Expanded Distribution of Pain as a Sign of Central Sensitization in Individuals With Symptomatic Knee Osteoarthritis

Girbés, Enrique Lluch; Dueñas, Lirios; Barbero, Marco; Falla, Deborah; Baert, Isabel; Meeus, Mira; Sánchez-Frutos, José; Aguilella, L.; Nijs, Jo

doi:10.2522/ptj.20150492

Cited by 110 publications

(93 citation statements)

References 74 publications

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“…Recently it has been shown that the size of the pain drawing areas in knee OA patients was not specifically correlated to preoccupation, attention, catastrophizing, or fear of pain but rather indirect assessments of central sensitization [36]. Therefore, the presence and significance of the degree of symmetry, as revealed by pain drawings, should further explored as an objective measure of symptom progression.…”

Section: Discussionmentioning

confidence: 99%

Distribution and symmetrical patellofemoral pain patterns as revealed by high-resolution 3D body mapping: a cross-sectional study

Boudreau

Kamavuako

Rathleff

2017

BMC Musculoskelet Disord

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BackgroundDetailed pain mapping of extent and distribution in individuals with patellofemoral pain (PFP) within and around a complex structure such as the knee has yet to be explored.MethodsPerceptions of on-going pain from adolescents and young adults (N = 35) with long-standing (>10 months) PFP were collected on high-resolution 3D digital body-schema of the knees. Location, area of pain, pain intensity, laterality, worse side of knee pain, symptom duration, and symmetry in bilateral knee pain were recorded. A threshold for naturally occurring variations in symmetrical knee pain drawings were collected from 18 healthy controls and used in combination with the development a symmetry index (0–1) to create a fuzzy rule for classifying symmetrical and non-symmetrical PFP patterns as compared to a PFP expert. The symmetry index was computed and tested using a correlation coefficient alone or in combination with the Jaccard index and the true and false positive rates (TPR and FPR, respectively) determined.ResultsThe peripatellar region was the common report of pain location however, novel and nonconforming PFP patterns were identified and the majority of individuals (22 of 27) with bilateral PFP expressed highly-symmetric mirror-image pain. Individuals with symptom duration of 5 years or more had a greater area of pain, compared to those with symptoms for less than 5 years. The total area of pain was correlated to symptom duration for those with extended symptoms durations and a progression towards an “O” shaped pattern emerged. A TPR of 100% for identifying symmetrical knee pain patterns was found however the expert PFP tended to be stricter, as reflected in FPR of 20%.ConclusionsA high proportion of PFP patterns or symptoms occur in mirrored locations and are exceptionally symmetrical, and long duration of symptoms appear to converge to an ‘O’ shape. Classifying symmetrical pain patterns is subjective however simple fuzzy rules and correlations can be used to increase objectivity. This study highlights a gap in knowledge of PFP symptom presentation, reveals what may be a natural progression of symptoms, and provides valuable clinical insight for both pain management and treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1521-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Distribution and symmetrical patellofemoral pain patterns as revealed by high-resolution 3D body mapping: a cross-sectional study

Boudreau

Kamavuako

Rathleff

2017

BMC Musculoskelet Disord

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“…Secondly, patients having CS often present with spreading pain, that is, pain that spreads outside the segmental area of primary nociception. Applied to the example of knee osteoarthritis, this criterion corresponds to someone having pain referring all over the affected low limb 40. Pain drawings (in which the patient marks areas affected by pain on an outline of a human body with anterior, posterior and lateral views) can be used to standardise and optimise the assessment of the individual’s pain distribution in a reliable way.…”

Section: Which Conditions Are Associated With Cs?mentioning

confidence: 99%

Central sensitisation: another label or useful diagnosis?

Nijs

Polli

Willaert

et al. 2019

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“…Previous studies have found satisfactory test‐retest reliability (intraclass correlation coefficient [ICC] = 0.88 to 0.97) and internal consistency (Cronbach’s alpha = 0.88 to 0.91) . Although the CSI does not actually measure CS, CSI scores have been found to be associated with subjective and objective CS‐related variables, including lower pain thresholds, wider distribution of pain, longer pain duration, levels of brain‐derived neurotrophic factor, and dysfunction of the descending pain‐modulatory system . Also, total CSI scores have been found to discriminate between subjects with presumably different levels of CS, including patients with chronic regional pain, widespread pain/FM, and controls .…”

Section: Introductionmentioning

confidence: 98%

Cross‐cultural Adaptation and Psychometric Properties of the Greek Version of the Central Sensitization Inventory

et al. 2020

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Objectives Recent studies support the opinion that central sensitization (CS) plays an important role in the pathophysiology of many chronic pain conditions. CS refers to hyperexcitability of the central nervous system, which can result in pain hypersensitivity and other somatosensory symptoms. Recognition of CS‐related symptomology is crucial in chronic pain evaluation and rehabilitation. The Central Sensitization Inventory (CSI) was created to evaluate symptoms that have been found to be associated with CS. The aim of the current study was the cross‐cultural adaptation of the CSI into Greek (CSI‐Gr). Methods To evaluate discriminate validity, 200 patients with chronic pain and 50 healthy control subjects participated. The sample was divided into 4 diagnostic groups (fibromyalgia, single pain complaints, multiple pain complaints, and a control group) and into 5 CSI severity subgroups, from subclinical to extreme. Convergent validity was determined by evaluation of the relationship between the CSI‐Gr and the Pain Catastrophizing Scale (PCS). Additionally, 30 patients completed the CSI a second time for the purpose of a test/retest analysis. Results The results showed high internal consistency (Cronbach's alpha = 0.994) and test‐retest reliability (intraclass correlation coefficient = 0.993). The standard error of measurement was 2.1. The CSI‐Gr correlated moderately with the PCS (r = 0.68). Statistically significant differences were found among the 3 comparison groups, with patients who had fibromyalgia reporting the highest CSI severity and healthy control subjects reporting the lowest severity. Conclusions As determined in the present study, the CSI‐Gr was found to be a reliable and valid tool for recognition of CS‐related symptomology.

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Expanded Distribution of Pain as a Sign of Central Sensitization in Individuals With Symptomatic Knee Osteoarthritis

Abstract: Expanded distribution of pain was correlated with some measures of CS in individuals with knee OA. Pain drawings may constitute an easy way for the early identification of CS in people with knee OA, but further research is needed.

Cited by 110 publications

References 74 publications

Distribution and symmetrical patellofemoral pain patterns as revealed by high-resolution 3D body mapping: a cross-sectional study

Distribution and symmetrical patellofemoral pain patterns as revealed by high-resolution 3D body mapping: a cross-sectional study

Central sensitisation: another label or useful diagnosis?

Cross‐cultural Adaptation and Psychometric Properties of the Greek Version of the Central Sensitization Inventory

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