Pain Trajectories in Knee Osteoarthritis—A Systematic Review and Best Evidence Synthesis on Pain Predictors

Abstract

Different profiles of pain progression have been reported in patients with knee osteoarthritis (OA), but the determinants of this heterogeneity are still to be sought. The aim of this systematic review was to analyze all studies providing information about knee OA pain trajectories to delineate, according to patients’ characteristics, an evidence-based evolution pattern of this disabling disease, which is key for a more personalized and effective management of knee OA. A literature search was performed on PubMed, Web of Science, Cochrane Library, and grey literature databases. The Cochrane Collaboration’s tool for assessing risk of bias was used, and a best-evidence synthesis was performed to define the predictors of pain evolution. Seven articles on 7747 patients affected by knee OA (mainly early/moderate) were included. Daily knee OA pain trajectories were unstable in almost half of the patients. In the mid-term, knee OA had a steady pain trajectory in 85% of the patients, 8% experienced pain reduction, while 7% experienced pain worsening. Low education, comorbidities, and depression were patient-related predictors of severe/worsening knee OA pain. Conversely, age, alcohol, smoking, pain coping strategies, and medications were unrelated to pain evolution. Conflicting/no evidence was found for all joint-related factors, such as baseline radiographic severity.

Minimal Clinically Important Difference and Patient Acceptable Symptom State in Patients With Knee Osteoarthritis Treated With PRP Injection

“… 11 Another applicable method is the pain trajectories evaluation, which aims, through a repetitive assessment of the patient’s pain level, to better characterize and evaluate different profiles of pain progression rather than with less reliable 1-time evaluations. 32 , 37 Similarly, the MCID and the PASS are important tools for documenting the magnitude of patient improvement and well-being after treatment, allowing a more patient-focused outcome than statistics can provide.…”

“…rather than with less reliable 1-time evaluations. 32,37 Similarly, the MCID and the PASS are important tools for documenting the magnitude of patient improvement and well-being after treatment, allowing a more patientfocused outcome than statistics can provide.…”

Intra-Articular Administration of Autologous Purified Adipose Tissue Associated with Arthroscopy Ameliorates Knee Osteoarthritis Symptoms

“…A limitation of this study was the lack of a control group. Therefore, we could not rule out the presence of a placebo effect, which can be crucial for pain symptoms [ 5 , 25 ]. Indeed, the presence of a control group is essential to confirm the efficacy of the described treatment versus arthroscopy alone, and will be a subject of our next study; moreover, further investigations will compare this new treatment with standard options such as hyaluronic acid or PRP injections.…”

Knee pain trajectories over 18 months in non-Hispanic Black and non-Hispanic White adults with or at risk for knee osteoarthritis

“…Given that OA-related pain can be experienced as persistent or intermittent, with ongoing fluctuations in intensity, longitudinal studies using annual or bi-annual assessments may not fully capture clinical pain variability [ 18 ], and daily assessments place undue burden on patients. Therefore, identification of pain trajectories in knee OA based upon quarterly assessments may prove optimal by balancing the benefit to burden ratio [ 34 ].…”

“…Furthermore, despite evidence for associations between sociodemographic factors and pain trajectories [ 18 , 34 ], little is known about the relationship between ethnicity/race and pain progression in knee OA. Previous research has demonstrated considerable health disparities in knee OA, with African Americans/non-Hispanic Blacks (NHBs) reporting greater overall levels of clinical pain and physical disability [ 21 , 35 – 37 ], and experimental pain sensitivity [ 10 , 37 , 38 ].…”