Pain sensitization in people with knee osteoarthritis: a systematic review and meta-analysis

Fingleton, Caitríona; Smart, Keith; Moloney, Niamh; Fullen, B.; Doody, Catherine

doi:10.1016/j.joca.2015.02.163

Cited by 335 publications

(318 citation statements)

References 42 publications

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“…Recognition of the role of central sensitisation in knee OA is increasing. From one perspective, persistent nociceptive input from joint structural changes in knee OA can increase the synaptic excitability and efficiency in the central pain pathway and result in central sensitisation, characterised by local and widespread hyperalgesia [52, 53], augmented spinal excitability and deficits in descending pain inhibition [54, 55]. Multiple other factors contribute to this process including unhealthy pain cognitions and a host of biological processes.…”

Section: Discussionmentioning

confidence: 99%

Addition of transcranial direct current stimulation to quadriceps strengthening exercise in knee osteoarthritis: A pilot randomised controlled trial

et al. 2017

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A randomised, assessor- and participant-blind, sham-controlled trial was conducted to assess the safety and feasibility of adding transcranial direct current stimulation (tDCS) to quadriceps strengthening exercise in knee osteoarthritis (OA), and provide data to inform a fully powered trial. Participants were randomised to receive active tDCS+exercise (AT+EX) or sham tDCS+exercise (ST+EX) twice weekly for 8 weeks whilst completing home exercises twice per week. Feasibility, safety, patient-perceived response, pain, function, pressure pain thresholds (PPTs) and conditioned pain modulation (CPM) were assessed before and after treatment. Fifty-seven people were screened for eligibility. Thirty (52%) entered randomisation and 25 (84%) completed the trial. One episode of headache in the AT+EX group was reported. Pain reduced in both groups following treatment (AT+EX: p<0.001, partial η2 = 0.55; ST+EX: p = 0.026, partial η2 = 0.18) but no between-group differences were observed (p = 0.18, partial η2 = 0.08). Function improved in the AT+EX (p = 0.01, partial η2 = 0.22), but not the ST+EX (p = 0.16, partial η2 = 0.08) group, between-group differences did not reach significance (p = 0.28, partial η2 = 0.052). AT+EX produced greater improvements in PPTs than ST+EX (p<0.05) (superolateral knee: partial η2 = 0.17; superior knee: partial η2 = 0.3; superomedial knee: partial η2 = 0.26). CPM only improved in the AT+EX group but no between-group difference was observed (p = 0.054, partial η2 = 0.158). This study provides the first feasibility and safety data for the addition of tDCS to quadriceps strengthening exercise in knee OA. Our data suggest AT+EX may improve pain, function and pain mechanisms beyond that of ST+EX, and provides support for progression to a fully powered randomised controlled trial.

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Section: Discussionmentioning

confidence: 99%

Addition of transcranial direct current stimulation to quadriceps strengthening exercise in knee osteoarthritis: A pilot randomised controlled trial

et al. 2017

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“…Widespread pain and pain sensitization appear to arise from a constellation of factors, including muscle nociceptor communication with neurons and neuronal sensitization by persistent nociceptor activation, impaired descending modulation by inhibitory neurons in the development of chronic pain, pressure hyperalgesia, thermal hyperalgesia, and spinal hyperexcitability. 30,31 The roles of specific cytokines, nerve growth factor, and sodium channel blockers in osteoarthritis-related pain are additionally being actively investigated 32 and may yield further insight into which patients are more likely to have successful outcomes from knee replacement. Translational research that bridges these pathways with the clinical phenotyping of widespread pain on a pain diagram would help to advance the field.…”

Section: Discussionmentioning

confidence: 99%

The association of pre-operative body pain diagram scores with pain outcomes following total knee arthroplasty

Dave

Selzer

Losina

et al. 2017

Osteoarthritis and Cartilage

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Objective Approximately 20% of total knee arthroplasty (TKA) recipients have suboptimal pain relief. We evaluated the association between pre-surgical widespread body pain and incomplete pain relief following TKA. Method This prospective analysis included 241 patients with knee OA undergoing unilateral TKA who completed questionnaires preoperatively and up to 12 months post-operatively. Questionnaires included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale and a body pain diagram. We derived the number of non-index painful body regions from the diagram. We used Poisson regression to determine the association between painful body regions identified preoperatively and both WOMAC pain at follow-up and improvement in pain as defined by the minimal clinically important difference (MCID). Results Mean subject age was 66 years (SD 9), and 61% were females. Adjusting for age, sex, co-morbid conditions, baseline pain, pain catastrophizing, and mental health, we found that more widespread body pain was associated with a higher likelihood of reporting 12-month WOMAC pain score >15 (relative risk [RR] per painful body region 1.39, 95% CI 1.18–1.63) and a greater likelihood of failing to achieve the MCID (RR 1.47, 95% CI 1.16–1.86). ). Pain catastrophizing was an independent predictor of persistent pain and failure to improve by the MCID (RR 3.57, 95% CI 1.73–7.31). Conclusions Pre-operative widespread pain was associated with greater pain at 12-months and failure to reach the MCID. Widespread pain as captured by the pain diagram, along with the pain catastrophizing score, may help identify persons with suboptimal TKA outcome.

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“…Clinical measures of sensitization include pressure pain threshold (PPT) testing, sensitivity mapping, mechanical temporal summation, mechanical allodynia, and conditioned pain modulation (4, 82). A recently published systematic review of pressure pain threshold (PPT) and heat pain threshold (HPT) studies suggests that sensitization in knee OA patients may be associated with symptom severity (85). Another recent systematic review suggests that OA pain is associated with central sensitization in a subset of patients, particularly those people with chronic pain (86).…”

Section: Central Sensitizationmentioning

confidence: 99%

The Role of Peripheral Nociceptive Neurons in the Pathophysiology of Osteoarthritis Pain

Miller

Tran

Obeidat

et al. 2015

Curr Osteoporos Rep

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Knee osteoarthritis is characterized by progressive damage and remodeling of all tissues in the knee joint. Pain is the main symptom associated with knee osteoarthritis. Recent clinical and pre-clinical studies shed light on the mechanisms that drive the pain associated with joint destruction. In this narrative review, we describe current knowledge regarding the changes in the peripheral and central nervous system that occur during the progression of osteoarthritis and discuss how therapeutic interventions may provide pain relief.

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Pain sensitization in people with knee osteoarthritis: a systematic review and meta-analysis

Abstract: Evidence from this systematic review and meta-analysis suggests that pain sensitization is present in people with knee OA and may be associated with knee OA symptom severity.

Cited by 335 publications

References 42 publications

Addition of transcranial direct current stimulation to quadriceps strengthening exercise in knee osteoarthritis: A pilot randomised controlled trial

Addition of transcranial direct current stimulation to quadriceps strengthening exercise in knee osteoarthritis: A pilot randomised controlled trial

The association of pre-operative body pain diagram scores with pain outcomes following total knee arthroplasty

The Role of Peripheral Nociceptive Neurons in the Pathophysiology of Osteoarthritis Pain

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