Affiliation:
1. Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine , Aalborg University , Aalborg , Denmark
2. Center for Mathematical Modelling of Knee Osteoarthritis, Department of Materials and Production , Aalborg University , Aalborg , Denmark
Abstract
Abstract
Objectives
The prevalence of osteoarthritis (OA) is rising, and pain is the hallmark symptom of OA. Pain in OA is complicated and can be influenced by multiple joint-related factors and factors related to, e.g., physiological, epigenetic, and pain sensory profiles. Increasing evidence suggests that a subset of patients with OA are pain sensitive. This can be assessed using quantitative sensory testing (QST). Common treatments of OA are total knee arthroplasty (TKA) and administration of 3-weeks of non-steroidal anti-inflammatory drugs (NSAIDs), which provide pain relief to many patients with OA. However, approx. 20% of patients experience chronic postoperative pain after TKA, whereas NSAIDs provide an average pain relief of approx. 25%. The current topical review focuses on the emerging evidence linking pretreatment QST to the treatment response of TKA and NSAID treatments.
Content
MEDLINE was systematically searched for all studies from 2000 to 2022 on pretreatment QST, TKA, and NSAIDs. Pre-clinical studies, reviews, and meta-analyses were excluded.
Summary
Currently, 14 studies on TKA and four studies on NSAIDs have been published with the aim to attempt prediction of the treatment response. The QST methodologies in the studies are inconsistent, but 11/14 (79%) studies on TKA and 4/4 (100%) studies on NSAIDs report statistically significant associations between pretreatment QST and chronic postoperative pain after TKA or analgesic effect after NSAID treatment. The strength of the associations remains low-to-moderate. The most consistent pretreatment QST predictors are pressure pain thresholds, temporal summation of pain, and conditioned pain modulation.
Outlook
The use of QST as predictors of standard OA treatment is interesting, but the predictive strength remains low-to-moderate. A transition of QST from a research-based setting and into the clinic is not advised until the predictive strength has been improved and the methodology has been standardized.
Subject
Anesthesiology and Pain Medicine,Neurology (clinical)
Reference98 articles.
1. Dieppe, P, Lohmander, L. Pathogenesis and management of pain in osteoarthritis. Lancet 2005;365:965–73. https://doi.org/10.1016/s0140-6736(05)71086-2.
2. Felson, DT. The sources of pain in knee osteoarthritis. Curr Opin Rheumatol 2005;17:624–8. https://doi.org/10.1097/01.bor.0000172800.49120.97.
3. Hannan, MT, Felson, DT, Pincus, T. Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatol 2000;27:1513–7.
4. Edwards, RR, Cahalan, C, Mensing, G, Smith, M, Haythornthwaite, JA. Pain, catastrophizing, and depression in the rheumatic diseases. Nat Rev Rheumatol 2011;7:216–24. https://doi.org/10.1038/nrrheum.2011.2.
5. Giordano, R, Petersen, KK, Andersen, HH, Simonsen, O, Arendt-Nielsen, L. Serum inflammatory markers in patients with knee osteoarthritis: a proteomic approach. Clin J Pain 2020;36:229–37. https://doi.org/10.1097/ajp.0000000000000804.
Cited by
8 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献