, Morocco
- Laboratory of Life and Health Sciences, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
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Gløersen M, Steen Pettersen P, Neogi T, Sexton J, Kvien TK, Hammer HB, Haugen IK. Associations between pain sensitization and measures of physical function in people with hand osteoarthritis: Results from the Nor-Hand study. Osteoarthritis Cartilage 2023; 31:1388-1395. [PMID: 37495183 PMCID: PMC10528207 DOI: 10.1016/j.joca.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/28/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To examine whether pain sensitization is associated with hand and lower extremity function in people with hand osteoarthritis (OA) in the Nor-Hand study. DESIGN Pain sensitization was assessed by pressure pain thresholds (PPTs) and temporal summation (TS). Hand function was assessed by Australian/Canadian Osteoarthritis Hand Index (AUSCAN) (range: 0-36), grip strength and Moberg pick-up test, and lower extremity function was assessed by Western Ontario and McMaster Universities Osteoarthritis Index (range: 0-68), 30-s chair stand test, and 40-m walk test. We examined whether sex-standardized PPT and TS values were cross-sectionally associated with measures of physical function using linear regression analyses. Beta coefficients were presented per sex-specific standard deviation of PPT and TS. The mediating effect of pain was examined by causal-inference based mediation analysis. RESULTS In 206 participants, higher PPTs at/near the hand, indicative of less peripheral and/or central pain sensitization, were associated with greater grip strength and better self-reported hand function (beta for PPT at finger joint on AUSCAN function: -1.41, 95% CI -2.40, -0.42). Higher PPTs at/near the hand, near the knee and at trapezius were associated with lower extremity function, although not statistically significant for all outcomes. Self-reported pain severity mediated the effect of PPT on self-reported function. TS was not associated with hand or lower extremity function. CONCLUSION Peripheral sensitization, and possibly central sensitization, was associated with impaired function. Effects of PPTs on self-reported function were mediated by self-reported pain, whereas there might be a direct effect of sensitization or effects through other mediators on performance-based function.
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Affiliation(s)
- Marthe Gløersen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; University of Oslo, Faculty of Medicine, Oslo, Norway.
| | - Pernille Steen Pettersen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, United States of America.
| | - Joseph Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
| | - Tore K Kvien
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; University of Oslo, Faculty of Medicine, Oslo, Norway.
| | - Hilde Berner Hammer
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; University of Oslo, Faculty of Medicine, Oslo, Norway.
| | - Ida K Haugen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
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Imagama T, Okazaki T, Matsuki Y, Kaneoka T, Kawakami T, Yamazaki K, Sakai T. Negative correlation between central sensitization and forgotten joint score-12 after total hip arthroplasty. J Orthop Surg Res 2023; 18:691. [PMID: 37715174 PMCID: PMC10504779 DOI: 10.1186/s13018-023-04175-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Central sensitization is a condition in which even mild stimuli cause pain due to increased neuronal reactivity in the dorsal horn of the spinal cord. It is one of factors of chronic pain in patients with osteoarthritis. However, it is unknown whether central sensitization relates to clinical outcomes after total hip arthroplasty (THA). This study aimed to clarify whether preoperative central sensitization relates to the forgotten joint score-12 (FJS) after THA. Moreover, the secondary outcome was to identify which items in the FJS were most related by central sensitization. METHODS This retrospective analysis included 263 hips (263 patients; 51 males and 212 females) that underwent primary THA in our institute and were available for evaluation one year postoperatively. The average patient age was 64.8 ± 11.9 years. The Central Sensitization Inventory (CSI) part A, which is a patient-reported outcome, was used to measure preoperative central sensitization. The correlation between preoperative CSI and postoperative FJS and the association between postoperative FJS and preoperative CSI severity were determined. Moreover, difference in each FJS item was evaluated by CSI severity. RESULTS Twenty-six patients (9.9%) had central sensitization preoperatively. Preoperative CSI scores and postoperative FJS were negatively correlated (r = - 0.331, p < 0.0001). The postoperative FJS was significantly lower in patients with moderate or higher preoperative CSI severity than that in patients with subclinical or mild preoperative CSI severity (p < 0.05). FJS items with movement of daily life were significantly worse in the moderate or higher CSI severity compared with subclinical group (p < 0.05 or p < 0.01). CONCLUSION Central sensitization prior to THA negatively related to postoperative FJS. In particular, the relationship of central sensitization was found to be significant in FJS items with movement, which would lead to lower patient satisfaction after THA. To get better postoperative outcomes in patients with preoperative central sensitization, improving central sensitization would be important.
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Affiliation(s)
- Takashi Imagama
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, 7558505, Japan.
| | - Tomoya Okazaki
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, 7558505, Japan
| | - Yuta Matsuki
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, 7558505, Japan
| | - Takehiro Kaneoka
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, 7558505, Japan
| | - Takehiro Kawakami
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, 7558505, Japan
| | - Kazuhiro Yamazaki
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, 7558505, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, 7558505, Japan
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Yüzügüldü SB, Kutlay Ş, Gök H. The relationship between inadequate response to physical therapy and central sensitization in patients with knee osteoarthritis: A prospective cohort study. Turk J Phys Med Rehabil 2023; 69:266-274. [PMID: 37674790 PMCID: PMC10478548 DOI: 10.5606/tftrd.2023.12020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/21/2023] [Indexed: 09/08/2023] Open
Abstract
Objectives: This study aims to investigate the relationship between physical therapy response and the presence of central sensitization (CS) in patients with painful knee osteoarthritis (OA). Patients and methods: Between May 2019 and March 2020, a total of 84 patients with knee OA (12 males, 72 females; mean age: 60.7±7.7 years; range 50 to 74 years) and 30 age and sex-matched controls (6 males, 24 females; mean age: 59.2±8.9 years; range 50 to 75 years) were included in this study. Knee pain and functional status were evaluated by Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Structural damage was assessed by knee radiography. The Central Sensitization Inventory (CSI), Beck Depression Inventory (BDI), Insomnia Severity Index (ISI), Pain Catastrophizing Scale (PCS), and PainDETECT Questionnaire (PDQ) were applied at baseline. Pain pressure thresholds (PPTs) of the patients were measured and compared with the control group. All patients underwent a total of 15 sessions of physical therapy program for five sessions/weekly. After treatment, the patients were divided into two groups as responders and non-responders according to the Osteoarthritis Research Society International (OARSI) criteria. Results: The CSI score of the patients in non-responder group was significantly higher compared to the responder group (p=0.004). Using a cut-off value of ≥40, the proportion of patients with CSI scores of ≥40 was significantly lower in the responder group compared to non-responder group (p=0.021). The PPT measurement values were significantly lower in the non-responder group compared to the responder and control groups (p <0.01). There was a significant difference in the frequency of hyperalgesia between the groups (p=0.021). Central sensitization and depression were the most significant predictors of non-response to physical therapy (p=0.045 and p=0.024, respectively). Conclusion: Our study results suggest the presence of CS and depression may result in an inadequate response to physical therapy in patients with knee OA. Clinicians should consider the findings of CS and depression in treatment planning.
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Affiliation(s)
- Serkan Burak Yüzügüldü
- Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Şehim Kutlay
- Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Haydar Gök
- Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Türkiye
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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: 6.0] [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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Mulrooney E, Neogi T, Dagfinrud H, Hammer HB, Pettersen PS, Gløersen M, Kvien TK, Magnusson K, Haugen IK. Comorbidities in people with hand OA and their associations with pain severity and sensitization: Data from the longitudinal Nor-Hand study. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100367. [PMID: 37234862 PMCID: PMC10206186 DOI: 10.1016/j.ocarto.2023.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Objective To determine whether the comorbidity burden and co-existing comorbidities are cross-sectionally and/or longitudinally associated with pain and pain sensitization in a cohort study of people with hand OA. Design We examined whether comorbidity burden and individual comorbidities based on the self-administered Comorbidity Index (range: 0-42) at baseline were associated with pain outcomes at baseline and 3 years follow-up. Pain outcomes included hand and overall bodily pain (range: 0-10) as well as pressure pain thresholds at the tibialis anterior muscle (kg/cm2) and temporal summation (distal radioulnar joint) as measures of central pain sensitization. We performed linear regression analyses adjusted for age, sex, body mass index, physical exercise and education. Results We included 300 and 196 participants in cross-sectional and longitudinal analyses, respectively. Using baseline data, the burden of comorbidities was associated with greater pain in hands (beta = 0.61, 95% CI 0.37, 0.85) and overall body (beta = 0.60, 95% CI 0.37, 0.87). Similar strength of associations was found between comorbidity burden (baseline) and follow-up pain. Among the individual comorbidities, back pain and depression were associated with nearly one unit higher pain score in hands and overall body at both baseline and follow-up. Only back pain was related to lower pressure pain thresholds at follow up (beta = -0.24, 95% CI -0.50, -0.001). Conclusion People with hand OA and greater comorbidity burden, co-existing back pain or depression reported greater pain severity than their counterparts, also 3 years later. These results acknowledge the relevance of accounting for comorbidities in the pain experience in people with hand OA.
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Affiliation(s)
- Elisabeth Mulrooney
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, United States
| | - Hanne Dagfinrud
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hilde Berner Hammer
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pernille Steen Pettersen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Marthe Gløersen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K. Kvien
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karin Magnusson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - Ida K. Haugen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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23
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Martel M, Gaudreault N, Pelletier R, Houde F, Harvey MP, Giguère C, Balg F, Leonard G. Relationship between Motor Corticospinal System, Endogenous Pain Modulation Mechanisms and Clinical Symptoms in Patients with Knee Osteoarthritis: New Perspectives on an Old Disease. Brain Sci 2023; 13:1154. [PMID: 37626509 PMCID: PMC10452861 DOI: 10.3390/brainsci13081154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
Knee osteoarthritis (OA) is a painful condition characterized by joint and bone changes. A growing number of studies suggest that these changes only partially explain the pain experienced by individuals with OA. The purpose of the current study was to evaluate if corticospinal and bulbospinal projection measurements were interrelated in patients with knee OA, and to explore the relationship between these neurophysiological measures and temporal summation (excitatory mechanisms of pain) on one hand, and clinical symptoms on the other. Twenty-eight (28) patients with knee OA were recruited. Corticospinal projections were measured using transcranial magnetic stimulation, while bulbospinal projections were evaluated with a conditioned pain modulation (CPM) protocol using a counter-irritation paradigm. Validated questionnaires were used to document clinical and psychological manifestations. All participants suffered from moderate to severe pain. There was a positive association between corticospinal excitability and the effectiveness of the CPM (rs = 0.67, p = 0.01, n = 13). There was also a positive relationship between pain intensity and corticospinal excitability (rs = 0.45, p = 0.03, n = 23), and between pain intensity and temporal summation (rs = 0.58, p = 0.01, n = 18). The results of this study highlight some of the central nervous system changes that could be involved in knee OA and underline the importance of interindividual variability to better understand and explain the semiology and pathophysiology of knee OA.
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Affiliation(s)
- Marylie Martel
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (M.M.); (N.G.); (R.P.)
- Research Centre on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC J1H 4C4, Canada; (F.H.); (M.-P.H.)
| | - Nathaly Gaudreault
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (M.M.); (N.G.); (R.P.)
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada;
| | - René Pelletier
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (M.M.); (N.G.); (R.P.)
- Research Centre on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC J1H 4C4, Canada; (F.H.); (M.-P.H.)
| | - Francis Houde
- Research Centre on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC J1H 4C4, Canada; (F.H.); (M.-P.H.)
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada;
| | - Marie-Philippe Harvey
- Research Centre on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC J1H 4C4, Canada; (F.H.); (M.-P.H.)
| | - Caroline Giguère
- Department of Diagnostic Radiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada;
| | - Frédéric Balg
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada;
- Department of Surgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
| | - Guillaume Leonard
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (M.M.); (N.G.); (R.P.)
- Research Centre on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC J1H 4C4, Canada; (F.H.); (M.-P.H.)
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Tian J, Jones G, Lin X, Zhou Y, King A, Vickers J, Pan F. Association between chronic pain and risk of incident dementia: findings from a prospective cohort. BMC Med 2023; 21:169. [PMID: 37143042 PMCID: PMC10161483 DOI: 10.1186/s12916-023-02875-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 04/19/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Chronic musculoskeletal pain has been linked to dementia; however, chronic pain typically occurs in multiple sites; therefore, this study was to investigate whether greater number of chronic pain sites is associated with a higher risk of dementia and its subtypes. METHODS Participants (N = 356,383) in the UK Biobank who were dementia-free at baseline were included. Pain in the hip, knee, back, and neck/shoulder or 'all over the body' and its duration were assessed. Participants were categorised into six groups: no chronic pain; chronic pain in 1, 2, 3, and 4 sites, and 'all over the body'. All-cause dementia and its subtypes were ascertained using hospital inpatient and death registry records. Cox regression was used to investigate the associations between the number of chronic pain sites and the incidence of all-cause dementia and its subtypes. RESULTS Over a median follow-up of 13 years, 4959 participants developed dementia. After adjustment for sociodemographic, lifestyle, comorbidities, pain medications, psychological problems, and sleep factors, greater number of chronic pain sites was associated with an increased risk of incident all-cause dementia (hazard ratio [HR] = 1.08 per 1 site increase, 95% CI 1.05-1.11) and Alzheimer's disease (AD) (HR = 1.09 per 1-site increase, 95% CI 1.04-1.13) in a dose-response manner but not vascular and frontotemporal dementia. No significant association was found between the number of chronic pain sites and the risk of incident all-cause dementia among a subsample that underwent a fluid intelligence test. CONCLUSIONS Greater number of chronic pain sites was associated with an increased risk of incident all-cause dementia and AD, suggesting that chronic pain in multiple sites may contribute to individuals' dementia risk and is an underestimated risk factor for dementia.
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Affiliation(s)
- Jing Tian
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, TAS, Hobart, 7000, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, TAS, Hobart, 7000, Australia
| | - Xin Lin
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, TAS, Hobart, 7000, Australia
| | - Yuan Zhou
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, TAS, Hobart, 7000, Australia
| | - Anna King
- Wicking Dementia Research and Education Centre, University of Tasmania, Private Bag 23, TAS, Hobart, 7000, Australia
| | - James Vickers
- Wicking Dementia Research and Education Centre, University of Tasmania, Private Bag 23, TAS, Hobart, 7000, Australia
| | - Feng Pan
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, TAS, Hobart, 7000, Australia.
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Tian J, Zhou Y, Lin X, Jones G, Pan F. Multisite Pain and Myocardial Infarction and Stroke: A Prospective Cohort and Mendelian Randomization Analysis. JACC. ADVANCES 2023; 2:100295. [PMID: 38939595 PMCID: PMC11198351 DOI: 10.1016/j.jacadv.2023.100295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/17/2023] [Accepted: 02/12/2023] [Indexed: 06/29/2024]
Abstract
Background Whether individuals with multisite pain had a higher risk of cardiovascular diseases is unclear. Objectives The purpose of this study was to investigate the longitudinal association of pain in multiple sites with incident myocardial infarction (MI) and stroke, and to disentangle the genetic causality of these associations. Methods A total of 281,760 participants (mean age: 56.3 years) who had no MI and stroke at baseline from UK Biobank study were included. Data on pain in the hip, knee, back and neck/shoulder, or 'all over the body' were collected. Chronic pain was defined if pain had lasted for ≥3 months. MI and stroke events were determined from hospital admission records and death registries. Cox regression and 2-sample Mendelian randomization were used for the analyses. Results During a median follow-up of 11.9 years, 4,854 had a first MI and 2,827 had a first stroke. In multivariable analyses, greater number of painful sites was dose-responsively associated with higher risks of incident MI and stroke, with a higher risk among participants with pain 'all over the body' (MI: HR: 1.65, 95% CI: 1.32-2.07; stroke: HR: 1.44, 95% CI: 1.13-1.85). Similar trends and associations were observed in those with chronic pain. Two-sample Mendelian randomization results supported a causal effect of multisite pain on MI risk, but not vice versa. No causal association was found between multisite pain and stroke risk. Conclusions Pain in multiple sites causally increases the risk of MI, highlighting that pain should be considered when assessing individuals' MI risk, and pain treatment and management may prevent MI risk.
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Affiliation(s)
- Jing Tian
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Yuan Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Xin Lin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Feng Pan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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26
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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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27
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Manfuku M, Nishigami T, Mibu A, Yamashita H, Imai R, Kanamori H, Sumiyoshi K. Predictors of persistent post-surgical pain intensity and interference at 1 year after breast cancer surgery: assessing central sensitization, central sensitivity symptoms, and psychological factors. Breast Cancer 2023; 30:271-281. [PMID: 36528837 DOI: 10.1007/s12282-022-01420-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Persistent post-surgical pain (PPSP) is associated with upper limb dysfunction and decreased quality of life and causes long-term suffering for breast cancer survivors after surgery. However, the predictors of PPSP remain unclear. The purpose of this study was to examine predictors of PPSP intensity and interference at 1 year postoperatively, focusing on treatment-related factors, pre- and postoperative central sensitization (CS), CS-related symptoms (e.g., muscle stiffness, fatigue, sleep disturbances), and psychological factors. METHODS Eighty-eight women with planned unilateral breast cancer surgery were included in this longitudinal study. CS, CS-related symptoms, and psychological factors were assessed preoperatively, 1 month postoperatively, and 1 year postoperatively. Analysis of covariance was used to compare the groups with and without PPSP, accounting for treatment-related factors. Multiple regression analysis was performed to identify predictors of PPSP intensity and interference at 1 year postoperatively. RESULTS Even after adjusting for covariates, preoperative and 1-month postoperative Central Sensitization Inventory scores in the PPSP group were significantly higher than scores in the group without PPSP. Multiple regression analysis showed that axillary lymph node dissection (ALND) and 1-month postoperative CS-related symptoms were independent predictors of PPSP intensity and interference at 1 year postoperatively (p < 0.01). CONCLUSION We found that ALND and 1-month postoperative CS-related symptoms were predictors of PPSP intensity and interference at 1 year postoperatively.
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Affiliation(s)
- Masahiro Manfuku
- Department of Rehabilitation, Breast Care Sensyu Clinic, Osaka, Japan.,Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Mihara , Hiroshima, Japan.
| | - Akira Mibu
- Department of Physical Therapy, Konan Women's University, Hyogo, Japan
| | - Hirofumi Yamashita
- Department of Rehabilitation, Nozomi Orthopaedic Clinic Saijo, Hiroshima, Japan
| | - Ryota Imai
- Graduate School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Osaka, Japan
| | - Hiroe Kanamori
- Department of Breast Surgery, Breast Care Sensyu Clinic, Osaka, Japan
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28
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Targeting macrophage polarization as a promising therapeutic strategy for the treatment of osteoarthritis. Int Immunopharmacol 2023; 116:109790. [PMID: 36736223 DOI: 10.1016/j.intimp.2023.109790] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) is a chronic osteoarthropathy characterized by the progressive degeneration of articular cartilage and synovial inflammation. Early OA clinical treatments involve intra-articular injection of glucocorticoids, oral acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), which are used for anti-inflammation and pain relief. However, long-term use of these agents will lead to inevitable side effects, even aggravate cartilage loss. At present, there are no disease-modifying OA drugs (DMOADs) yet approved by regulatory agencies. Polarization regulation of synovial macrophages is a new target for OA treatment. Inhibiting M1 polarization and promoting M2 polarization of synovial macrophages can alleviate synovial inflammation, relieve joint pain and inhibit articular cartilage degradation, which is a promising strategy for OA treatment. In this study, we describe the molecular mechanisms of macrophage polarization and its key role in the development of OA. Subsequently, we summarize the latest progress of strategies for OA treatment through macrophage reprogramming, including small molecule compounds (conventional western medicine and synthetic compounds, monomer compounds of traditional Chinese medicine), biomacromolecules, metal/metal oxides, cells, and cell derivatives, and interprets the molecular mechanisms, hoping to provide some information for DMOADs development.
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29
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Overton M, Swain N, Falling C, Gwynne-Jones D, Fillingim R, Mani R. Activity-related pain predicts pain and functional outcomes in people with knee osteoarthritis: A longitudinal study. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1082252. [PMID: 36713644 PMCID: PMC9880771 DOI: 10.3389/fpain.2022.1082252] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023]
Abstract
Knee Osteoarthritis (OA) is a prevalent musculoskeletal condition, commonly resulting in pain and disability. However, pain and disability in this population are poorly related with the degree of structural joint damage. Underlying pain mechanisms, including activity-related pain and sensitization assessed via Quantitative Sensory Testing (QST), may better predict pain and functional outcomes of those with knee OA. Therefore, the aim of this study was to explore whether activity-related pain and sensitization assessed via QST predict future pain, function, fatigue, physical performance and quality of life outcomes in those living in the community with knee OA. Eighty-six participants with knee OA were recruited in Dunedin, New Zealand. Those eligible to participate underwent baseline testing including QST as well as measures of activity-related pain including Movement-evoked Pain (MEP) and Sensitivity to Physical Activity (SPA). Outcome measures exploring pain, function, fatigue and quality of life outcomes were collected at baseline, and two follow-up periods (two and nine weeks). Univariable linear regression models were developed followed by multivariable linear regression models for each prognostic marker adjusting for age, gender, BMI, OA duration, baseline pain intensity and socioeconomic status. Activity-related measures of pain, including MEP and SPA, demonstrated predictive associations with pain and functional outcomes prospectively in those with knee OA. Therefore, those demonstrating activity-related pain are at future risk of greater pain, disability and reduced quality of life. Larger, externally validated longitudinal studies are required which include individuals with more severe knee OA.
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Affiliation(s)
- Mark Overton
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand,Correspondence: Mark Overton
| | - Nicola Swain
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Carrie Falling
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - David Gwynne-Jones
- Department of Surgical Sciences, Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Roger Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), Department of Community Dentistry and Behavioural Science, University of Florida, Gainesville, FL, United States
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Chen T, Or CK. Automated machine learning-based prediction of the progression of knee pain, functional decline, and incidence of knee osteoarthritis in individuals at high risk of knee osteoarthritis: Data from the osteoarthritis initiative study. Digit Health 2023; 9:20552076231216419. [PMID: 38033512 PMCID: PMC10685797 DOI: 10.1177/20552076231216419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023] Open
Abstract
Objective This study aimed to examine the performance of machine learning models in predicting the progression of knee pain, functional decline, and incidence of knee osteoarthritis (OA) in high-risk individuals, with automated machine learning (AutoML) being used to automate the prediction process. Design There were four stages in the process of our AutoML-integrated prediction. Stage 1-Data preparation: The data of 3200 eligible individuals in the Osteoarthritis Initiative (OAI) study who were considered at high risk of knee OA at the baseline visit were extracted and used. Specifically, 1094 variables from the OAI study were used to predict the changes in knee pain, physical function, and incidence of knee OA (i.e. the first occurrence of frequent knee symptoms and definite tibial osteophytes (Kellgren and Lawrence grade ≥2)) over a 9-year period. Stage 2-Model training: The AutoML approach was used to automatically train nine widely used machine learning (ML) models. Stage 3-Model testing: The AutoML approach was used to automatically test the performance of the ML models. Stage 4-Selection of important input variables: The AutoML approach automated the process of computing the importance scores of all input variables and identifying the most important ones, using the technique of permutation feature importance. Results Using the AutoML approach, the weighted ensemble model and the CatBoost model showed the best performance among all nine ML models. For the prediction of each outcome in each year, the five most important input variables were identified, most of which were obtained from self-reported questionnaire surveys and radiographic imaging reports. Conclusion The AutoML approach has shown potential in automating the process of using ML models to predict long-term changes in knee OA-related outcomes. Its use could support the deployment of ML solutions, facilitating the provision of personalized interventions to prevent the deterioration of knee health and incident knee OA.
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Affiliation(s)
- Tianrong Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Calvin Kalun Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
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Schaible HG, König C, Ebersberger A. Spinal pain processing in arthritis: Neuron and glia (inter)actions. J Neurochem 2022. [PMID: 36520021 DOI: 10.1111/jnc.15742] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
Diseases of joints are among the most frequent causes of chronic pain. In the course of joint diseases, the peripheral and the central nociceptive system develop persistent hyperexcitability (peripheral and central sensitization). This review addresses the mechanisms of spinal sensitization evoked by arthritis. Electrophysiological recordings in anesthetized rats from spinal cord neurons with knee input in a model of acute arthritis showed that acute spinal sensitization is dependent on spinal glutamate receptors (AMPA, NMDA, and metabotropic glutamate receptors) and supported by spinal actions of neuropeptides such as neurokinins and CGRP, by prostaglandins, and by proinflammatory cytokines. In several chronic arthritis models (including immune-mediated arthritis and osteoarthritis) spinal glia activation was observed to be coincident with behavioral mechanical hyperalgesia which was attenuated or prevented by intrathecal application of minocycline, fluorocitrate, and pentoxyfylline. Some studies identified specific pathways of micro- and astroglia activation such as the purinoceptor- (P2 X7 -) cathepsin S/CX3 CR1 pathway, the mobility group box-1 protein (HMGB1), and toll-like receptor 4 (TLR4) activation, spinal NFκB/p65 activation and others. The spinal cytokines TNF, interleukin-6, interleukin-1β, and others form a functional spinal network characterized by an interaction between neurons and glia cells which is required for spinal sensitization. Neutralization of spinal cytokines by intrathecal interventions attenuates mechanical hyperalgesia. This effect may in part result from local suppression of spinal sensitization and in part from efferent effects which attenuate the inflammatory process in the joint. In summary, arthritis evokes significant spinal hyperexcitability which is likely to contribute to the phenotype of arthritis pain in patients.
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Affiliation(s)
- Hans-Georg Schaible
- Institute of Physiology 1/Neurophysiology, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Christian König
- Institute of Physiology 1/Neurophysiology, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Andrea Ebersberger
- Institute of Physiology 1/Neurophysiology, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
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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: 3] [Impact Index Per Article: 1.5] [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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Bruehl S, Billings FT, Anderson S, Polkowski G, Shinar A, Schildcrout J, Shi Y, Milne G, Dematteo A, Mishra P, Harden RN. Preoperative Predictors of Complex Regional Pain Syndrome Outcomes in the 6 Months Following Total Knee Arthroplasty. THE JOURNAL OF PAIN 2022; 23:1712-1723. [PMID: 35470089 PMCID: PMC9560974 DOI: 10.1016/j.jpain.2022.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/30/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
This prospective observational study evaluated preoperative predictors of complex regional pain syndrome (CRPS) outcomes in the 6 months following total knee arthroplasty (TKA). Participants were n = 110 osteoarthritis patients (64.5% female) undergoing unilateral TKA with no prior CRPS history. Domains of negative affect (depression, anxiety, catastrophizing), pain (intensity, widespread pain, temporal summation of pain [TSP]), pain interference, sleep disturbance, and pro-inflammatory status (tumor necrosis factor-alpha [TNF-a]) were assessed preoperatively. CRPS outcomes at 6-week and 6-month follow-up included the continuous CRPS Severity Score (CSS) and dichotomous CRPS diagnoses (2012 IASP criteria). At 6 months, 12.7% of participants met CRPS criteria, exhibiting a "warm CRPS" phenotype. Six-week CSS scores were predicted by greater preoperative depression, anxiety, catastrophizing, TSP, pain intensity, sleep disturbance, and TNF-a (P's < .05). Provisional CRPS diagnosis at 6 weeks was predicted by higher preoperative TSP, sleep disturbance, and TNF-a (P's < .05). CSS scores at 6 months were predicted by more widespread and intense preoperative pain, and higher preoperative TSP, pain interference, and TNF-a (P's < .01). CRPS diagnosis at 6 months was predicted only by more widespread and intense pain preoperatively (P's < .05). Risk for CRPS following TKA appears to involve preoperative central sensitization and inflammatory mechanisms. Preoperative negative affect is unlikely to directly influence long-term CRPS risk. PERSPECTIVE: This article identifies preoperative predictors of CRPS features at 6 months following total knee arthroplasty, including more widespread pain and higher pain intensity, temporal summation of pain, pain interference, and tumor necrosis factor-alpha levels. Findings suggest the importance of central sensitization and inflammatory mechanisms in CRPS risk following tissue trauma.
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Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Frederic T Billings
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sara Anderson
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory Polkowski
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew Shinar
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan Schildcrout
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yaping Shi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ginger Milne
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anthony Dematteo
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Puneet Mishra
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - R Norman Harden
- Departments of Physical Medicine and Rehabilitation and Physical Therapy and Human Movement Science, Northwestern University, Chicago, Illinois
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Moore MN, Wallace BI, Song J, Muhammad LN, Heisler AC, Clauw DJ, Bolster MB, Marder W, Neogi T, Wohlfahrt A, Dunlop DD, Lee YC. Correlation of Fibromyalgia Survey Questionnaire and Quantitative Sensory Testing Among Patients With Active Rheumatoid Arthritis. J Rheumatol 2022; 49:1052-1057. [PMID: 35649554 PMCID: PMC10044496 DOI: 10.3899/jrheum.220046] [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] [Accepted: 05/17/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) commonly demonstrate disordered pain processing associated with high pain sensitization. Pain sensitization is often assessed using quantitative sensory testing (QST), which is burdensome to patients. The self-administered Fibromyalgia Survey Questionnaire (FSQ) has been proposed as a low-burden, surrogate measure of central pain sensitization. We examined the correlation between FSQ and QST in patients with active RA. METHODS Participants in the Central Pain in Rheumatoid Arthritis (CPIRA) cohort underwent FSQ and QST evaluation at enrollment. QST measures included pressure pain threshold (PPT) at the thumb, trapezius, wrist, and knee; temporal summation (TS) at the wrist and arm; and conditioned pain modulation (CPM). Partial Spearman correlation between FSQ and each QST measure was assessed, adjusted for demographic factors, study site, disease characteristics, and pain catastrophizing. Sensitivity analyses included (1) stratified analysis by sex and (2) evaluation of how each component of FSQ associates with the QST measures. RESULTS Among 285 participants with active RA, FSQ was weakly but statistically significantly correlated with PPT (r range = -0.31 to -0.21), and TS (r range = 0.13-0.15) at all sites in unadjusted analyses. After adjustment, statistically significant correlations persisted for TS at the wrist and PPT at all sites (except the thumb). Sensitivity analyses did not identify differences in association based on sex or with individual FSQ components. CONCLUSION FSQ and QST were correlated among participants with active RA, but the strength of association was weak. QST and FSQ are not interchangeable measures of pain sensitization.
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Affiliation(s)
- Meriah N Moore
- M.N. Moore, MD, MSc, Clinical Instructor, W. Marder, MD, Clinical Professor, Internal Medicine/Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan;
| | - Beth I Wallace
- B.I. Wallace, MD, MSc, Assistant Professor, Internal Medicine/Rheumatology, University of Michigan Medical School, and VA Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, Michigan
| | - Jing Song
- J. Song, MS, A.C. Heisler, MD, MSc, D.D. Dunlop, PhD, Professor Emeritus, Internal Medicine/Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lutfiyya N Muhammad
- L.N. Muhammad, PhD, MPH, Assistant Professor, Preventive Medicine/Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew C Heisler
- J. Song, MS, A.C. Heisler, MD, MSc, D.D. Dunlop, PhD, Professor Emeritus, Internal Medicine/Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel J Clauw
- D.J. Clauw, MD, Professor, Anesthesiology, Internal Medicine/Rheumatology, Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Marcy B Bolster
- M.B. Bolster, MD, Associate Professor, Internal Medicine/Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts
| | - Wendy Marder
- M.N. Moore, MD, MSc, Clinical Instructor, W. Marder, MD, Clinical Professor, Internal Medicine/Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Tuhina Neogi
- T. Neogi, MD, PhD, Professor, Internal Medicine/Rheumatology, Boston University School of Medicine, Evans Biomedical Research Center, Boston, Massachusetts
| | - Alyssa Wohlfahrt
- A. Wohlfahrt, MS, Tufts University School of Medicine, Boston, Massachusetts
| | - Dorothy D Dunlop
- J. Song, MS, A.C. Heisler, MD, MSc, D.D. Dunlop, PhD, Professor Emeritus, Internal Medicine/Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yvonne C Lee
- Y.C. Lee, MD, MMSc, Associate Professor, Medicine/Rheumatology, Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Norman KS, Goode AP, Alvarez C, Hu D, George SZ, Schwartz TA, Danyluk ST, Fillipo R, Kraus VB, Huebner JL, Cleveland RJ, Jordan JM, Nelson AE, Golightly YM. Association of Biomarkers with Individual and Multiple Body Sites of Pain: The Johnston County Osteoarthritis Project. J Pain Res 2022; 15:2393-2404. [PMID: 36000076 PMCID: PMC9393091 DOI: 10.2147/jpr.s365187] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Biochemical biomarkers may provide insight into musculoskeletal pain reported at individual or multiple body sites. The purpose of this study was to determine if biomarkers or pressure-pain threshold (PPT) were associated with individual or multiple sites of pain. Methods This cross-sectional analysis included 689 community-based participants. Self-reported symptoms (ie, pain, aching, or stiffness) were ascertained about the neck, upper back/thoracic, low back, shoulders, elbows, wrist, hands, hips, knees, ankles, and feet. Measured analytes included CXCL-6, RANTES, HA, IL-6, BDNF, OPG and NPY. A standard dolorimeter measured PPT. Logistic regression was used determine the association between biomarkers and PPT with individual and summed sites of pain. Results Increased IL-6 and HA were associated with knee pain (OR=1.30, 95% CI 1.03, 1.64) and (OR=1.32, 95% CI 1.01, 1.73) respectively; HA was also associated with elbow/wrist/hand pain (OR=1.60, 95% CI 1.22, 2.09). Those with increased NPY levels were less likely to have shoulder pain (OR=0.56, 95% CI 0.33, 0.93). Biomarkers HA (OR=1.50, 95% CI 1.07, 2.10), OPG (OR=1.74, 95% CI 1.00, 3.03), CXCL-6 (OR=1.75, 95% CI 1.02, 3.01) and decreased PPT (OR=3.97, 95% CI 2.22, 7.12) were associated with multiple compared to no sites of pain. Biomarker HA (OR=1.57, 95% CI 1.06, 2.32) and decreased PPT (OR=3.53, 95% CI 1.81, 6.88) were associated with multiple compared to a single site of pain. Conclusion Biomarkers of inflammation (HA, OPG, IL-6 and CXCL-6), pain (NPY) and PPT may help to understand the etiology of single and multiple pain sites.
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Affiliation(s)
- Katherine S Norman
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Adam P Goode
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - David Hu
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Steven Z George
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Todd A Schwartz
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Stephanie T Danyluk
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca Fillipo
- Duke Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, NC, USA
| | - Virginia B Kraus
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Duke Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Janet L Huebner
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca J Cleveland
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Orthopedics, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
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Imai R, Imaoka M, Nakao H, Hida M, Tazaki F, Inoue T, Orui J, Nakamura M. Association between chronic pain with presarcopenia and central sensitization in Japanese community-dwelling older adults: A cross-sectional study. Medicine (Baltimore) 2022; 101:e29998. [PMID: 35960105 PMCID: PMC9371568 DOI: 10.1097/md.0000000000029998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Older people with chronic pain are at higher risk of developing sarcopenia. Central sensitization (CS) has been implicated in chronic pain among community-dwelling older adults. However, a relationship between CS and chronic pain with sarcopenia has not been established. This cross-sectional study aimed to clarify the relationship between chronic pain with sarcopenia or presarcopenia and CS among community-dwelling older adults. We assessed chronic pain and sarcopenia in 104 older adults participating in community health checks. We defined sarcopenia using the Asian Working Group for Sarcopenia (AWGS) consensus recommendations based on the following outcomes: low muscle mass, low muscle strength, and slow gait speed. Pain-related assessments included pain intensity, the Pain Catastrophizing Scale, the CS Inventory-9, the pressure pain threshold, the Tampa Scale of Kinesiophobia-11, and the EuroQol 5-dimension 5-level (EQ5D-5L). Chronic pain was defined by related symptoms within the month prior to the health check that had continued for ≥ 3 months and corresponded to a numerical rating scale score of ≥ 1 at the site of maximum pain. The prevalence of chronic pain was 43.3%. In addition, the prevalence of chronic pain with sarcopenia or presarcopenia was 29.8%. A logistic regression analysis revealed that the pressure pain threshold (odds ratio: 0.82, 95% CI: 0.95-1.02) and the EQ5D-5L (odds ratio: 0.58, 95% CI: 0.36-0.76) were significantly associated with the presence of chronic pain with sarcopenia or presarcopenia. Chronic pain with sarcopenia or presarcopenia was affected by central sensitization. Therefore, CS should be evaluated in the elderly.
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Affiliation(s)
- Ryota Imai
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan
- *Correspondence: Ryota Imai, PhD, School of Rehabilitation, Osaka Kawasaki Rehabilitation University, 158 Mizuma, Kaizuka, Osaka 597-0104, Japan (e-mail: )
| | - Masakazu Imaoka
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan
| | - Hidetoshi Nakao
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan
| | - Mitsumasa Hida
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan
| | - Fumie Tazaki
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan
| | - Takao Inoue
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan
| | - Junya Orui
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan
| | - Misa Nakamura
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan
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Hoteit F, Erhmann Feldman D, Carlesso LC. Factors Associated with Intermittent, Constant, and Mixed Pain in People with Knee Osteoarthritis. Physiother Can 2022; 74:267-275. [PMID: 37325210 PMCID: PMC10262826 DOI: 10.3138/ptc-2020-0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/18/2020] [Accepted: 02/01/2021] [Indexed: 08/26/2023]
Abstract
Purpose: To explore factors associated with intermittent, constant, and mixed pain in people with knee osteoarthritis. Method: We conducted a secondary analysis of a cross-sectional multicentre study with adults ≥ 40 years with knee osteoarthritis. Participants completed questionnaires on personal (e.g., demographics, comorbidities), physical (e.g., physical function), psychological (e.g., depressive symptoms), pain (e.g., qualities), and tests for physical performance and nervous system sensitivity. We qualified patients' pain as intermittent, constant, or mixed using the Modified painDETECT Questionnaire and assessed associations with the variables using multinomial logistic regression. Results: The 279 participants had an average age of 63.8 years (SD 9.6), BMI of 31.5 kg/m2 (SD 8.7), and 58.6% were female. Older age (odds ratio [OR] 0.95; 95% CI: 0.90, 1.00) and higher self-reported physical function (OR 0.94; 95% CI: 0.91, 0.98) were associated with a lower likelihood of mixed pain compared with intermittent pain. Higher pain intensity (OR 1.25; 95% CI: 1.07, 1.47) was related to a 25% higher likelihood of mixed pain compared with intermittent pain. Conclusions: This study provides initial data for associations of personal, pain, and physical function factors with different pain patterns. Awareness of these factors can help clinicians develop targeted strategies for managing patients' pain.
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Affiliation(s)
- Fatme Hoteit
- School of Rehabilitation, Physiotherapy Program, Université de Montréal, Montreal, Quebec, Canada
| | - Debbie Erhmann Feldman
- School of Rehabilitation, Physiotherapy Program, and School of Public Health, Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation, Institute of Public Health Research, Université de Montréal, Montreal, Quebec, Canada
| | - Lisa C. Carlesso
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Research Institute of St. Joseph’s Hamilton, Hamilton, Ontario, Canada
- School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
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Kim HA. Osteoarthritis - Insights From Recent Research. JOURNAL OF RHEUMATIC DISEASES 2022; 29:132-139. [PMID: 37475969 PMCID: PMC10324928 DOI: 10.4078/jrd.2022.29.3.132] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 07/22/2023]
Abstract
Osteoarthritis (OA) is the most common form of arthritis and is a growing public health concern in the aging society. In rapidly aging societies such as in Korea, the increasing prevalence of OA may present serious new health issues. There is no treatment for OA that can either prevent or slow the progression of joint damage. For the development of effective therapeutics, precise understating of its pathogenesis is important. In this review, the current evidence of etiopathogenesis of OA is discussed. First, while epidemiologic study of OA are still dominated by reports from Western countries, findings from Korean epidemiologic studies are highlighted. Then, recent progresses in genetics, especially in the field of genome wide association study and mendelian randomization studies, are reviewed with focus on Asian population. Lastly, sex difference in pain etopathogenesis is reviewed. Studies of OA pathogenesis including epidemiology, genetics, animal model and pain signaling will aid in progress towards treatment of OA.
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Affiliation(s)
- Hyun Ah Kim
- Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Institute for Skeletal Aging, Hallym University, Chuncheon, Korea
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Roby NU, Packham TL, MacDermid JC, Carlesso LC. Validity of the Central Sensitization Inventory (CSI) through Rasch analysis in patients with knee osteoarthritis. Clin Rheumatol 2022; 41:3159-3168. [PMID: 35754083 DOI: 10.1007/s10067-022-06248-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/01/2022] [Accepted: 06/14/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION/OBJECTIVE Central sensitization (CS) is a known contributor to chronic pain in people with knee osteoarthritis (KOA) and is commonly measured by psychophysical testing or patient-reported methods such as the Central Sensitization Inventory (CSI). However, previous studies have shown a weak association between the two. We therefore sought to evaluate the validity of the CSI through Rasch analysis in patients with KOA. METHOD We performed a secondary analysis of a multicenter cohort study with patients with KOA consulting orthopedic surgeons. Rasch analysis was conducted considering person factors of age, sex, BMI, pain intensity, pain catastrophizing, and quantitative sensory test findings using pressure pain thresholds and temporal summation to assess how the CSI fits to the Rasch model (supporting validity). We used RUMM2030 software to model fit estimates, making adjustments as required to achieve model fit (P > 0.05). RESULTS Data from 293 patients were included (58.7% female, mean age 63.6 years, 49.1% obese) Initial evaluation with Rasch modelling indicated misfit. Eleven of 25 items on the CSI displayed disordered thresholds which were rescored by collapsing response categories until the thresholds demonstrated sequential progression. Reanalysis demonstrated persistent model misfit so a subtest was developed to address local dependency of 6 items. Thereafter, model fit was achieved (P = 0.071, indicating not differing from Rasch model) and acceptable unidimensionality (P = 0.068 with 95% CI 0.043-0.093). CONCLUSIONS The CSI was able to be fit to the Rasch model after rescoring while retaining all 25 items. The unidimensionality validates CS as measured by the CSI as a singular construct. Key Points • The Central Sensitization Inventory (CSI) was able to be fit to the Rasch model after rescoring while retaining all 25 items. • The unidimensionality of the CSI validates CS as a singular construct. • Our results suggest rescoring of the CSI for people with KOA, but it should be confirmed and replicated in larger samples prior to clinical use.
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Affiliation(s)
- Naym U Roby
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, 1400 Main St. W, IAHS 441, Hamilton, ON, L8S 1C7, Canada
| | - Tara L Packham
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, 1400 Main St. W, IAHS 441, Hamilton, ON, L8S 1C7, Canada
| | - Joy C MacDermid
- Physical Therapy and Surgery, Western University, London, ON, Canada
| | - Lisa C Carlesso
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, 1400 Main St. W, IAHS 441, Hamilton, ON, L8S 1C7, Canada.
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Steen Pettersen P, Neogi T, Magnusson K, Mathiessen A, Hammer HB, Uhlig T, Kvien TK, Haugen IK. Associations between joint pathologies and central sensitization in persons with hand osteoarthritis: results from the Nor-Hand study. Rheumatology (Oxford) 2022; 61:2316-2324. [PMID: 34559196 PMCID: PMC9157061 DOI: 10.1093/rheumatology/keab708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/10/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Pain sensitization is associated with pain severity in persons with hand OA. What contributes to pain sensitization is unclear. This study explores whether hand OA pathologies and symptom duration are related to central sensitization. METHOD Participants with hand OA in the Nor-Hand study underwent bilateral hand radiography and US examination. Central sensitization was assessed with pressure pain thresholds (PPT) at remote sites (wrist, trapezius and tibialis anterior muscles) and temporal summation. We examined whether hand OA pathologies, independent of each other, including structural severity (Kellgren-Lawrence sum score, presence of erosive hand OA), inflammatory severity (greyscale synovitis and power Doppler activity sum scores) and symptom duration, were related to central sensitization, adjusting for age, sex, BMI, comorbidities and OA-severity of knee/hip. RESULTS In 291 participants (88% women, median age 61 years, interquartile range 57-66 years) Kellgren-Lawrence, greyscale synovitis and power Doppler activity sum scores were not associated with lower PPTs at remote sites. Persons with erosive hand OA had lower PPTs at the wrist (adjusted beta -0.75, 95% CI -1.32, -0.19) and tibialis anterior (adjusted beta -0.82, 95% CI -1.54, -0.09) and had greater temporal summation (adjusted beta 0.56, 95% CI 0.12, 1.01) compared with persons with non-erosive disease. No associations were found for symptom duration. CONCLUSIONS A person's overall amount of structural or inflammatory hand OA pathologies was not associated with central sensitization. Although persons with erosive hand OA showed greater signs of central sensitization, the small differences suggest that central sensitization is mainly explained by factors other than joint pathologies.
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Affiliation(s)
- Pernille Steen Pettersen
- Division of Rheumatology and Research, Diakonhjemmet Hospital
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Karin Magnusson
- Orthopaedics, Clinical Epidemiology Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Norwegian Institute of Public Health, Cluster for Health Services Research
| | | | - Hilde Berner Hammer
- Division of Rheumatology and Research, Diakonhjemmet Hospital
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Till Uhlig
- Faculty of Medicine, University of Oslo, Oslo, Norway
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ida K Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital
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Mibu A, Nishigami T, Tanaka K, Yono S, Manfuku M, Imai R. Does a combination of self‐reported signs related to central sensitization and pressure pain threshold allow for a more detailed classification of pain‐related characteristics in patients with chronic musculoskeletal pain?: A cross‐sectional study. Pain Pract 2022; 22:556-563. [DOI: 10.1111/papr.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Akira Mibu
- Department of Physical Therapy, Konan Women’s University Kobe Hyogo Japan
| | - Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare Prefectural University of Hiroshima Mihara Hiroshima Japan
| | | | - Satoko Yono
- Department of Rehabilitation, Tanabe Orthopaedics Osaka Osaka Japan
| | | | - Ryota Imai
- Department of Physical Therapy Osaka Kawasaki Rehabilitation University Osaka Japan
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Mulrooney E, Neogi T, Dagfinrud H, Hammer HB, Pettersen PS, Gaarden TL, Engedal K, Kvien TK, Magnusson K, Haugen IK. The associations of psychological symptoms and cognitive patterns with pain and pain sensitization in people with hand osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100267. [DOI: 10.1016/j.ocarto.2022.100267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
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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: 10] [Impact Index Per Article: 5.0] [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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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: 3] [Impact Index Per Article: 1.5] [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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Aoyagi K, Liew JW, Farrar JT, Wang N, Carlesso L, Kumar D, Frey Law L, Lewis CE, Nevitt M, Neogi T. Does weight-bearing versus non-weight-bearing pain reflect different pain mechanisms in knee osteoarthritis?: the Multicenter Osteoarthritis Study (MOST). Osteoarthritis Cartilage 2022; 30:545-550. [PMID: 34801670 PMCID: PMC8940656 DOI: 10.1016/j.joca.2021.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/05/2021] [Accepted: 10/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is predominantly characterized by pain with weight-bearing activities. Pain at rest also occurs but the mechanisms for this are not clear. We evaluated the relations of nociceptive signal alterations to weight-bearing and non-weight-bearing pain in knee OA. DESIGN We used data from a NIH-funded longitudinal cohort of older adults with or at risk of knee OA. We evaluated quantitative sensory testing (QST) measures (pressure pain threshold (PPT) at patellae and the wrist; mechanical temporal summation (TS); conditioned pain modulation (CPM)). Each WOMAC pain question was dichotomized as having at least moderate pain, and we further categorized them as weight-bearing pain and non-weight-bearing pain. We evaluated the relation of QST measures to each pain outcome using logistic regression, adjusting for potential confounders. RESULTS 2,749 participants (5,479 knees) were included (mean age 64 ± 11, 57% female). Each SD unit decrease in patellar PPT was associated with greater odds of both weight-bearing pain (OR 1.51 (95% CI 1.27, 1.79)) and non-weight-bearing pain (OR 1.46 (1.20-1.77)), while wrist PPT was associated with greater odds of weight-bearing pain (OR 1.27 (1.15, 1.39)) but only with pain during sitting/lying (OR 1.20 (1.01, 1.43)). TS was significantly associated with greater odds of pain with walking and stairs (OR 1.11 (1.01, 1.23), 1.11 (1.03, 1.20), respectively). CPM was not associated with any pain outcomes. CONCLUSIONS Our findings challenge the hypothesis that non-weight-bearing pain may reflect greater pain sensitization and/or inefficient CPM than weight-bearing pain in knee OA, suggesting other mechanisms are likely responsible.
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Affiliation(s)
- K Aoyagi
- Boston University School of Medicine, Boston, MA, USA.
| | - J W Liew
- Boston University School of Medicine, Boston, MA, USA.
| | - J T Farrar
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
| | - N Wang
- Boston University School of Public Health, Boston, MA, USA.
| | | | - D Kumar
- Boston University School of Medicine, Boston, MA, USA.
| | | | - C E Lewis
- University of Alabama, Birmingham, AL, USA.
| | - M Nevitt
- University of California San Francisco, San Francisco, CA, USA.
| | - T Neogi
- Boston University School of Medicine, Boston, MA, USA.
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Previtali D, Capone G, Marchettini P, Candrian C, Zaffagnini S, Filardo G. High Prevalence of Pain Sensitization in Knee Osteoarthritis: A Meta-Analysis with Meta-Regression. Cartilage 2022; 13:19476035221087698. [PMID: 35356833 PMCID: PMC9137298 DOI: 10.1177/19476035221087698] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The aim of this meta-analysis was to study the evidence on pain sensitization in knee osteoarthritis (OA), providing a quantitative synthesis of its prevalence and impact. Factors associated with pain sensitization were also investigated. METHODS Meta-analysis; PubMed (MEDLINE), Cochrane Central Register (CENTRAL), and Web of Science were searched on February 2021. Level I to level IV studies evaluating the presence of pain sensitization in patients with symptomatic knee OA, documented through a validated method (questionnaires or quantitative sensory testing), were included. The primary outcome was the prevalence of pain sensitization. Factors influencing the prevalence were also evaluated, as well as differences in terms of pain thresholds between knee OA patients and healthy controls. RESULTS Fifty-three articles including 7,117 patients were included. The meta-analysis of proportion documented a prevalence of pain sensitization of 20% (95% confidence interval [CI] = 16%-26%) with a significant heterogeneity of results (I2 = 89%, P < 0.001). The diagnostic tool used was the main factor influencing the documented prevalence of pain sensitization (P = 0.01). Knee OA patients presented higher pain sensitivity compared with healthy controls, both in terms of local pressure pain threshold (standardized mean difference [SMD] = -1.00, 95% CI = -1.67 to -0.32, P = 0.007) and distant pressure pain threshold (SMD = -0.54, 95% CI = -0.76 to -0.31, P < 0.001). CONCLUSIONS Knee OA pain presents features that are consistent with a significant degree of pain sensitization. There is a high heterogeneity in the reported results, mainly based on the diagnostic tool used. The identification of the best methods to detect pain sensitization is warranted to correctly evaluate and manage symptoms of patients affected by knee OA. REGISTRATION PROSPERO CRD42019123347.
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Affiliation(s)
- Davide Previtali
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Gianluigi Capone
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland,Gianluigi Capone, Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Via Tesserete 46, 6900 Lugano, Switzerland.
| | - Paolo Marchettini
- Fisiopatologia e Terapia del Dolore, Dipartimento di Farmacologia, Careggi Università di Firenze, Florence, Italy,Terapia del Dolore, CDI Centro Diagnostico Italiano, Milan, Italy
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | | | - Giuseppe Filardo
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland,Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Carlesso LC, Feldman DE, Vendittoli PA, LaVoie F, Choinière M, Bolduc MÈ, Fernandes J, Newman N, Sabouret P. Use of IMMPACT Recommendations to Explore Pain Phenotypes in People with Knee Osteoarthritis. PAIN MEDICINE 2022; 23:1708-1716. [PMID: 35266543 DOI: 10.1093/pm/pnac044] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/24/2022] [Accepted: 03/07/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is a disease of multiple phenotypes of which a chronic pain phenotype (PP) is known. Previous PP studies have focused on one domain of pain and included heterogenous variables. We sought to identify multidimensional PPs using the IMMPACT recommendations and their relationship to clinical outcomes. METHODS Participants >40 years of age with knee OA having a first-time orthopaedic consultation at five university affiliated hospitals in Montreal, Quebec and Hamilton (Canada) were recruited. Latent profile analysis was used to determine PPs (classes) using variables recommended by IMMPACT. This included pain variability, intensity and qualities, somatization, anxiodepressive symptoms, sleep, fatigue, pain catastrophizing, neuropathic pain, and quantitative sensory tests. We used MANOVA and Chi-square tests to assess differences in participant characteristics across the classes and linear and Poisson regression to evaluate the association of classes to outcomes of physical performance tests, self-reported function and provincial healthcare data. RESULTS 343 participants were included (mean age 64 years, 64% female). Three classes were identified with increasing pain burden (class3 > class1), characterized by significant differences across most self-report measures and temporal summation, and differed in terms of female sex, younger age, lower optimism and pain self-efficacy. Participants in class2 and class3 had significantly worse self-reported function, stair climb and 40m walk tests, and higher rates of healthcare usage compared to those in class1. CONCLUSIONS Three distinct PPs guided by IMMPACT recommendations were identified, predominated by self-report measures and temporal summation. Using this standardized approach may improve PP study variability and comparison.
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Affiliation(s)
- Lisa C Carlesso
- School of Rehabilitation Science, McMaster University, Associate, Research Institute St. Joseph's Hamilton, Canada; School of Rehabilitation, Université de Montreal, Montreal, Canada
| | - Debbie Ehrmann Feldman
- School of Rehabilitation, School of Public Health, Department of Social and Preventive Medicine, Université de Montreal,Centre for interdisciplinary research in rehabilitation,Institute of Public Health Research,Université de Montréal, Montreal, Canada
| | - Pascal-André Vendittoli
- Département de Chirurgie, Hôpital Maisonneuve-Rosemont,Université de Montréal, Montréal, QC, Canada
| | - Frédéric LaVoie
- Service de chirurgie orthopédique,Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Manon Choinière
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Canada; Research Center of the Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Marie-Ève Bolduc
- Service de chirurgie orthopédique,Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Julio Fernandes
- Department of Orthopaedic Surgery, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada; Faculty of Medicine, Université de Montréal, Montréal, Canada; Department of Orthopaedic Surgery, Hôpital Jean-Talon, Montréal, QC, Canada
| | - Nicholas Newman
- Service de chirurgie orthopédique,Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Pierre Sabouret
- Service de chirurgie orthopédique,Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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48
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Vriezekolk JE, Peters YAS, Steegers MAH, Davidson ENB, van den Ende CHM. Pain descriptors and determinants of pain sensitivity in knee osteoarthritis: a community-based cross-sectional study. Rheumatol Adv Pract 2022; 6:rkac016. [PMID: 35350719 PMCID: PMC8947773 DOI: 10.1093/rap/rkac016] [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: 09/28/2021] [Accepted: 02/22/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
To explore pain characteristics in individuals with knee osteoarthritis (KOA), to compare pain sensitivity across individuals with KOA, chronic back pain (CBP) and pain-free individuals (NP), and to examine the relationship between clinical and pain characteristics with pain sensitivity in KOA.
Methods
Cross-sectional, community-based online survey. Two datasets were combined comprising Dutch individuals of ≥ 40 years of age, experiencing chronic knee pain (KOA, N = 445), chronic back pain (CBP, N = 504), or no pain (NP, N = 256). Demographic and clinical characteristics, global health, physical activity/exercise, and pain characteristics including intensity, spreading, duration, quality (SF-MPQ), and sensitivity (PSQ) were assessed. Differences between (sub)groups were examined using analyses of variance or Chi-square tests. Regression analyses were performed to examine determinants of pain sensitivity in the KOA group.
Results
Quality of pain was most commonly described as aching, tender, and tiring-exhausting. Overall, the KOA group had higher levels of pain sensitivity compared to NP group, but lower levels than the CBP group. Univariately, pain intensity, its variability and spreading, global health, exercise, and having comorbidities were weakly related to pain sensitivity (standardized betas: 0.12-0.27). Symptom duration was not related to pain sensitivity. Older age, higher levels of continuous pain, lower levels of global health, and exercise uniquely contributed, albeit modest, to pain sensitivity (P<0.05).
Conclusion
Continuous pain such as aching and tenderness in combination with decreased physical activity may be indicative for a subgroup of individuals at risk for pain sensitivity and, ultimately, poor treatment outcomes.
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Affiliation(s)
- Johanna E Vriezekolk
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Yvonne A S Peters
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Monique A H Steegers
- Radboud Institute for Health Sciences,Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Anesthesiology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Cornelia H M van den Ende
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
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49
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Saito M, Ito H, Okahata A, Furu M, Nishitani K, Kuriyama S, Nakamura S, Kawata T, Ikezoe T, Tsuboyama T, Ichihashi N, Tabara Y, Matsuda F, Matsuda S. Ultrasonographic Changes of the Knee Joint Reflect Symptoms of Early Knee Osteoarthritis in General Population; The Nagahama Study. Cartilage 2022; 13:19476035221077403. [PMID: 35225002 PMCID: PMC9137311 DOI: 10.1177/19476035221077403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Radiographic changes in knee osteoarthritis (OA) are not always associated with symptoms, especially in its early stages. Ultrasonography (US) can detect early changes in the knee joint, but the changes that reflect symptoms have not been fully elucidated. This study aimed to identify US-detectable changes in the knee that are often associated with knee symptoms and demonstrate the feasibility of early diagnosis in symptomatic knee OA using US. DESIGN In this cross-sectional community-based study, 1,667 participants aged ≥60 years (1,103 women [66%]) were included. All participants concurrently underwent US and radiography of the knee and completed the Knee Society Knee Scoring System (KSS) questionnaire. Simple and multiple regression analyses were used to examine the associations between US findings and KSS symptom subscales. RESULTS Among all participants, medial meniscus protrusion and medial osteophytes, age, and body mass index showed significant associations with KSS symptom scores. Among 894 participants with Kellgren-Lawrence (KL) grade ≤1, medial osteophytes and age were significantly associated with KSS symptom score. US measures were more related to KSS symptoms than KL grades. CONCLUSIONS Among the knee US-detectable changes, medial osteophytes were strongly associated with knee symptoms. Osteophytes are reliable predictors of symptomatic early knee OA, even in participants with few radiographic OA changes.
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Affiliation(s)
- Motoo Saito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan,Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan,Hiromu Ito, Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606-8507, Japan.
| | - Akinori Okahata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Moritoshi Furu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomotoshi Kawata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tome Ikezoe
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tadao Tsuboyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan,Department of Physical Therapy, School of Health Sciences, Bukkyo University, Kyoto, Japan
| | - Noriaki Ichihashi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan,Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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50
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Deep learning approach to predict pain progression in knee osteoarthritis. Skeletal Radiol 2022; 51:363-373. [PMID: 33835240 PMCID: PMC9232386 DOI: 10.1007/s00256-021-03773-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop and evaluate deep learning (DL) risk assessment models for predicting pain progression in subjects with or at risk of knee osteoarthritis (OA). MATERIALS AND METHODS The incidence and progression cohorts of the Osteoarthritis Initiative, a multi-center longitudinal study involving 9348 knees in 4674 subjects with or at risk of knee OA that began in 2004 and is ongoing, were used to conduct this retrospective analysis. A subset of knees without and with pain progression (defined as a 9-point or greater increase in pain score between baseline and two or more follow-up time points over the first 48 months) was randomly stratified into training (4200 knees with a mean age of 61.0 years and 60% female) and hold-out testing (500 knees with a mean age of 60.8 years and 60% female) datasets. A DL model was developed to predict pain progression using baseline knee radiographs. An artificial neural network was used to develop a traditional risk assessment model to predict pain progression using demographic, clinical, and radiographic risk factors. A combined model was developed to combine demographic, clinical, and radiographic risk factors with DL analysis of baseline knee radiographs. Area under the curve (AUC) analysis was performed using the hold-out testing dataset to evaluate model performance. RESULTS The traditional model had an AUC of 0.692 (66.9% sensitivity and 64.1% specificity). The DL model had an AUC of 0.770 (76.7% sensitivity and 70.5% specificity), which was significantly higher (p < 0.001) than the traditional model. The combined model had an AUC of 0.807 (72.3% sensitivity and 80.9% specificity), which was significantly higher (p < 0.05) than the traditional and DL models. CONCLUSIONS DL models using baseline knee radiographs had higher diagnostic performance for predicting pain progression than traditional models using demographic, clinical, and radiographic risk factors.
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