Neuropathic-like symptoms and the association with joint-specific function and quality of life in patients with hip and knee osteoarthritis

Abstract

ObjectiveThere is an association between osteoarthritis-related pain severity and function, yet clear evidence about the sole influence of neuropathic-like symptoms on joint function and health-related quality of life (HRQoL) is lacking. Previous studies among knee OA patients show an association between neuropathic-like symptoms, lower functional status and lower quality of life, however analyses were unadjusted or had limited adjustment for influential covariates like pain intensity. The aim of this study was therefore to determine the influence of neuropathic-like symptoms—adjusted for multiple influential covariates—on joint-specific function and HRQoL in hip and knee OA patients.MethodsIn this observational study 255 patients (117 with hip OA and 138 with knee OA) completed the modified painDETECT questionnaire (mPDQ) to identify subjects with neuropathic-like symptoms (mPDQ score>12, possible neuropathic pain [NP] phenotype). The WOMAC and the RAND-36 were used to asses respectively function and HRQoL. Results were adjusted stepwise for age, sex and BMI (Model 1); back disorder, painful body regions, comorbidities and previous surgery (Model 2); and pain intensity and analgesic usage (Model 3).ResultsA possible NP phenotype was experienced by 37% of hip and 46% of knee OA patients. Final model 3 analysis revealed that hip OA patients with neuropathic-like symptoms scored significantly lower on pain-related aspects of HRQoL (ΔRAND-36 bodily pain: 6.8 points, p = 0.047) compared to patients with the unlikely NP phenotype. In knee OA patients, a possible NP phenotype was associated with diminished joint function (ΔWOMAC domains ranging 7.1 to 10.5 points, p<0.05) and more deficits on the physical functional aspect of HRQoL (ΔRAND-36 physical functioning: 6.8 points, p = 0.016).ConclusionNeuropathic-like symptoms deteriorate the subjective rating of pain-related quality of life in hip OA patients and significantly influence function in knee OA patients.

Pain-related behavior is associated with increased joint innervation, ipsilateral dorsal horn gliosis, and dorsal root ganglia activating transcription factor 3 expression in a rat ankle joint model of osteoarthritis

“… 17 It is important to note that a high number of individuals suffering from OA report pain sensations comparable to those described in neuropathies. 3 , 19 …”

Nerve growth factor antibody for the treatment of osteoarthritis pain and chronic low-back pain: mechanism of action in the context of efficacy and safety

“…47 Indeed, although OA pain is believed to be predominantly nociceptive in origin, a population of OA patients (estimates vary greatly between 5% and 65%) can show aspects of neuropathic pain (eg, burning, numbness, and tingling), and the OA population is likely a heterogeneous mix of pain states. 10,86…”

Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis

“…In knee OA, specifically, this intermittent, sharp pain often arises unpredictably and is associated with giving way or locking of the knee [31]. A minority of people with OA [36,37,38] describe pain qualities, such as burning, shooting, or electric shocks, and more recent evidence shows that some describe perceptual disturbances, including feeling as if their painful limb is altered in size [39,40,41], missing [32,42], or difficult to control [39,42].…”