Future Directions in Painful Knee Osteoarthritis: Harnessing Complexity in a Heterogeneous Population

Author:

Kittelson Andrew J.1,George Steven Z.2,Maluf Katrina S.3,Stevens-Lapsley Jennifer E.4

Affiliation:

1. A.J. Kittelson, PT, DPT, Rehabilitation Science, Graduate School, University of Colorado, Mail Stop C244, 13121 E 17th Ave, Room 3116, Aurora, CO 80045 (USA).

2. S.Z. George, PT, PhD, Department of Physical Therapy, University of Florida, Gainesville, Florida, and Brooks Rehabilitation, Jacksonville, Florida.

3. K.S. Maluf, PT, PhD, Physical Therapy and Rehabilitation Science Programs, Department of Physical Medicine and Rehabilitation, University of Colorado.

4. J.E. Stevens-Lapsley, PT, PhD, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado.

Abstract

This perspective article proposes a conceptual model for the pain experience for individuals diagnosed with knee osteoarthritis (OA). Pain in knee OA is likely a heterogeneous, multifactorial phenomenon that involves not only the OA disease process but also elements specific to patient psychology and pain neurophysiology. The relevant contributions to the pain experience for any individual patient remain difficult, if not impossible, to definitively determine, and the rationale for many clinical treatment decisions arises primarily from a mechanistic understanding of OA pathophysiology. The Osteoarthritis Research Society International (OARSI) recently identified “phenotyping” of OA pain as a research priority to “better target pain therapies to individual patients.” This perspective article proposes that contributions from 3 domains—knee pathology, psychological distress, and pain neurophysiology—should be considered equally important in future efforts to understand pain phenotypes in knee OA. Ultimately, characterization of pain phenotypes may aid in the understanding of the pain experience and the development of interventions specific to pain for individual patients.

Publisher

Oxford University Press (OUP)

Subject

Physical Therapy, Sports Therapy and Rehabilitation

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