Pain sensitivity profiles in patients with advanced knee osteoarthritis

Abstract

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.

Physical performance and movement-evoked pain profiles in community-dwelling individuals at risk for knee osteoarthritis

“…Similarly, previous research has demonstrated increased generalized pressure pain sensitivity in patients with knee OA pain, suggesting the presence of central sensitization to mechanical stimuli (Arendt-Nielsen et al 2010; Frey-Law et al 2016). These lower functioning participants also exhibited greater heat and mechanical temporal summation.…”

“…Indeed, movement-evoked pain is associated with sensitization of peripheral Aδ and C-fiber afferents (Brucini et al 1981; Hendiani et al 2003), while spontaneous pain or pain at rest is related to sensitization at the dorsal horn and spinal cord (Schaible et al, 2002). Also, increased heat temporal summation implicates centrally-mediated mechanisms, and evidence suggests that in some individuals, peripheral and central nervous system mechanisms significantly contribute to knee OA pain (Murphy et al 2011; Arendt-Nielsen et al 2010; Frey-Law et al 2016; Cardoso et al 2016). Future mechanism-based research is needed incorporating measures of temporal summation of movement-evoked pain and their associations with physical function and intervention outcomes.…”

“…Recent evidence demonstrates considerable inter-individual heterogeneity among people with knee pain across a number of clinical, experimental and psychological variables (Cruz-Almeida et al 2013; Cardoso et al 2016; Frey-Law et al 2016). There is likely similar heterogeneity in physical functional performance among individuals with knee pain that accounts for distinct functional trajectories (i.e., get worse or recover over time) (van Dijk et al 2006).…”

The Potential Role of Sensory Testing, Skin Biopsy, and Functional Brain Imaging as Biomarkers in Chronic Pain Clinical Trials: IMMPACT Considerations

“…In particular, there is substantial heterogeneity across individuals with fibromyalgia (FM) and chronic musculoskeletal pain conditions such as osteoarthritis (OA; e.g., [3, 52, 65, 142, 153]), with similar sensory heterogeneity also observed in patients with systemic inflammatory conditions such as rheumatoid arthritis [92]. Moreover, since no particular QST profile is unique to a given pain diagnosis (e.g., [63]), these “trans-etiological” patterns of sensory symptoms and deficits may reflect distinct pain mechanisms, and it may be possible to group together individuals with similar sensory profiles diagnosed with these conditions.…”

Terapias intervencionistas para manejo de dolor en Osteoartrosis de rodilla sintomática

“…La osteoartrosis (OA) de rodilla es un desorden mecánico y dinámico multifactorial de la articulación, inducido por mediadores enzimáticos, que comprende diferentes fases y fenotipos, dando como resultado la pérdida del cartíla-go articular, esclerosis del hueso subcondral, formación de osteofitos y quistes subcondrales, que puede afectar a uno o más de los tres compartimentos articulares (1,2) y en donde el dolor es la característica clínica más importante, asocián-dose frecuentemente a un trastorno de sensibilización central y periférica (1,3,4), con cambios en los umbrales de dolor evidenciados por hiperalgesia mecánica y térmica (principalmente al frío) (5). Esta articulación es diartrodial, con un sistema biológico complejo en donde el cartílago articular, una estructura avascular y aneural, se encuentra funcional y anatómicamente entre dos estructuras altamente vascularizadas e inervadas como lo son la membrana sinovial y el hueso subcondral, ambos dotados de receptores de calor, quimiorreceptores y mecanorreceptores (1).…”