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Vigotsky AD, Cong O, Pinto CB, Barroso J, Perez J, Petersen KK, Arendt-Nielsen L, Hardt KD, Manning D, Apkarian AV, Branco P. Prognostic value of preoperative mechanical hyperalgesia and neuropathic pain qualities for postoperative pain after total knee replacement. Eur J Pain 2024. [PMID: 38850090 DOI: 10.1002/ejp.2295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/26/2024] [Accepted: 05/20/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Total knee replacement (TKR) is the gold standard treatment for end-stage chronic osteoarthritis pain, yet many patients report chronic postoperative pain after TKR. The search for preoperative predictors for chronic postoperative pain following TKR has been studied with inconsistent findings. METHODS This study investigates the predictive value of quantitative sensory testing (QST) and PainDETECT for postoperative pain 3, 6 and 12 months post-TKR. We assessed preoperative and postoperative (3 and 6 months) QST measures in 77 patients with knee OA (KOA) and 41 healthy controls, along with neuropathic pain scores in patients (PainDETECT). QST parameters included pressure pain pressure threshold (PPT), pain tolerance threshold (PTT), conditioned pain modulation (CPM) and temporal summation (TS) using cuff algometry, alongside mechanical hyperalgesia and temporal summation to repeated pinprick stimulation. RESULTS Compared to healthy controls, KOA patients at baseline demonstrated hyperalgesia to pinprick stimulation at the medial knee undergoing TKR, and cuff pressure at the calf. Lower cuff algometry PTT and mechanical pinprick hyperalgesia were associated with preoperative KOA pain intensity. Moreover, preoperative pinprick pain hyperalgesia explained 25% of variance in pain intensity 12 months post-TKR and preoperative neuropathic pain scores also captured 30% and 20% of the variance in postoperative pain at 6 and 12 months respectively. A decrease in mechanical pinprick hyperalgesia from before surgery to 3 months after TKR was associated with lower postoperative pain at the 12 months post-TKR follow-up. CONCLUSION Our findings suggest that preoperative pinprick hyperalgesia and neuropathic-like pain symptoms show predictive value for the development of chronic post-TKR pain. SIGNIFICANCE STATEMENT This study's findings hold significant implications for chronic pain management in knee osteoarthritis patients, particularly those undergoing total knee replacement surgery (TKR). Mechanical hyperalgesia and neuropathic pain-like characteristics predict postoperative pain 1 year after TKR, emphasizing the importance of understanding pain phenotypes in OA for selecting appropriate pain management strategies. The normalization of hyperalgesia after surgery correlates with better long-term outcomes, further highlighting the therapeutic potential of addressing abnormal pain processing mechanisms pre- and post-TKR.
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Affiliation(s)
- Andrew D Vigotsky
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering and Statistics, Northwestern University, Evanston, Illinois, USA
| | - Olivia Cong
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Camila B Pinto
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joana Barroso
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer Perez
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kristian Kjaer Petersen
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Material and Production, Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Faculty of Engineering and Science, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Material and Production, Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Faculty of Engineering and Science, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Kevin D Hardt
- Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Manning
- Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - A Vania Apkarian
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Paulo Branco
- Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Power JD, Perruccio AV, Canizares M, Davey JR, Gandhi R, Mahomed NN, Syed K, Veillette C, Rampersaud YR. The impact of diabetes status on pain and physical function following total joint arthroplasty for hip and knee osteoarthritis: variation by sex and body mass index. Sci Rep 2024; 14:11152. [PMID: 38750058 PMCID: PMC11096302 DOI: 10.1038/s41598-024-61847-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
Few studies have examined diabetes impact on total joint arthroplasty (TJA) outcomes, with variable findings. We investigated the association between diabetes and post-TJA physical function and pain, examining whether diabetes impact differs by sex and BMI. Patient sample completed questionnaires within 3 months prior to hip or knee TJA for osteoarthritis (OA) and 1-year post-surgery. Surgical 'non-response' was defined as < 30% improvement in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function at 1-year. Two adjusted logistic regression models were estimated: (1) excluding, (2) including an interaction between diabetes, sex and BMI. The sample (626 hip, 754 knee) was 54.9% female, had mean BMI of 30.1, 13.0% reported diabetes. In adjusted models excluding an interaction, diabetes was not associated with non-response. However, a significant 3-way interaction (physical function: p = 0.003; pain: p = 0.006) between diabetes, sex, and BMI was found and was associated with non-response: non-response probability increased with increasing BMI in men with diabetes, but decreased with increasing BMI in women in diabetes. Findings suggest uncertainty in diabetes impact may be due to differential impacts by sex and BMI. A simple consideration of diabetes as present vs. absent may not be sufficient, with implications for the large TJA population.
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Affiliation(s)
- J Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada.
- Arthritis Community Research & Epidemiology Unit, Toronto, ON, Canada.
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada
- Arthritis Community Research & Epidemiology Unit, Toronto, ON, Canada
- Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada
- Arthritis Community Research & Epidemiology Unit, Toronto, ON, Canada
| | - J Roderick Davey
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada
- Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Rajiv Gandhi
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada
- Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Nizar N Mahomed
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada
- Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Khalid Syed
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada
- Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Christian Veillette
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada
- Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Y Raja Rampersaud
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada
- Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Riddle DL, Henderson N. Six-month pain and function outcome expectations were established for total knee arthroplasty using the smallest worthwhile effect. PLoS One 2024; 19:e0300439. [PMID: 38687733 PMCID: PMC11060529 DOI: 10.1371/journal.pone.0300439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/28/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Interpretations of patient-reported outcome measures following knee arthroplasty lack context and typically do not account for costs, risks and benefits compared to an alternative treatment. The primary purpose of our paper is to estimate expectations patients have for pain and function destination outcome, six-months following surgery relative to the outcome expected if knee arthroplasty was not done. Secondary purposes were to determine if statistically significant changes in the smallest worthwhile six-month outcome occurred following an interactive discussion and to assess the construct validity of the expected six-month outcome obtained at baseline. METHODS This was a secondary analysis of a prospective longitudinal cohort study of 121 patients undergoing knee arthroplasty. Smallest worthwhile effect estimates were determined and expected six-month KOOS Pain and Function, daily activity measures were established during a pre-operative visit. RESULTS The average six-month expected (the destination of interest) KOOS Pain score was 75 (IQR = 64 to 86) and the average KOOS Function, daily activity score was 74 (IQR = 59 to 86). The smallest worthwhile effect discussion led to significant changes in expected destination scores. For example, KOOS Pain expected outcome changed from 87.7 (9.8) to 75.0 (13.6), a statistically significant reduction in expected outcome (t(119) = 16.942, p < 0.001. CONCLUSION Six-month expected KOOS outcomes following knee arthroplasty were established and approximate the average six-month outcomes reported in the literature. Validity of these estimates was established. These data can be used to aid shared decision-making discussions regarding patient expectations of knee arthroplasty outcomes during a patient encounter.
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Affiliation(s)
- Daniel L. Riddle
- Departments of Physical Therapy, Orthopaedic Surgery and Rheumatology, Virginia Commonwealth University, Richmond, Virginia, United Stated of America
| | - Nancy Henderson
- Department of Rehabilitation Sciences, Georgia Southern University- Armstrong Campus, Savannah, Georgia, United Stated of America
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Kim MS, Kim JJ, Kang KH, Lee JH, In Y. Central Sensitization and Neuropathic Pain Cumulatively Affect Patients Reporting Inferior Outcomes Following Total Knee Arthroplasty. J Bone Joint Surg Am 2024; 106:102-109. [PMID: 37943951 DOI: 10.2106/jbjs.23.00399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
UPDATE This article was updated on November 17, 2023, because of previous errors, which were discovered after the preliminary version of the article was posted online. On page 102, the text that had read "In a post hoc analysis of the preoperative results, Group 1 showed significantly inferior WOMAC pain, function, and total scores compared with Group 4 (p < 0.05 for all). Groups 2 and 3 showed worse preoperative WOMAC pain, function, and total subscores compared with Group 4 (p < 0.05 for all). These results remained the same at 2 years after surgery." now reads "In a post hoc analysis of the preoperative results, Groups 1, 2, and 3 showed significantly inferior WOMAC pain, function, and total scores compared with Group 4 (p < 0.05 for all). At 2 years postoperatively, Group 1 showed inferior WOMAC pain, function, and total scores compared with the other groups (p < 0.05 for all). Also, Groups 2 and 3 had worse WOMAC pain, function and total scores compared with Group 4 (p < 0.05 for all)." Also, on page 106, the title of Table IV, which had previously read "Inter-Group Comparison of Preoperative Scores (Post Hoc Analysis)" now reads "Inter-Group Comparison of Postoperative Scores (Post Hoc Analysis)."
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Roberts DW. Why Does My Knee Still Hurt After My Knee Replacement?: Commentary on an article by Man Soo Kim, MD, PhD, et al.: "Central Sensitization and Neuropathic Pain Cumulatively Affect Patients Reporting Inferior Outcomes Following Total Knee Arthroplasty". J Bone Joint Surg Am 2024; 106:e2. [PMID: 38231195 DOI: 10.2106/jbjs.23.01128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Donald W Roberts
- Northwest Surgical Specialists Research Foundation, Vancouver, Washington
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Fernández-de-las-Peñas C, Florencio LL, de-la-Llave-Rincón AI, Ortega-Santiago R, Cigarán-Méndez M, Fuensalida-Novo S, Plaza-Manzano G, Arendt-Nielsen L, Valera-Calero JA, Navarro-Santana MJ. Prognostic Factors for Postoperative Chronic Pain after Knee or Hip Replacement in Patients with Knee or Hip Osteoarthritis: An Umbrella Review. J Clin Med 2023; 12:6624. [PMID: 37892762 PMCID: PMC10607727 DOI: 10.3390/jcm12206624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Knee and hip osteoarthritis are highly prevalent in the older population. Management of osteoarthritis-related pain includes conservative or surgical treatment. Although knee or hip joint replacement is associated with positive outcomes, up to 30% of patients report postoperative pain in the first two years. This study aimed to synthesize current evidence on prognostic factors for predicting postoperative pain after knee or hip replacement. An umbrella review of systematic reviews was conducted to summarize the magnitude and quality of the evidence for prognostic preoperative factors predictive of postoperative chronic pain (>6 months after surgery) in patients who had received knee or hip replacement. Searches were conducted in MEDLINE, CINAHL, PubMed, PEDro, SCOPUS, Cochrane Library, and Web of Science databases from inception up to 5 August 2022 for reviews published in the English language. A narrative synthesis, a risk of bias assessment, and an evaluation of the evidence confidence were performed. Eighteen reviews (nine on knee surgery, four on hip replacement, and seven on both hip/knee replacement) were included. From 44 potential preoperative prognostic factors, just 20 were judged as having high or moderate confidence for robust findings. Race, opioid use, preoperative function, neuropathic pain symptoms, pain catastrophizing, anxiety, other pain sites, fear of movement, social support, preoperative pain, mental health, coping strategies, central sensitization-associated symptoms, and depression had high/moderate confidence for an association with postoperative chronic pain. Some comorbidities such as heart disease, stroke, lung disease, nervous system disorders, and poor circulation had high/moderate confidence for no association with postoperative chronic pain. This review has identified multiple preoperative factors (i.e., sociodemographic, clinical, psychological, cognitive) associated with postoperative chronic pain after knee or hip replacement. These factors may be used for identifying individuals at a risk of developing postoperative chronic pain. Further research can investigate the impact of using such prognostic data on treatment decisions and patient outcomes.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark;
| | - Lidiane L. Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
| | - Ana I. de-la-Llave-Rincón
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
| | | | - Stella Fuensalida-Novo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (J.A.V.-C.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark;
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Juan A. Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (J.A.V.-C.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Marcos J. Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (J.A.V.-C.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Ogawa H, Nakamura Y, Sengoku M, Shimokawa T, Ohnishi K, Akiyama H. Effect of medial opening wedge distal tibial tuberosity osteotomy on possible neuropathic pain in patients with osteoarthritis of the knee. Knee 2023; 43:114-121. [PMID: 37385112 DOI: 10.1016/j.knee.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 03/22/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND There is a paucity of literature regarding the changes and features of neuropathic pain (NP) in knee osteoarthritis (OA) following medial opening wedge distal tibial tuberosity osteotomy (OWDTO). This study aimed to investigate the effect of OWDTO on NP in knee OA; we hypothesized that OWDTO improves knee symptoms and functions and also meets patient satisfaction in those with knee OA with possible NP or without NP. METHODS Fifty-two consecutive patients who underwent OWDTO were categorized into the unlikely NP and possible NP groups using the painDETECT questionnaire. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and the Knee Society Score 2011 (KSS 2011) were compared between the groups preoperatively and at the 1-year follow-up. RESULTS The number of patients having possible NP significantly decreased from 12 (23.1%) preoperatively to one (1.9%) postoperatively (p < 0.001). The patient with postoperative possible NP also had possible NP preoperatively. All preoperative sub-scores of WOMAC were significantly higher in the possible NP group than in the unlikely NP group (p = 0.018, 0.013, 0.004, and 0.005, respectively); however, the postoperative scores did not differ between the two groups. Regarding the KSS 2011, the preoperative scores for symptom and functional activities were significantly lower in the possible NP group than in the unlikely NP group (p = 0.031 and 0.024, respectively). CONCLUSIONS OWDTO is an effective surgery for patients with possible NP; it improves symptoms and knee function as well as meets patient satisfaction. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine. Yanagido 1-1, Gifu 501-1194, Japan; Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. Hayashi-machi 6-85-1, Ogaki, Gifu 503-0015, Japan.
| | - Yutaka Nakamura
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. Hayashi-machi 6-85-1, Ogaki, Gifu 503-0015, Japan
| | - Masaya Sengoku
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. Hayashi-machi 6-85-1, Ogaki, Gifu 503-0015, Japan
| | - Tetsuya Shimokawa
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. Hayashi-machi 6-85-1, Ogaki, Gifu 503-0015, Japan
| | - Kazuichiro Ohnishi
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. Hayashi-machi 6-85-1, Ogaki, Gifu 503-0015, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine. Yanagido 1-1, Gifu 501-1194, Japan
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Schmidt H, Blechschmidt V. [Nociplastic pain in research and practice : Overview of biopsychosocial principles, possibilities and difficulties]. Schmerz 2023:10.1007/s00482-023-00734-5. [PMID: 37432482 DOI: 10.1007/s00482-023-00734-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 07/12/2023]
Abstract
Traditionally, two mechanistic pain categories were distinguished: nociceptive and neuropathic pain. After the definitions of these two mechanistic descriptors were refined more precisely in the International Association for the Study of Pain (IASP) taxonomy in 2011, a large group of patients remained whose pain could not be assigned to either of the two categories. Nociplastic pain was therefore proposed as a third mechanistic descriptor in 2016. This review article presents the current state of the integration of nociplastic pain into research and clinical practice. In particular, the possibilities and difficulties of applying this concept are addressed from a human and animal experimental research perspective.
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Affiliation(s)
- Hannah Schmidt
- Abteilung für Neurophysiologie, Mannheimer Zentrum für Translationale Neurowissenschaft, Universität Heidelberg, Ludolf-Krehl-Str. 13-17, 68167, Mannheim, Deutschland
| | - Vivian Blechschmidt
- Abteilung für Neurophysiologie, Mannheimer Zentrum für Translationale Neurowissenschaft, Universität Heidelberg, Ludolf-Krehl-Str. 13-17, 68167, Mannheim, Deutschland.
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Vervullens S, Meert L, Meeus M, Baert I, Heusdens CHW, Caethoven C, Charpentier N, Vervliet A, Smeets RJEM. Evolution of somatosensory processing signs after nociceptive targeted surgery in patients with musculoskeletal disorders: a systematic review. Pain 2023; 164:1428-1450. [PMID: 36727896 DOI: 10.1097/j.pain.0000000000002867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/30/2022] [Indexed: 02/03/2023]
Abstract
ABSTRACT Surgery is often advised when conservative treatment fails in musculoskeletal pain conditions, but a substantial proportion still suffers chronic pain after surgery. Somatosensory processing system (SPS) signs were previously studied as potential predictors for chronic postsurgical pain, but results are inconsistent. Therefore, studying the evolution of SPS signs could be of added value. The aim was to summarize all studies that measured how SPS signs evolved after nociceptive targeted surgery in musculoskeletal disorders and to find preoperative, perioperative, and postoperative predictors for the evolution of these SPS signs. Data were summarized, and risk of bias and level of evidence and recommendation were determined. Twenty-one studies were included. Five scored a low, 3 a moderate, and 13 a high risk of bias. In general, no consistent evolution of SPS signs comparing preoperative and postoperative values and predictors for this evolution in musculoskeletal disorders could be found. In most cases, static quantitative sensory testing (QST) did not change or conflicting results were found. On the other hand, dynamic QST mostly improved after surgery. Worthfully mentioning is that worsening of SPS signs was only seen at a follow-up of <3 months after surgery, that conclusions are stronger when evaluating dynamic QST with a follow-up of ≥3 months after surgery, and that pain improvement postsurgery was an important predictor. Future high-quality research should focus on the evolution of SPS signs after nociceptive targeted surgery, accounting for pain improvement groups and focusing on preoperative, perioperative, and postoperative predictors of this evolution.
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Affiliation(s)
- Sophie Vervullens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University Maastricht, the Netherlands
- Pain in Motion International Research Group (PiM) Antwerp, Belgium
| | - Lotte Meert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University Maastricht, the Netherlands
- Pain in Motion International Research Group (PiM) Antwerp, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group (PiM) Antwerp, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Isabel Baert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group (PiM) Antwerp, Belgium
| | - Christiaan H W Heusdens
- Department of Orthopedics and Traumatology, University Hospital of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Cleo Caethoven
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Nina Charpentier
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Amber Vervliet
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Rob J E M Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University Maastricht, the Netherlands
- Pain in Motion International Research Group (PiM) Antwerp, Belgium
- CIR Revalidatie, Eindhoven, the Netherlands
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Goldoni ES, Bittencourt JV, do Espirito Santo LR, Sousa EBD, Faria JLRD, Alexandre DJDA, Nogueira LAC. Neuropathic-like symptoms and central sensitization related signs and symptoms negatively affect the functional performance of patients with knee osteoarthritis – a cross-sectional study. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100358. [PMID: 37122842 PMCID: PMC10133749 DOI: 10.1016/j.ocarto.2023.100358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/09/2023] Open
Abstract
Objective This study aimed to compare the functional performance among participants with a neuropathic-like symptoms (NS) and central sensitization related signs and symptoms (CS), and their knee osteoarthritis (OA) counterparts. Methods A cross-sectional observational study was conducted with 125 participants with knee OA (94 females, mean age 63.1 ± 7.4 years). Participants completed a self-reported questionnaire with personal and clinical features and musculoskeletal pain characteristics, including NS (PainDETECT), CS (Central Sensitization Inventory, CSI), and conditioned pain modulation. Self-reported functional disability (Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC) and functional mobility (Timed Up and Go, TUG) were compared among patients with NS, CS, and their knee OA counterparts using the one-way analysis of variance (ANOVA). Results Thirty-three (26.4%) participants had NS and CS, eighteen (14.4%) had NS, twenty-seven (21.6%) participants had CS, and 47 (37.6%) had knee OA with no NS or CS. A one-way ANOVA revealed greater functional limitation in the group with NS and CS (mean = 67.5 ± 12.0) or NS (mean = 56.7 ± 17.5) than the group without these symptoms (mean = 32.0 ± 20.7) with a statistical significance difference [F(3, 121) = 29.434, p < 0.001] in the WOMAC Total score. The group with NS and CS (mean = 19.2 ± 7.4) or NS (mean = 16.3 ± 6.3) had slower velocity than the group without these symptoms (mean = 11.6 ± 3.5) with a statistical significance difference [F(3,121) = 10.045, p < 0.001] in the TUG test. Conclusion Participants with knee osteoarthritis and NS or CS pain phenotype have greater functional limitations than their counterparts.
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Affiliation(s)
- Enrico Seixas Goldoni
- Rehabilitation Science Postgraduate Programme at Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Juliana Valentim Bittencourt
- Rehabilitation Science Postgraduate Programme at Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
- Corresponding author. Centro Universitário Augusto Motta (UNISUAM), Avenida Paris, 84, Bonsucesso, CEP 21041-020, Rio de Janeiro, RJ, Brazil.
| | | | - Eduardo Branco de Sousa
- Physiotherapy Department at Jamil Haddad National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
| | - José Leonardo Rocha de Faria
- Physiotherapy Department at Jamil Haddad National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
| | | | - Leandro Alberto Calazans Nogueira
- Rehabilitation Science Postgraduate Programme at Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
- Physiotherapy Department at Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
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11
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Karateev AE, Nesterenko VA, Makarov MA, Lila AM. Chronic post-traumatic pain: rheumatological and orthopedic aspects. RHEUMATOLOGY SCIENCE AND PRACTICE 2022. [DOI: 10.47360/1995-4484-2022-526-537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Trauma causes a complex local and systemic reaction of the macroorganism, the consequences of which can be various functional, neurological and psychoemotional disorders. One of the most painful complications of injuries of the musculoskeletal system is chronic post-traumatic pain (CPTP), which occurs, depending on the severity of the damage, in 10–50% of cases. The pathogenesis of this syndrome is multifactorial and includes the development of chronic inflammation, degenerative changes (fibrosis, angiogenesis, heterotopic ossification), pathology of the muscular and nervous systems, neuroplastic changes leading to the development of central sensitization, as well as depression, anxiety and catastrophization. Risk factors for CPTP should be considered the severity of injury, comorbid diseases and conditions (in particular, obesity), stress and serious trauma-related experiences (within the framework of post-traumatic stress disorder), the development of post-traumatic osteoarthritis and chronic tendopathy, genetic predisposition, deficiencies in treatment and rehabilitation in the early period after injury. To date, there is no clear system of prevention and treatment of CPTP. Considering the pathogenesis of this suffering, adequate anesthesia after injury, active anti–inflammatory therapy (including local injections of glucocorticoids), the use of hyaluronic acid, slow-acting symptomatic agents and autologous cellular preparations – platelet-riched plasma, mesenchymal stem cells, etc. are of fundamental importance. However, therapeutic and surgical methods of CPTP control require further study
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Affiliation(s)
| | | | | | - A. M. Lila
- V.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation
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12
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Pan TT, Gao W, Song ZH, Long DD, Cao P, Hu R, Chen DY, Zhou WJ, Jin Y, Hu SS, Wei W, Chai XQ, Zhang Z, Wang D. Glutamatergic neurons and myeloid cells in the anterior cingulate cortex mediate secondary hyperalgesia in chronic joint inflammatory pain. Brain Behav Immun 2022; 101:62-77. [PMID: 34973395 DOI: 10.1016/j.bbi.2021.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- Ting-Ting Pan
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - Wei Gao
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - Zi-Hua Song
- Department of Neurobiology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China; Innovation Laboratory of Terahertz Biophysics, National Innovation Institute of Defense Technology, Beijing 100071, China
| | - Dan-Dan Long
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - Peng Cao
- Department of Neurobiology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Rui Hu
- Department of Neurobiology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Dan-Yang Chen
- Department of Neurobiology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Wen-Jie Zhou
- Department of Neurobiology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Yan Jin
- Department of Neurobiology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Shan-Shan Hu
- Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China
| | - Wei Wei
- Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China
| | - Xiao-Qing Chai
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - Zhi Zhang
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China; Department of Neurobiology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Di Wang
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China.
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13
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Wang D, Chai XQ, Hu SS, Pan F. Joint synovial macrophages as a potential target for intra-articular treatment of osteoarthritis-related pain. Osteoarthritis Cartilage 2022; 30:406-415. [PMID: 34861384 DOI: 10.1016/j.joca.2021.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/19/2021] [Accepted: 11/22/2021] [Indexed: 02/02/2023]
Abstract
Osteoarthritis is the most common form of joint disease and is one of the leading causes of chronic pain. Given the multi-factorial nature, numerous efforts have been made to clarify the multiple factors impacting the pain symptoms and joint pathology, including synovial macrophages in particular. Accumulating evidence from studies involving human participants and experimental animal models suggests that accumulating macrophages in synovial tissue are implicated in peripherally mediated pain sensitization of affected joints in osteoarthritis. Crosstalk between synovial macrophages and the innervating primary nociceptive neurons is thought to contribute to this facilitated pain processing by the peripheral nervous system. Due to high plasticity and complexity of synovial macrophages in the joint, safe therapies targeting single cells or molecules are currently lacking. Using advanced technologies (such as single-cell RNA sequencing and mass cytometry), studies have shown that diverse subpopulations of synovial macrophages exist in the distinct synovial microenvironments of specific osteoarthritis subtypes. Considerable progress has been made in delineating the molecular mechanisms of various subsets of synovial macrophages in the development of osteoarthritis. To develop a novel intra-articular treatment paradigm targeting synovial macrophages, we have summarized in this review the recent advances in identifying the functional consequences of synovial macrophage sub-populations and understanding of the molecular mechanisms driving macrophage-mediated remodeling.
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Affiliation(s)
- D Wang
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei 230001, China.
| | - X-Q Chai
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei 230001, China.
| | - S-S Hu
- The Key Laboratory of Anti-inflammatory and Immune Medicine, Ministry of Education, PR China (Anhui Medical University), Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China.
| | - F Pan
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS 7000, Australia.
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14
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van Helvoort EM, Welsing PMJ, Jansen MP, Gielis WP, Loef M, Kloppenburg M, Blanco F, Haugen IK, Berenbaum F, Bay-Jensen AC, Ladel C, Lalande A, Larkin J, Loughlin J, Mobasheri A, Weinans H, Lafeber F, Eijkelkamp N, Mastbergen S. Neuropathic pain in the IMI-APPROACH knee osteoarthritis cohort: prevalence and phenotyping. RMD Open 2021; 7:rmdopen-2021-002025. [PMID: 34911812 PMCID: PMC8679113 DOI: 10.1136/rmdopen-2021-002025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/28/2021] [Indexed: 12/11/2022] Open
Abstract
Objectives Osteoarthritis (OA) patients with a neuropathic pain (NP) component may represent a specific phenotype. This study compares joint damage, pain and functional disability between knee OA patients with a likely NP component, and those without a likely NP component. Methods Baseline data from the Innovative Medicines Initiative Applied Public-Private Research enabling OsteoArthritis Clinical Headway knee OA cohort study were used. Patients with a painDETECT score ≥19 (with likely NP component, n=24) were matched on a 1:2 ratio to patients with a painDETECT score ≤12 (without likely NP component), and similar knee and general pain (Knee Injury and Osteoarthritis Outcome Score pain and Short Form 36 pain). Pain, physical function and radiographic joint damage of multiple joints were determined and compared between OA patients with and without a likely NP component. Results OA patients with painDETECT scores ≥19 had statistically significant less radiographic joint damage (p≤0.04 for Knee Images Digital Analysis parameters and Kellgren and Lawrence grade), but an impaired physical function (p<0.003 for all tests) compared with patients with a painDETECT score ≤12. In addition, more severe pain was found in joints other than the index knee (p≤0.001 for hips and hands), while joint damage throughout the body was not different. Conclusions OA patients with a likely NP component, as determined with the painDETECT questionnaire, may represent a specific OA phenotype, where local and overall joint damage is not the main cause of pain and disability. Patients with this NP component will likely not benefit from general pain medication and/or disease-modifying OA drug (DMOAD) therapy. Reserved inclusion of these patients in DMOAD trials is advised in the quest for successful OA treatments. Trial registration number The study is registered under clinicaltrials.gov nr: NCT03883568.
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Affiliation(s)
| | - Paco M J Welsing
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mylène P Jansen
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Marieke Loef
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Margreet Kloppenburg
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Francisco Blanco
- Servicio de Reumatologia, INIBIC-Hospital Universitario A Coruña, A Coruña, Spain
| | - Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Francis Berenbaum
- Rheumatology, Sorbonne Université, Paris, France.,INSERM, Paris, France
| | | | | | - Agnes Lalande
- Institut de Recherches Internationales Servier, Suresnes, France
| | | | - John Loughlin
- Musculoskeletal Research Group, Newcastle University, Newcastle upon Tyne, UK
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Harrie Weinans
- Orthopedics, UMC Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Floris Lafeber
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Niels Eijkelkamp
- Center for Translational Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Simon Mastbergen
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
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15
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Long wait times for knee and hip total joint replacement in Canada: An isolated health system problem, or a symptom of a larger problem? OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100141. [DOI: 10.1016/j.ocarto.2021.100141] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023] Open
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