A mechanism‐based pain sensitivity index to characterize knee osteoarthritis patients with different disease stages and pain levels

Arendt-Nielsen, Lars; Egsgaard, Line Lindhardt; Petersen, Kristian Kjær; Eskehave, Thomas Navndrup; Graven‐Nielsen, Thomas; Hoeck, Hans Christian; Simonsen, Ole

doi:10.1002/ejp.651

Cited by 122 publications

(139 citation statements)

References 47 publications

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“…Recently, a single pain sensitivity index based on QST z-scores was proposed [2] to characterize the degree of hypersensitivity in this population. However, the varied pain sensitivity profiles observed in this patient cohort support the conclusion by Neziri et al [40] that multimodal pain assessment is necessary for optimal patient characterization.…”

Section: Discussionmentioning

confidence: 99%

Pain sensitivity profiles in patients with advanced knee osteoarthritis

Law

Bohr

Sluka

et al. 2016

Pain

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The development of patient profiles to subgroup individuals on a variety of variables has gained attention as a potential means to better inform clinical decision-making. Patterns of pain sensitivity response specific to quantitative sensory testing (QST) modality have been demonstrated in healthy subjects. It has not been determined if these patterns persist in a knee osteoarthritis population. In a sample of 218 participants, 19 QST measures along with pain, psychological factors, self-reported function, and quality of life were assessed prior to total knee arthroplasty. Component analysis was used to identify commonalities across the 19 QST assessments to produce standardized pain sensitivity factors. Cluster analysis then grouped individuals that exhibited similar patterns of standardized pain sensitivity component scores. The QST resulted in four pain sensitivity components: heat, punctate, temporal summation, and pressure. Cluster analysis resulted in five pain sensitivity profiles: a “low pressure pain” group, an “average pain” group, and three “high pain” sensitivity groups who were sensitive to different modalities (punctate, heat, and temporal summation). Pain and function differed between pain sensitivity profiles, along with sex distribution; however no differences in OA grade, medication use, or psychological traits were found. Residualizing QST data by age and sex resulted in similar components and pain sensitivity profiles. Further, these profiles are surprisingly similar to those reported in healthy populations suggesting that individual differences in pain sensitivity are a robust finding even in an older population with significant disease.

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Section: Discussionmentioning

confidence: 99%

Pain sensitivity profiles in patients with advanced knee osteoarthritis

Law

Bohr

Sluka

et al. 2016

Pain

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“…47,55,67,77,78) and in some cases, a positive correlation between these traits and chronic pain intensity. 2,16,53 It is thus possible that similar mechanisms are responsible for pain chronification regardless of the origin of the nervous system pathology. The results of this study contribute further by showing that the severity and the extent of CNP distribution may be attributed to different mechanisms; ie, hyperexcitability and loss of inhibitory control, respectively.…”

Section: The Relationship Between Spinothalamic Tract Lesion Centralmentioning

confidence: 96%

Differential pain modulation properties in central neuropathic pain after spinal cord injury

Gruener

Zeilig

Laufer

et al. 2016

Pain

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It seems that central neuropathic pain (CNP) is associated with altered abilities to modulate pain; whereas dysfunction in descending pain inhibition is associated with the extent of chronic pain distribution, enhanced pain excitation is associated with the intensity of chronic pain. We investigated the hypothesis that CNP is associated with decreased descending pain inhibition along with increased neuronal excitability and that both traits are associated with spinothalamic tract (STT) damage. Chronic spinal cord injury subjects with CNP (n = 27) and without CNP (n = 23) and healthy controls (n = 20) underwent the measurement of pain adaptation, conditioned pain modulation (CPM), tonic suprathreshold pain (TSP), and spatial summation of pain above injury level. Central neuropathic pain subjects also underwent at and below-lesion STT evaluation and completed the questionnaires. Central neuropathic pain subjects showed decreased CPM and increased enhancement of TSP compared with controls. Among CNP subjects, the dysfunction of CPM and pain adaptation correlated positively with the number of painful body regions. The magnitude of TSP and spatial summation of pain correlated positively with CNP intensity. STT scores correlated with CNP intensity and with TSP, so that the more affected the STT below injury level, the greater the CNP and TSP magnitude. It seems that CNP is associated with altered abilities to modulate pain, whereas dysfunction in descending pain inhibition is associated with the extent of chronic pain distribution and enhanced pain excitation is associated with the intensity of chronic pain. Thus, top-down processes may determine the spread of CNP, whereas bottom-up processes may determine CNP intensity. It also seems that the mechanisms of CNP may involve STT-induced hyperexcitability. Future, longitudinal studies may investigate the timeline of this scenario.

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“…Recent QST studies in individuals with OA have revealed distinct subgroups consistent with significant central nervous system (CNS) alterations to pain processing and even to predict treatment outcomes [2,3,22,28,30,33]. Whereas most previous investigators have examined QST measures as individual variables, a more sophisticated approach would consider patterns of responses across multiple QST measures.…”

Section: Introductionmentioning

confidence: 99%

“…Although QST phenotypic heterogeneity has been reported in healthy individuals [13,16,25], less is known in knee OA. Recent investigations have used pressure pain thresholds, temporal summation of pressure pain and conditioned pain modulation as a mechanism-based pain sensitivity index to characterize knee OA with different disease stages and pain levels [2] and their associations with post-operative outcomes [46]. Accounting for inter-individual variability in experimental pain may lead to improved translation of results from the laboratory to the clinic.…”

Section: Introductionmentioning

confidence: 99%

Experimental pain phenotyping in community-dwelling individuals with knee osteoarthritis

Cardoso

Riley

Glover

et al. 2016

Pain

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Pain among individuals with knee osteoarthritis (OA) is associated with significant disability in older adults, and recent evidence demonstrates enhanced experimental pain sensitivity. Although previous research showed considerable heterogeneity in the OA clinical pain presentation, less is known regarding the variability in responses to experimental pain. The present study included individuals with knee OA (n = 292) who participated in the Understanding Pain and Limitations in Osteoarthritic Disease study and completed demographic and psychological questionnaires followed by a multimodal quantitative sensory testing (QST) session. Quantitative sensory testing measures were subjected to variable reduction procedures to derive pain sensitivity index scores, which in turn were entered into a cluster analysis. Five clusters were significantly different across all pain sensitivity index variables (P < 0.001) and were characterized by: (1) low pain sensitivity to pressure pain (N = 39); (2) average pain sensitivity across most modalities (N = 88); (3) high temporal summation of punctate pain (N = 38); (4) high cold pain sensitivity (N = 80); and (5) high sensitivity to heat pain and temporal summation of heat pain (N = 41). Clusters differed significantly by race, gender, somatic reactivity, and catastrophizing (P < 0.05). Our findings support the notion that there are distinct subgroups or phenotypes based on experimental pain sensitivity in community-dwelling older adults with knee OA, expanding previous findings of similar cluster characterizations in healthy adults. Future research is needed to further understand the pathophysiological mechanisms underlying pain within these subgroups, which may be of added value in tailoring effective treatments for people with OA.

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A mechanism‐based pain sensitivity index to characterize knee osteoarthritis patients with different disease stages and pain levels

Abstract: Radiological scores, contrary to clinical pain intensity/duration, were poorly associated with QST parameters. The pain sensitivity index could classify OA patients with different degrees of OA and pain.

Cited by 122 publications

References 47 publications

Pain sensitivity profiles in patients with advanced knee osteoarthritis

Pain sensitivity profiles in patients with advanced knee osteoarthritis

Differential pain modulation properties in central neuropathic pain after spinal cord injury

Experimental pain phenotyping in community-dwelling individuals with knee osteoarthritis

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