Quantitative Sensory Testing Protocols to Evaluate Central and Peripheral Sensitization in Knee OA: A Scoping Review

Abstract

Objective This scoping review analyzed various quantitative sensory testing methodologies used in the assessment of sensitization and how sensitization is defined in people with knee osteoarthritis. Design A scoping review. Setting All clinical and research settings. Subjects Non-surgical adults with knee osteoarthritis. Methods This scoping review was guided by existing scoping review methodologies. Relevant studies were extracted from the following electronic databases: Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Allied and Complementary Medicine Database and the Cumulative Index to Nursing Allied Health Literature. Abstract and full article screening and data extraction were performed in pairs. Information on quantitative sensory testing techniques and parameters was extracted and summarized in tables. General and technique specific definitions of sensitization were extracted from included texts. Results Our search yielded 4199 articles, of which 50 were included in our review. The most common quantitative sensory test was pressure pain threshold. In total 28 unique testing sites were found speaking to the high degree of variability between studies. Sensitization was poorly defined with only 8 studies fully operationalizing it, 22 partially, and the remainder did not provide sufficient information to meet our criteria. Conclusion This scoping review has provided an overview of the most common methods of quantitative sensory testing being implemented in the assessment of nervous system sensitization to nociceptive signaling in people with knee osteoarthritis. This study provides a foundation for future development of quantitative sensory testing methodology for research and clinical practice in the osteoarthritis population.

Associations between markers of inflammation and altered pain perception mechanisms in people with knee osteoarthritis: a systematic review

“…Lack of consistency across QST protocols remains a challenge within the field of OA. 25 Because of different protocols of pain testing and a variety of inflammatory markers being used, combining and summarising data for developing an overview of current literature were challenging. However, we carefully evaluated the methodological quality of the included papers and performed the best level of evidence that takes into account both study design and RoB.…”

“…12 24 The most common QST modalities include pain pressure threshold (PPT) (to test for widespread hyperalgesia) and/or temporal summation (TS) (to assess spinal hyperexcitability) and/or conditioned pain modulation (CPM) (to assess a descending inhibitory pathway). 25 Due to the complexity of OA pain, the underlying mechanisms have long been unclear, but it is now known that the typical low-grade chronic inflammation of the arthritic joint might be involved in pain generation or altered pain perception. 26 27 Inflammation of richly innervated structures, such as the synovial membrane (termed synovitis) or lesions in the subchondral bone (termed bone marrow lesions (BMLs)), can contribute to or has been associated with pain.…”

“… 12 24 The most common QST modalities include pain pressure threshold (PPT) (to test for widespread hyperalgesia) and/or temporal summation (TS) (to assess spinal hyperexcitability) and/or conditioned pain modulation (CPM) (to assess a descending inhibitory pathway). 25 …”

Conservative Management of Acute Sports-Related Concussions: A Narrative Review

“…The central sensitization framework can be used to guide conservative interventions, and clinical researchers have used it to guide treatment in several areas of sports medicine, including chronic low back pain [8][9][10], shoulder pain [11], knee pain [12], chronic myofascial pain [13], tendinopathy [14,15], temporomandibular disorders [16], migraines [17], and post-traumatic headaches [18]. The key insight of the central sensitization model is that chronic pain syndromes can be prevented through early proactive interventions, using the biopsychosocial model of pain as a guide.…”

Cross-cultural adaptation and validation for central sensitization inventory: based on Chinese patients undergoing total knee arthroplasty for knee osteoarthritis

“…Several attempts have been made to objectively quantify CS, such as Quantitative Sensory Testing (QST) [ 14 , 15 ] and (f)MRI [ 16 , 17 ]. While these tools can provide valuable information, they are often complex, time-consuming, and expensive [ 18 ].…”