High Prevalence of Pain Sensitization in Knee Osteoarthritis: A Meta-Analysis with Meta-Regression

Previtali, Davide; Capone, Gianluigi; Marchettini, Paolo; Candrian, Christian; Zaffagnini, Stefano; Filardo, Giuseppe

doi:10.1177/19476035221087698

Cited by 16 publications

(14 citation statements)

References 110 publications

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“…Pain is the main symptom for KOA patients, which severely decreases the quality of life [ 55 ] and the function of joints [ 56 ]. After long-term disease, patients with KOA showed higher pain sensitivities at the knee joints [ 57 ], further lowering treatment sensitivities. Moreover, older patients presented poor prognoses during the treatment [ 58 ], affecting the treatment.…”

Section: Discussionmentioning

confidence: 99%

Multiple Injections of Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Current Evidence in Randomized Controlled Trials

Xing

Yan

et al. 2023

JPM

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In recent years, various clinical trials have focused on treating knee osteoarthritis (KOA) with multiple injections of platelet-rich plasma (PRP). However, compared with the multiple hyaluronic acid (m-HA) injections, the clinical efficacy of multiple PRP (m-PRP) injections for KOA still remains controversial among these studies. Therefore,we aimed to compare the clinical effectiveness of m-PRP injections with m-HA injections in the treatment of KOA in this systematic review. Relevant clinical trials were searched via bibliographic databases, including Medline, PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials, to compare the m-PRP and m-HA injections in the treatment of KOA. Finally, fourteen randomized controlled trials, including 1512 patients, showed the postoperative VAS, WOMAC, IKDC, or EQ-VAS scores and were enrolled in this systematic review. Compared with the group of intra-articular m-HA injections, the group of intra-articular m-PRP injections was lower in the VAS scores at 3-month (WMD = −0.25; 95%CI, −0.40 to −0.10, P = 0.0009) and 12-month (WMD = −0.64; 95%CI, −0.79 to −0.49, p < 0.00001) follow-ups. In addition, the group of intra-articular m-PRP injections was also lower in the WOMAC scores at 1-month (WMD = −1.23; 95%CI, −2.17 to −0.29, p = 0.01), 3-month (WMD = −5.34; 95%CI, −10.41 to −0.27, p = 0.04), 6-month (WMD = −11.02; 95%CI, −18.09 to −3.95, p = 0.002), and 12-month (WMD = −7.69; 95%CI, −12.86 to −2.52, p = 0.004) follow-ups. Furthermore, compared with the group of intra-articular m-HA injections, the group of intra-articular m-PRP injections was higher in the IKDC scores at 3-month (WMD = 7.45; 95%CI, 2.50 to 12.40, p = 0.003) and 6-month (WMD = 5.06; 95%CI, 1.94 to 8.18, p = 0.001) follow-ups. However, the long-term adverse side of m-PRP injections for KOA still needs more large-scale trials and long-term follow-ups.

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Section: Discussionmentioning

confidence: 99%

Multiple Injections of Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Current Evidence in Randomized Controlled Trials

Xing

Yan

et al. 2023

JPM

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“…Chronic pain is the hallmark of KOA. During the presence of ongoing joint pain in KOA, a maladaptive neural signaling in the brain and spinal cord will occurs in these subjects as called "central sensitization" (Previtali et al, 2022). The central sensitization may result in sensory input being strongly ampli ed in the brain and spinal cord (Lluch et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Thalamocortical dysconnectivity in knee osteoarthritis

Mao

Yang

Wang

et al. 2023

Preprint

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Previous studies have suggested abnormal morphology and function of the thalamus and cortex in KOA. However, it is not known whether the thalamocortical network is differentially affected in this disorder. In this study, we examined functional and effective connectivity between thalamus and the major divisions of the cortex in 27 healthy controls and 27 KOA participants using functional magnetic resonance imaging. We also explored the topological features of the whole brain based on graph theory analysis. The results suggested that patients with KOA had significantly reduced resting-state functional connectivity (rsFC) of the thalamo-sensorimotor pathway, enhanced rsFC of the thalamo-medial/lateral frontal cortex (mFC/LFC), parietal, lateral temporal and occipital pathways, decreased effective connectivity of the left sensorimotor-to-thalamus pathway and enhanced effective connectivity of the right thalamus-to-sensorimotor pathway as compared with of healthy controls. The functional connectivity of the thalamo-sensorimotor and thalamo-mFC pathways was enhanced when performing multi-source interference task. Moreover, patients with KOA showed changed nodal properties associated with thalamo-cortical circuits including the medial and dorsal superior/middle frontal gyrus, inferior parietal gyrus, left thalamus, etc. as compared with healthy controls. Correlation analysis suggested significant negative correlation between thalamo-mFC’s rsFC and pain intensity, between thalamo-sensorimotor task-related connectivity and disease duration/depression scores, as well as positive correlation between right frontal nodal properties and pain intensity in KOA. Taken together, these findings establish abnormal and differential alterations of the thalamocortical network associated with pain characteristics in KOA, which extends our understanding of its’ role in the pathophysiology of KOA.

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“…Recent studies indicate that a high prevalence of pain sensitization in patients with KOA, at 20%; further, patients with pain sensitization have poorer quality of life compared to those without sensitization. 43 , 44 Therefore, clarifying the role of sensitization in chronic joint pain has important clinical implications. Local PPT is an indicator of peripheral sensitization, signifying nociceptor activation.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Pain Sensitization Associated with Response to Exercise Therapy in Patients with Knee Osteoarthritis: A Prospective Cohort Study

Hattori¹,

Ohga²,

Shimo³

et al. 2022

JPR

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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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High Prevalence of Pain Sensitization in Knee Osteoarthritis: A Meta-Analysis with Meta-Regression

Cited by 16 publications

References 110 publications

Multiple Injections of Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Current Evidence in Randomized Controlled Trials

Multiple Injections of Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Current Evidence in Randomized Controlled Trials

Thalamocortical dysconnectivity in knee osteoarthritis

Predictive Value of Pain Sensitization Associated with Response to Exercise Therapy in Patients with Knee Osteoarthritis: A Prospective Cohort Study

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