Patients With Knee Osteoarthritis Who Score Highly on the PainDETECT Questionnaire Present With Multimodality Hyperalgesia, Increased Pain, and Impaired Physical Function

Abstract

Objectives:PainDETECT is a self-report questionnaire that can be used to identify features of neuropathic pain. A proportion of patients with knee osteoarthritis (OA) score highly on the PainDETECT questionnaire. This study aimed to determine whether those with a higher “positive neuropathic” score on the PainDETECT questionnaire also had greater pain, hypersensitivity, and reduced function compared with individuals with knee OA with lower PainDETECT scores.Materials and Methods:In total, 130 participants with knee OA completed the PainDETECT, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Pain Quality Assessment Scale questionnaires. Quantitative sensory testing was carried out at 3 sites (both knees and elbow) using standard methods. Cold and heat pain thresholds were tested using a Peltier thermode and pressure pain thresholds using a digital algometer. Physical function was assessed using 3 timed locomotor function tests.Results:In total, 22.3% of participants scored in the “positive neuropathic” category with a further 35.4% in the unclear category. Participants in the “positive neuropathic” category reported higher levels of pain and more impaired function based on the WOMAC questionnaire (P<0.0001). They also exhibited increased levels of hyperalgesia at the knee and upper limb sites for all stimulation modalities except heat pain thresholds at the OA knee. They were also slower to complete 2 of the locomotion tasks.Discussion:This study identified a specific subgroup of people with knee OA who exhibited PainDETECT scores in the “positive neuropathic” category. These individuals experienced increased levels of pain, widespread, multimodality hyperalgesia, and greater functional impairment than the remaining cohort. Identification of OA patients with this pain phenotype may permit more targeted and effective pain management.

Nerves in Bone: Evolving Concepts in Pain and Anabolism

“…Thus, even in the absence of a change in innervation, inflammation can elicit pain in response to normally innocuous stimuli (allodynia) or increase sensitivity to noxious stimuli (hyperalgesia). In many cases bone pain also presents as cutaneous sensitivity at sites surrounding or distant to the injury (referred pain) . This fact has been leveraged in preclinical studies for the relative ease of studying thermal and mechanical sensitivity of the skin near the affected bone as a surrogate for bone pain (reviewed in Nencini and Ivanusic).…”

“…In many cases bone pain also presents as cutaneous sensitivity at sites surrounding or distant to the injury (referred pain). (167)(168)(169)(170) This fact has been leveraged in preclinical studies for the relative ease of studying thermal and mechanical sensitivity of the skin near the affected bone as a surrogate for bone pain (reviewed in Nencini and Ivanusic (171) ). However, preclinical studies that that use cutaneous sensitivity as a surrogate for bone pain may overestimate analgesic efficacy, impacting potential for clinical translational success.…”

Mechanistic pain profiling as a tool to predict the efficacy of 3-week nonsteroidal anti-inflammatory drugs plus paracetamol in patients with painful knee osteoarthritis

“…The predictive value of mechanistic pain profiling in the treatment of osteoarthritic pain Recent reviews have concluded that there is a neuropathic component in a subpopulation of OA patients [6,13]. The PainDetect questionnaire aims to identify a positive, unclear and negative neuropathic pain component in chronic pain patients [20], and studies have identified 5 -30% [32,35,37] of OA patients with a positive neuropathic pain component. Furthermore, OA patients with a positive neuropathic pain component have been found to report higher pain intensities and widespread pressure hyperalgesia compared with an unclear or negative neuropathic pain component [35].…”

Altered Primary Motor Cortex Structure, Organization, and Function in Chronic Pain: A Systematic Review and Meta-Analysis

“…89 A mixture of neuropathic and non-neuropathic pain components were identified not only in chronic nonspecific LBP, 90 but ankylosing spondylitis back pain, 110 and knee and hip OA. 26,36,59,61 However, it is unclear whether a neuropathic pain subgroup exists in other pain conditions. Future studies should investigate whether distinct pain subgroups exist within chronic pain conditions and whether these subgroups present with different M1 changes.…”