Neuropathic pain in osteoarthritis: A review of pathophysiological mechanisms and implications for treatment

Dimitroulas, Theodoros; Duarte, Rui; Behura, Asis; Kitas, George D.; Raphael, Jacob

doi:10.1016/j.semarthrit.2014.05.011

Cited by 161 publications

(115 citation statements)

References 103 publications

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“…62 Individuals with high levels of pain refractory to analgesic treatment but with minor joint changes may exhibit signs and symptoms characteristic of neuropathic pain fulfilling the criteria of validated neuropathic pain questionnaires. 65 Pulsed RF when applied to the afferent axon of the sciatic nerve in rats damages unmyelinated C-fibers more than A-delta and A-beta myelinated fibers. 66 This finding suggests that pulsed RF could be particularly useful in providing analgesia for conditions with a significant neuropathic involvement such as posttraumatic knee pain.…”

Section: Future Avenues For Clinical Research and Practicementioning

confidence: 98%

Radiofrequency Procedures to Relieve Chronic Knee Pain

Bhatia

Peng

Cohen

2016

Regional Anesthesia and Pain Medicine

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Radiofrequency treatments on the knee joint (major or periarticular nerve supply or intra-articular branches) have the potential to reduce pain from osteoarthritis or persistent postarthroplasty pain. Ongoing concerns regarding the quality, procedural aspects, and monitoring of outcomes in publications on this topic remain. Randomized controlled trials of high methodological quality are required to further elaborate role of these interventions in this population.

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Section: Future Avenues For Clinical Research and Practicementioning

confidence: 98%

Radiofrequency Procedures to Relieve Chronic Knee Pain

Bhatia

Peng

Cohen

2016

Regional Anesthesia and Pain Medicine

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“…It has typical clinical features regardless of where in the body it occurs that aid in its diagnosis. For instance, neuropathic pain is often characterized as waxing and waning, and lancinating, and it may be accompanied by paresthesias, numbness, tingling, and shooting sensations 21, 22, 23, 24, 25, 26. Neuropathic pain also typically follows the distribution of one or more sensory nerves that are damaged or inflamed.…”

Section: Mechanisms Of Orofacial Painmentioning

confidence: 99%

Applications of sensory and physiological measurement in oral‐facial dental pain

Dabiri

Harper

Kapila

et al. 2018

Special Care in Dentistry

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Dentists regularly employ a variety of self‐report and sensory techniques to aid in the diagnosis and treatment of tooth‐related disease. Many of these techniques leverage principles borrowed from psychophysics, the quantitative measurement of the relationship between stimuli and evoked sensations, which falls under the larger umbrella of quantitative sensory testing (QST). However, most clinicians fail to meet the bar for what could be considered quantitative sensory testing, and instead focus on qualitative and dichotomous “yes/no” aspects of sensory experience. With our current subjective measurements for pain assessments, diagnosis and treatment of dental pain in young children and individuals (any age) with severe cognitive impairment rely extensively on third‐party observations. Consequently, the limitation of inadequate pain diagnosis can lead to poor pain management. In this review, it discusses mechanisms that underlie acute and chronic dental pain. It details the measurement of somatosensory responses and pulpal blood flow as objective measures of tooth health and pain. It proposes that bridging these varied methodologies will significantly improve diagnosis and treatment of orofacial pain and pathology. It concludes that improving the precision of sensory measurements could yield important improvements in diagnostic challenges in pulpal pathology for noncommunicative and cognitively impaired individuals.

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“…In recent years, a second type of pain has been associated with OA, and seems to be most prominent in patients with severe OA (KL 4) [31, 32]. This is termed neuropathic pain and, although there is overlap with nociceptive pain, it has an extra dimension which renders it pharmacologically separate.…”

Section: Nociceptive and Neuropathic Pain In Oamentioning

confidence: 99%

Use of Saline as a Placebo in Intra-articular Injections in Osteoarthritis: Potential Contributions to Nociceptive Pain Relief

Bar‐Or¹,

Rael²,

Brody³

2017

TORJ

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Background:Osteoarthritis of the knee (OAK) is a severe debilitating condition characterized by joint pain, stiffness, and resultant limited mobility. In recent years, intra-articular (IA) injections have been used to relieve symptoms and have succeeded to varying degrees either with sodium hyaluronate preparations or with a biologic.Objective:The objective of this review is to evaluate multiple studies that demonstrate some relief from the symptoms of OAK in the saline arm of various clinical trials.Method:A thorough literature search (PubMed) was performed assessing the pain efficacy of various compounds compared to saline injections in clinical trials. A total of 73 studies were identified in the literature search including a total of 5,816 patients. These clinical trials all involved the IA injection of a viscosupplement (hyaluronate, platelet rich plasma (PRP), etc.) or a biologic (the low molecular weight fraction (< 5kDa) of human serum albumin (LMWF-5A)). For all of these studies, the control arm was injection of sterile physiological saline that approximates the salt concentration and total solute concentration of blood and most tissues.Results:Based on our review of the current literature, the tested compounds performed with mixed results when compared to saline injections. Moreover, OAK is a variable disease, with severity measured on the Kellgren and Lawrence (KL) scale where various hyaluronate preparations have a therapeutic effect mostly on KL 2-3 patients while a biologic works best on KL 3-4 patients.Conclusion:Since the effect of saline injection is always greater than no treatment, the evaluations of these treatments can be confounded in clinical trials. Therefore, the question of whether there are known therapeutic effects of saline injections might explain these results.

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Neuropathic pain in osteoarthritis: A review of pathophysiological mechanisms and implications for treatment

Cited by 161 publications

References 103 publications

Radiofrequency Procedures to Relieve Chronic Knee Pain

Radiofrequency Procedures to Relieve Chronic Knee Pain

Applications of sensory and physiological measurement in oral‐facial dental pain

Use of Saline as a Placebo in Intra-articular Injections in Osteoarthritis: Potential Contributions to Nociceptive Pain Relief

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