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Mandl LA, Lin MA, Gottesman SP, Mich‐Gennari E, Wall N, Nathif A, Ma X, Aizer J. An Online Program for Primary Care Practitioners to Enhance Confidence in Ability to Care for Patients With or at Risk of Painful Knee Osteoarthritis. ACR Open Rheumatol 2024; 6:145-154. [PMID: 38158771 PMCID: PMC10933678 DOI: 10.1002/acr2.11643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Primary care practitioners (PCPs) care for the majority of patients with knee osteoarthritis (KOA). Despite the existing evidence-based guidelines, PCPs often feel unequipped to evaluate and effectively treat patients with KOA. To address this need, we designed and implemented a free internet-based program focusing on the diagnosis and treatment of KOA. We assessed whether the program led to improvements in participants' confidence in their knowledge and skills related to effectively recognizing and caring for patients with or at risk of KOA. METHODS We used Caffarella's integrative model to develop a program aligned with the American College of Rheumatology 2019 Guideline for the treatment of KOA. The program incorporated 18 case-based questions to provide retrieval practice and mastery experiences. We assessed changes in participants' confidence in their KOA knowledge and skills after program completion. RESULTS Of the first 353 learners completing the program, 53.8% were women, 41.9% had a clinical focus in primary care, and 69.1% were nonphysicians. Overall confidence in KOA knowledge and skills improved after program completion (P < 0.001; effect size = 1.28, 95% confidence interval 1.12-1.45), with largest improvements among participants with lower pre-program confidence. A total of 95.8% of participants indicated they would recommend the program to others. CONCLUSION A free online program focusing on the effective care for patients with KOA attracted a wide range of learners, even though it targeted PCPs. Participants overwhelmingly endorsed it as highly relevant and would recommend it to others. Whether improvements in confidence translate into better patient outcomes is an important area for future research.
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Affiliation(s)
- Lisa A. Mandl
- Hospital for Special Surgery and Weill Cornell MedicineNew YorkNew York
| | | | | | | | - Nicole Wall
- Hospital for Special SurgeryNew YorkNew York
| | - Anan Nathif
- Hospital for Special SurgeryNew YorkNew York
| | | | - Juliet Aizer
- Hospital for Special Surgery and Weill Cornell MedicineNew YorkNew York
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Larsen JB, Madeleine P, Sørensen LB, Sachau J, Otto JC, Baron R, Arendt-Nielsen L. Subgrouping of facilitatory or inhibitory conditioned pain modulation responses in patients with chronic knee pain. Explorative analysis from a multicentre trial. Eur J Pain 2024; 28:335-351. [PMID: 37746845 DOI: 10.1002/ejp.2185] [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: 10/20/2022] [Revised: 07/07/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Facilitatory and inhibitory conditioned pain modulation (CPM) responses are observed in healthy volunteers and chronic pain patients, but the clinical implications for phenotyping are unknown. This study aimed to subgroup and compare chronic knee pain patients according to their CPM responses. METHODS This explorative, cross-sectional study included 127 patients with chronic knee pain (osteoarthritis or following total knee arthroplasty). Individual CPM responses were categorized as facilitatory (test stimuli pain intensity increased when conditioning stimuli were applied), as inhibitory (test stimuli pain intensity decreased) or as no change (defined as less than 5.3% change in pain intensity). Outcomes were clinical pain intensities, temporal summation, widespread pain, self-reported physical function, PainDETECT questionnaire and Pain Quality Assessment Scale. Data were analysed as comparisons between the inhibitory and the facilitatory groups and using multivariate linear regression models. RESULTS Fifty-four patients had facilitatory CPM responses, 49 had inhibitory CPM responses, and 24 showed no change in CPM response. A between-group difference was observed for self-reported physical function, with the facilitatory CPM group reporting better function (54.4 vs. 46.0, p = 0.028) and the facilitatory CPM group reported more deep pain sensations (3.2 vs. 2.0, p = 0.021). The remaining outcomes showed no between-group differences. Higher clinical pain intensity and facilitated temporal summation were associated in the facilitated CPM group but not in the inhibitory CPM group. CONCLUSION These explorative findings indicated that quantitative clinical and experimental differences exist between facilitatory or inhibitory CPM responses in a chronic knee pain patient population. Differences in patients' CPM responses should be further investigated to unravel possible clinical importance. SIGNIFICANCE Our findings confirm that conditioned pain modulation consist of inhibitory and facilitatory responders among a patient population with chronic knee pain. This explorative study indicates that patients with either facilitatory or inhibitory conditioned pain modulation could exhibit differences in pain outcomes. Subgrouping of chronic pain patients depending on individual conditioned pain modulation responses could be considered in phenotyping patients prior to inclusion in clinical trials or used for personalizing the management regime.
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Affiliation(s)
- J B Larsen
- Musculoskeltal Health and Implementation, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - P Madeleine
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - L B Sørensen
- Musculoskeltal Health and Implementation, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - J Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - J C Otto
- Ameos Clinic Eutin, Eutin, Germany
| | - R Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - L Arendt-Nielsen
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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Beckwée D, Nijs J, Bierma-Zeinstra SMA, Leemans L, Leysen L, Puts S, Rice D, Schiphof D, Bautmans I. Exercise therapy for knee osteoarthritis pain: how does it work? A study protocol for a randomised controlled trial. BMJ Open 2024; 14:e074258. [PMID: 38199628 PMCID: PMC10806725 DOI: 10.1136/bmjopen-2023-074258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Muscle strengthening training (MST) and behavioural graded activity (BGA) show comparable effects on knee osteoarthritic (KOA) pain, but the mechanisms of action remain unclear. Both exercise-induced anti-inflammation and central sensitisation are promising pathways for pain relief in response to exercise therapy in patients with KOA: MST has the potential to decrease inflammation and BGA has the potential to decrease central sensitisation. Hence, this study aims to examine inflammation and central sensitisation as mediators for the effect of MST and/or BGA on pain in patients with KOA. METHODS AND ANALYSIS The Knee OsteoArthritis PAIN trial started on 10 January 2020 (anticipated end: April 2024). The three-arm clinical trial aims to recruit 90 KOA patients who will be randomly allocated to 12 weeks of (1) MST, (2) BGA or (3) care as usual. Assessments will be performed at baseline, 13 and 52 weeks after finishing the intervention. Outcomes, including pain (Knee injury and Osteoarthritis Outcome Score), were chosen in line with the OARSI recommendations for clinical trials of rehabilitation interventions for OA and the IMMPACT/OMERACT recommendations for the assessment of physical function in chronic pain clinical trials. Inflammation as well as features of central sensitisation (including conditioned pain modulation, offset analgesia, temporal summation of pain and event-related potentials following electrical stimulation), will be considered as treatment mediators. A multiple mediators model will be estimated with a path-analysis using structural equation models. In July 2023, all 90 KOA patients have been included and 42 participants already finished the study. ETHICS AND DISSEMINATION This study obtained ethics approval (B.U.N. 143201941843). Unravelling the mechanisms of action of exercise therapy in KOA will not only be extremely valuable for researchers, but also for exercise immunology and pain scientists and clinicians. TRIAL REGISTRATION NUMBER NCT04362618.
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Affiliation(s)
- David Beckwée
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Movement Antwerp (MOVANT) research group, Universiteit Antwerpen, Antwerpen, Belgium
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussel, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Goteborg, Sweden
- University Hospital Brussels, Brussels, Belgium
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, Netherlands
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lynn Leemans
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Laurence Leysen
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Sofie Puts
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussel, Belgium
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - David Rice
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- Department of Anaesthesiology and Perioperative Medicine, Waitematā Pain Service, Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Ivan Bautmans
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussel, Belgium
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Skogberg O, Karlsson L, Bäckryd E, Lemming D. Tonic cuff pressure pain sensitivity in chronic pain patients and its relation to self-reported physical activity. Scand J Pain 2024; 24:sjpain-2023-0033. [PMID: 38095182 DOI: 10.1515/sjpain-2023-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/09/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVES Physical inactivity is a global health concern and a significant problem among chronic pain patients. They often experience pain flare-ups when they try to increase their physical activity level. Most research on the relationship between pain sensitivity and physical activity has been on healthy participants. Data on chronic pain patients are lacking. Using cuff pressure algometry, this study investigated tonic cuff pressure pain sensitivity and its associations to self-reported physical activity and other patient-reported outcomes in chronic pain patients. METHODS Chronic pain patients (n=78) were compared to healthy controls (n=98). Multivariate data analysis was used to investigate the associations between tonic cuff pressure pain sensitivity, physical activity, and other patient-reported outcome measures. RESULTS The three most important variables for group discrimination were perceived health status (EQVAS: p(corr)=-0.85, i.e., lower in patients), depression (HADS-D: p(corr)=0.81, i.e., higher in patients), and the tonic cuff pressure pain sensitivity variable maximum pain intensity (VAS-peak-arm: p(corr)=0.75, i.e., higher in patients). In patients, the most important predictors for high VAS-peak-arm were female sex (p(corr)=-0.75), higher number of painful regions (p(corr)=0.72), higher pain intensity (p(corr)=0.55), followed by lower level of self-reported physical activity (p(corr)=-0.39). VAS-peak-arm in patients correlated negatively with self-reported physical activity (rho=-0.28, p=0.018). CONCLUSIONS Physical activity may be the most important patient-changeable variable correlating to pain sensitivity. This study highlights the importance of more research to further understand how increased physical activity may decrease pain sensitivity in chronic pain patients.
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Affiliation(s)
- Olof Skogberg
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Linn Karlsson
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Emmanuel Bäckryd
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Dag Lemming
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Maritime and Civil Aviation Department, Swedish Transport Agency, Norrköping, Sweden
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Clausen MB, Rathleff MS, Graven-Nielsen T, Bandholm T, Christensen KB, Hölmich P, Thorborg K. Level of pain catastrophising determines if patients with long-standing subacromial impingement benefit from more resistance exercise: predefined secondary analyses from a pragmatic randomised controlled trial (the SExSI Trial). Br J Sports Med 2023; 57:842-848. [PMID: 36898767 PMCID: PMC10439263 DOI: 10.1136/bjsports-2022-106383] [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] [Accepted: 02/04/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE The primary aim was to investigate the effectiveness of adding more resistance exercise to usual care on pain mechanisms (including temporal summation, conditioned pain modulation (CPM) and local pain sensitivity) and pain catastrophising in people with subacromial impingement at 16 weeks follow-up. Second, to investigate the modifying effect of pain mechanisms and pain catastrophising on the interventions' effectiveness in improving shoulder strength and disability METHODS: 200 consecutive patients were randomly allocated to usual exercise-based care or the same plus additional elastic band exercise to increase total exercise dose. Completed add-on exercise dose was captured using an elastic band sensor. Outcome measures recorded at baseline, 5 weeks, 10 weeks and 16 (primary end point) weeks included temporal summation of pain (TSP) and CPM assessed at the lower leg, pressure pain threshold at the deltoid muscle (PPT-deltoid), pain catastrophising and the Shoulder Pain and Disability Index. RESULTS Additional elastic band exercise was not superior to usual exercise-based care in improving pain mechanisms (TSP, CPM and PPT-deltoid) or pain catastrophising after 16 weeks. Interaction analyses showed that pain catastrophising (median split) modified the effectiveness of additional exercises (effect size 14 points, 95% CI 2 to 25), with superior results in the additional exercise group compared with the usual care group in patients with less pain catastrophising. CONCLUSION Additional resistance exercise added to usual care was not superior to usual care alone in improving pain mechanisms or pain catastrophising. Additional exercise was, however, superior in improving self-reported disability in patients with lower levels of pain catastrophising at baseline. TRIAL REGISTRATION NUMBER NCT02747251.
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Affiliation(s)
- Mikkel Bek Clausen
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice, Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Bandholm
- Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Karl Bang Christensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Thorborg
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark
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Plinsinga ML, Vuvan V, Maclachlan L, Klyne D, Graven-Nielsen T, Vicenzino B, Hodges P, Bjarke Vaegter H. Pain-related cognitions and emotional distress are not associated with conditioned pain modulation: an explorative analysis of 1142 participants with acute, subacute, and chronic pain. Pain 2023; 164:1593-1599. [PMID: 36728470 DOI: 10.1097/j.pain.0000000000002864] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/12/2022] [Indexed: 02/03/2023]
Abstract
ABSTRACT Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many pain conditions. This study explored whether common negative pain cognitions and emotional factors were related to lower CPM in individuals across the spectrum from acute to chronic pain. Previously collected data on the CPM effect, pain-related cognitions (fear of movement, pain catastrophizing), and emotional distress (depression, anxiety) through questionnaires from 1142 individuals with acute, subacute, or chronic pain were used. The presence of negative psychological factors was dichotomized according to cutoff values for questionnaires. Associations between the presence of each negative psychological factor and the amplitude of pain reduction in the CPM paradigm was explored with Generalized Linear Models adjusted for sex, age, body mass index, and pain duration. A secondary analysis explored the cumulative effect of psychological factors on CPM. When dichotomized according to cutoff scores, 20% of participants were classified with anxiety, 19% with depression, 36% with pain catastrophizing, and 48% with fear of movement. The presence of any negative psychological factor or the cumulative sum of negative psychological factors was associated with lower CPM (individual factor: β between -0.15 and 0.11, P ≥ 0.08; total: β between -0.27 and -0.12, P ≥ 0.06). Despite the common observation of psychological factors and reduced CPM in musculoskeletal pain, these data challenge the assumption of a linear relationship between these variables across individuals with acute, subacute, and chronic pain. Arguably, there was a nonsignificant tendency for associations in nonexpected directions, which should be studied in a more homogenous population.
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Affiliation(s)
- Melanie Louise Plinsinga
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Viana Vuvan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Liam Maclachlan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- The Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - David Klyne
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Thomas Graven-Nielsen
- Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Paul Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Henrik Bjarke Vaegter
- Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Strijbos DO, van der Sluis G, van Houtert WFC, Straat AC, van Zaanen Y, de Groot S, Klomp S, Krijnen WP, Kooijman CM, van den Brand I, Reneman MF, Boymans TAEJ, Kuijer PPFM. Protocol for a multicenter study on effectiveness and economics of the Back At work After Surgery (BAAS): a clinical pathway for knee arthroplasty. BMC Musculoskelet Disord 2023; 24:199. [PMID: 36927339 PMCID: PMC10018987 DOI: 10.1186/s12891-023-06203-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/27/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Optimizing return to work (RTW) after knee arthroplasty (KA) is becoming increasingly important due to a growing incidence of KA and poor RTW outcomes after KA. We developed the Back At work After Surgery (BAAS) clinical pathway for optimized RTW after KA. Since the effectiveness and cost analysis of the BAAS clinical pathway are still unknown, analysis on effectiveness and costs of BAAS is imperative. METHOD This protocol paper has been written in line with the standards of Standard Protocol Items: Recommendations for Interventional Trails. To assess the effectiveness and cost-effectiveness for RTW, we will perform a multicenter prospective cohort study with patients who decided to receive a total KA (TKA) or an unicompartmental KA (UKA). To evaluate the effectiveness of BAAS regarding RTW, a comparison to usual care will be made using individual patient data on RTW from prospectively performed cohort studies in the Netherlands. DISCUSSION One of the strengths of this study is that the feasibility for the BAAS clinical pathway was tested at first hand. Also, we will use validated questionnaires and functional tests to assess the patient's recovery using robust outcomes. Moreover, the intervention was performed in two hospitals serving the targeted patient group and to reduce selection bias and improve generalizability. The limitations of this study protocol are that the lead author has an active role as a medical case manager (MCM) in one of the hospitals. Additionally, we will use the data from other prospective Dutch cohort studies to compare our findings regarding RTW to usual care. Since we will not perform an RCT, we will use propensity analysis to reduce the bias due to possible differences between these cohorts. TRAIL REGISTRATION This study was retrospectively registered at clinicaltrails.gov ( https://clinicaltrials.gov/ct2/show/NCT05690347 , date of first registration: 19-01-2023).
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Affiliation(s)
- Daniël O. Strijbos
- grid.7177.60000000084992262Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Public Health, Societal Participation and Health, Quality of Care, Van Der Boechorststraat 8, 1081 BT Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sports, Rehabilitation & Development, Van Der Boechorststraat 7-9, 1081 BT Amsterdam, the Netherlands
- grid.477604.60000 0004 0396 9626Department of Health Innovations, Nij Smellinghe Hospital Drachten, Compagnonsplein 1, Drachten, 9202 NN the Netherlands
| | - Geert van der Sluis
- grid.477604.60000 0004 0396 9626Department of Health Innovations, Nij Smellinghe Hospital Drachten, Compagnonsplein 1, Drachten, 9202 NN the Netherlands
- grid.411989.c0000 0000 8505 0496Hanze University of Applied Sciences Groningen, Zernikeplein 7, 9747 AS Groningen, the Netherlands
| | - Wim F. C. van Houtert
- grid.477604.60000 0004 0396 9626Department of Health Innovations, Nij Smellinghe Hospital Drachten, Compagnonsplein 1, Drachten, 9202 NN the Netherlands
- grid.411989.c0000 0000 8505 0496Hanze University of Applied Sciences Groningen, Zernikeplein 7, 9747 AS Groningen, the Netherlands
| | - A. Carlien Straat
- grid.7177.60000000084992262Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Public Health, Societal Participation and Health, Quality of Care, Van Der Boechorststraat 8, 1081 BT Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sports, Rehabilitation & Development, Van Der Boechorststraat 7-9, 1081 BT Amsterdam, the Netherlands
| | - Yvonne van Zaanen
- grid.7177.60000000084992262Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | | | - Simon Klomp
- a.S.R. Insurances, Archimedeslaan 10, 3584 BA Utrecht, the Netherlands
| | - Wim P. Krijnen
- grid.411989.c0000 0000 8505 0496Hanze University of Applied Sciences Groningen, Zernikeplein 7, 9747 AS Groningen, the Netherlands
| | - Carolien M. Kooijman
- grid.477604.60000 0004 0396 9626Department of Health Innovations, Nij Smellinghe Hospital Drachten, Compagnonsplein 1, Drachten, 9202 NN the Netherlands
| | - Igor van den Brand
- grid.416373.40000 0004 0472 8381Department of Orthopaedics, Elizabeth Tweesteden Hospital, Doctor Deelenlaan 5, 5042 AD Tilburg, The Netherlands
| | - Michiel F. Reneman
- grid.4830.f0000 0004 0407 1981Department of Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tim A. E. J. Boymans
- grid.412966.e0000 0004 0480 1382Maastricht UMC +, Department of Orthopaedics, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - P. Paul F. M. Kuijer
- grid.7177.60000000084992262Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Public Health, Societal Participation and Health, Quality of Care, Van Der Boechorststraat 8, 1081 BT Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sports, Rehabilitation & Development, Van Der Boechorststraat 7-9, 1081 BT Amsterdam, the Netherlands
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Aoyagi K, Law LF, Carlesso L, Nevitt M, Lewis CE, Wang N, Neogi T. Post-surgical contributors to persistent knee pain following knee replacement: The Multicenter Osteoarthritis Study (MOST). OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100335. [PMID: 36798734 PMCID: PMC9926203 DOI: 10.1016/j.ocarto.2023.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Objective Pain persistence following knee replacement (KR) occurs in ∼20-30% of patients. Although several studies have identified preoperative risk factors for persistent post-KR pain, few have focused on post-KR contributing factors. We sought to determine whether altered nociceptive signaling and other peripheral nociceptive drivers present post-operatively contribute to post-KR pain. Design We included participants from the Multicenter Osteoarthritis Study who were evaluated ∼12 months after KR. We evaluated the relation of measures of pain sensitivity [pressure pain threshold (PPT), temporal summation (TS), and conditioned pain modulation (CPM)] and the number of painful body sites to post-KR WOMAC knee pain, and of the number of painful sites to altered nociceptive signaling using linear or logistic regression models, as appropriate. Results 171 participants (mean age 69 years, 62% female) were included. TS was associated with worse WOMAC pain post-KR (β = 0.77 95% CI:0.19-1.35) and reduced odds of achieving patient acceptable symptom state (aOR = 0.54 95%CI:0.34-0.88). Inefficient CPM was also associated with worse WOMAC pain post-KR (β = 1.43 95% CI:0.15-2.71). In contrast, PPT was not associated with these outcomes. The number of painful body sites present post-KR was associated with TS (β = 0.05, 95% CI:0.01, 0.05). Conclusions Post-KR presence of central sensitization and inefficient descending pain modulation was associated with post-KR pain. We also noted that presence of other painful body sites contributes to altered nociceptive signaling, and this may thus also contribute to the experience of knee pain post-KR. Our findings provide novel insights into central pain mechanisms and other peripheral pain sources contributing to post-KR persistent knee pain.
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Affiliation(s)
- Kosaku Aoyagi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
- Department of Rehabilitation Sciences, University of Texas at El Paso, El Paso, TX, USA
| | | | | | - Michael Nevitt
- University of California San Francisco, San Francisco, CA, USA
| | | | - Na Wang
- Boston University School of Public Health, Boston, MA, USA
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
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Kılıçaslan HÖ, Genç A, Tuncer S. Central sensitization in osteoarthritic knee pain: A cross-sectional study. Turk J Phys Med Rehabil 2023; 69:89-96. [PMID: 37201014 PMCID: PMC10186014 DOI: 10.5606/tftrd.2023.10470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/07/2022] [Indexed: 05/20/2023] Open
Abstract
Objectives The aim of this study was to investigate central sensitization and associated factors in knee osteoarthritis (OA) patients and compare them with rheumatoid arthritis (RA) patients and healthy controls. Patients and methods This cross-sectional study was conducted with 125 participants (7 males, 118 females; mean age: 57.2±8.2 years; range, 45 to 75 years) between January 2017 and December 2018. Sixty-two patients with symptomatic knee OA, 32 RA patients with knee pain, and 31 healthy controls constituted the participants. Central sensitization was investigated with the Central Sensitization Inventory (CSI) and pressure pain threshold (PPT) measurements. Pain, functional status, and psychosocial features were assessed with self-reported questionnaires. Results The OA and RA groups had significantly lower PPT values at local, peripheral, and remote regions compared to the healthy controls. Pressure hyperalgesia was shown at the knee with a 43.5% prevalence, 27.4% at the leg, and 8.1% at the forearm of OA patients. Pressure hyperalgesia was present at the knee, leg, and forearm in 37.5%, 25%, and 9.4% of RA patients, respectively. Pressure pain threshold values, CSI scores, frequency of pressure hyperalgesia, and frequency of central sensitization according to the CSI were not statistically different between the OA and RA groups. Psychosocial features and structural damage were not correlated with PPT values in the OA group. Conclusion The severity of chronic pain and functional status may be the clinical clues to recognizing patients with central sensitization since local joint damage does not play a direct role in the etiopathogenesis of central sensitization in OA patients and severe pain persisting in the chronic process is associated with central sensitization regardless of the pathogenesis.
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Affiliation(s)
- Hamide Özge Kılıçaslan
- Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Aysun Genç
- Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Safiye Tuncer
- Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Türkiye
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10
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Overton M, Swain N, Falling C, Gwynne-Jones D, Fillingim R, Mani R. Activity-related pain predicts pain and functional outcomes in people with knee osteoarthritis: A longitudinal study. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1082252. [PMID: 36713644 PMCID: PMC9880771 DOI: 10.3389/fpain.2022.1082252] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023]
Abstract
Knee Osteoarthritis (OA) is a prevalent musculoskeletal condition, commonly resulting in pain and disability. However, pain and disability in this population are poorly related with the degree of structural joint damage. Underlying pain mechanisms, including activity-related pain and sensitization assessed via Quantitative Sensory Testing (QST), may better predict pain and functional outcomes of those with knee OA. Therefore, the aim of this study was to explore whether activity-related pain and sensitization assessed via QST predict future pain, function, fatigue, physical performance and quality of life outcomes in those living in the community with knee OA. Eighty-six participants with knee OA were recruited in Dunedin, New Zealand. Those eligible to participate underwent baseline testing including QST as well as measures of activity-related pain including Movement-evoked Pain (MEP) and Sensitivity to Physical Activity (SPA). Outcome measures exploring pain, function, fatigue and quality of life outcomes were collected at baseline, and two follow-up periods (two and nine weeks). Univariable linear regression models were developed followed by multivariable linear regression models for each prognostic marker adjusting for age, gender, BMI, OA duration, baseline pain intensity and socioeconomic status. Activity-related measures of pain, including MEP and SPA, demonstrated predictive associations with pain and functional outcomes prospectively in those with knee OA. Therefore, those demonstrating activity-related pain are at future risk of greater pain, disability and reduced quality of life. Larger, externally validated longitudinal studies are required which include individuals with more severe knee OA.
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Affiliation(s)
- Mark Overton
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand,Correspondence: Mark Overton
| | - Nicola Swain
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Carrie Falling
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - David Gwynne-Jones
- Department of Surgical Sciences, Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Roger Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), Department of Community Dentistry and Behavioural Science, University of Florida, Gainesville, FL, United States
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Patient-Reported Outcome on Quality of Life and Pain after Revision Arthroplasty for Periprosthetic Joint Infection: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11237182. [PMID: 36498756 PMCID: PMC9741318 DOI: 10.3390/jcm11237182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/27/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
This study aims to explore the quality of life (QOL) and pain after revision surgery for periprosthetic joint infection (PJI) based on patients' reported outcomes. A cross-sectional questionnaire survey was conducted and 137 valid responses were included (response rate 64.0%). A total of 42 patients underwent debridement with implant retention (DAIR), 31 underwent one-stage revision, and 64 underwent two-stage revision. The average overall SF-36 score was 70.3. The DAIR group had significantly higher SF-36 than the two-stage revision group (p = 0.01). There was no significant difference between the one-stage revision group and the other two groups. A total of 74.5% of patients reported pain with an average McGill Pain Questionnaire (MPQ) score of 8.6. There was no significant difference in the MPQ scores among the three groups. Simple linear regression analyses demonstrated that higher preoperative PMN%, VAS, and shorter hospital stay were associated with pain (adjusted R2 = 4%, p = 0.020; adjusted R2 = 2.1%, p = 0.048; adjusted R2 = 2.1%, p = 0.049; respectively). We concluded that the overall QOL of patients after revision surgery for PJI is generally satisfactory. Persistent pain is prevalent, but the severity was mostly mild. Preoperative PMN%, VAS, and hospital stay were associated with postoperative pain.
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Jaibaji M, Sohatee M, Volpin A, Konan S. Metaphyseal fixation in revision knee arthroplasty: a systematic review of the literature and meta-analysis of mid-long-term outcomes of metaphyseal sleeves and cones. Acta Orthop Belg 2022; 88:617-627. [PMID: 36791717 DOI: 10.52628/88.3.0000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Metaphyseal augmentation has in recent years formed a key strategy in management of bone loss in revision knee arthroplasty. There are studies reporting excellent short-term results, however long- term data is lacking. There is also a paucity of studies comparing the most frequently utilised augments, metaphyseal sleeves, and cones. We conducted a systematic review and meta-analysis to evaluate and compare the mid to long term outcomes of metaphyseal cones and sleeves. We conducted systematic search of 4 databases (Medline, Embase, CINALH and PubMed). Seventeen studies were found to be eligible for inclusion of which ten investigated metaphyseal sleeves and the remaining seven investigated cones. Mean follow up across all studies was 6.2 years. The total number of patients included in the studies was 1319 and the number of knees operated on was 1431. We noted a higher revision rate of metaphyseal cones when compared to sleeves 10.85% vs 6.31 (p=0.007). Reoperation rates were also higher in cones compared to sleeves, 13.78% vs 3.68% (p<0.001). Prosthetic joint infection was the most common reason for revision. The difference in conversion rates, based on augment location was statistically significant p=0.019. When undertaking further sub-analysis; there was no statistically significant difference when comparing revision rates of; tibial vs femoral augments p=0.108, tibial vs tibial & femur p=0.54 but a difference was seen between femoral vs tibial & femoral augments p=0.007. Based on our data, metaphyseal sleeves demonstrate significantly lower revision rates compared to metaphyseal cones. However overall, both demonstrate reliable mid to long-term outcomes.
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Loomans L, Debaenst N, Leirs D, Leirs G. Correlations in radiographic and MAKO Total Knee Robotic-Assisted Surgery intraoperative limb coronal alignment. Acta Orthop Belg 2022; 88:549-558. [PMID: 36791709 DOI: 10.52628/88.3.10171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Robotic-assisted arthroplasty has become increasingly established in recent years. The aim of the study is to determine if intraoperative coronal alignment during robotic-assisted total knee arthroplasty correlates with radiographic alignment. We prospectively compared the pre- and postoperative limb alignment values measured on long leg standing radiographs with intraoperative robotic-assisted measurements for 100 patients who underwent primary total knee arthroplasty. Two-tailed bivariate Pearson correla- tions were performed to evaluate the strength of the association between radiographic and robotic- assisted alignment. The intraclass correlation coeffi- cient (ICC) was used to estimate interrater reliability. There was a male/female ratio of 1.16 and the mean age was 67 years (range 42-88). Robotic-assisted measurements slightly overestimated the degree of varus relative to radiographs. Radiographic and robotic-assisted measurements were strongly correlated (r = 0.915, p < 0.001) preoperatively, with a difference of 1.6 ± 3.2°. The average measure ICC was 0.996 with a 95% confidence interval from 0.995 to 0.997 (p < 0.001). Postoperatively a bigger difference was measured (3.1° ± 1.9°), comparing radiographic and MAKO alignment. A moderate correlation was observed between the postoperative radiographic and MAKO outcome alignment (r = 0.604, p < 0.001). The average measure ICC was 0.977 with a 95% confidence interval from 0.967 to 0.984 (p < 0.001). There is a strong correlation in the preoperative set- ting between radiographic and robotic-assisted lower limb alignment and a moderate correlation in the post-operative setting. The values measured by the MAKO Total Knee application were considerably more in varus.
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Vieira B, Brandão M, Warkentin S, Henriques A, Abelha F, Lucas R. Body image dissatisfaction and experimental pressure pain sensitivity in a cohort of 13-year-old adolescents. J Psychosom Res 2022; 158:110912. [PMID: 35468315 DOI: 10.1016/j.jpsychores.2022.110912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aimed to quantify the associations between body image (dis)satisfaction and pressure pain thresholds in adolescents, using data from Generation XXI, a population-based cohort study in Portugal. METHODS We assessed 1785 13-year old adolescents cross-sectionally. Body image satisfaction was measured using the Children's Figure Rating Scale. Pain detection and tolerance thresholds were assessed using cuff pressure algometry. We quantified the associations between body image categories (satisfied, prefers slightly thinner, prefers much thinner, and prefers heavier) and pain detection and tolerance thresholds using linear and logistic regression for continuous and binary (odds of achieving the highest distribution quarter) outcomes, respectively. Models were adjusted to pubertal stage and body mass index. RESULTS Adolescents who desired a heavier silhouette had lower pressure pain tolerance thresholds when compared to those who were satisfied (linear regression coefficient: -3.95; 95% confidence interval: -6.68, -1.21), which was more precise in boys (-3.51; -7.17, -0.08). Those adolescents also had lower odds of achieving the highest quarter of pressure pain tolerance threshold (odds ratio: 0.66; 0.48, 0.90), especially girls (0.58; 0.35, 0.98). Adolescents who desired much thinner silhouettes had lower odds of achieving the highest quarter of pressure pain tolerance (0.68; 0.46, 1.00), and this was clearer in girls (0.66; 0.48, 0.90). Pain detection thresholds did not show robust associations with body image dissatisfaction. CONCLUSION Our study suggests an association between satisfaction with one's silhouette and pain tolerance in adolescents from the general population, arguing for an integrated approach to the assessment of body image and pain sensitivity.
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Affiliation(s)
- Beatriz Vieira
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Maria Brandão
- EPIUnit - Unidade de Investigação em Epidemiologia, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.
| | - Sarah Warkentin
- EPIUnit - Unidade de Investigação em Epidemiologia, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.
| | - Ana Henriques
- EPIUnit - Unidade de Investigação em Epidemiologia, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.
| | - Fernando Abelha
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Department of Anesthesiology, Surgery and Physiology, Centro Hospitalar de São João, Porto, Portugal.
| | - Raquel Lucas
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal; EPIUnit - Unidade de Investigação em Epidemiologia, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.
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15
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Mechanisms and manifestations in musculoskeletal pain: from experimental to clinical pain settings. Pain 2022; 163:S29-S45. [PMID: 35984370 DOI: 10.1097/j.pain.0000000000002690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/09/2022] [Indexed: 01/18/2023]
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16
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Previtali D, Capone G, Marchettini P, Candrian C, Zaffagnini S, Filardo G. High Prevalence of Pain Sensitization in Knee Osteoarthritis: A Meta-Analysis with Meta-Regression. Cartilage 2022; 13:19476035221087698. [PMID: 35356833 PMCID: PMC9137298 DOI: 10.1177/19476035221087698] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The aim of this meta-analysis was to study the evidence on pain sensitization in knee osteoarthritis (OA), providing a quantitative synthesis of its prevalence and impact. Factors associated with pain sensitization were also investigated. METHODS Meta-analysis; PubMed (MEDLINE), Cochrane Central Register (CENTRAL), and Web of Science were searched on February 2021. Level I to level IV studies evaluating the presence of pain sensitization in patients with symptomatic knee OA, documented through a validated method (questionnaires or quantitative sensory testing), were included. The primary outcome was the prevalence of pain sensitization. Factors influencing the prevalence were also evaluated, as well as differences in terms of pain thresholds between knee OA patients and healthy controls. RESULTS Fifty-three articles including 7,117 patients were included. The meta-analysis of proportion documented a prevalence of pain sensitization of 20% (95% confidence interval [CI] = 16%-26%) with a significant heterogeneity of results (I2 = 89%, P < 0.001). The diagnostic tool used was the main factor influencing the documented prevalence of pain sensitization (P = 0.01). Knee OA patients presented higher pain sensitivity compared with healthy controls, both in terms of local pressure pain threshold (standardized mean difference [SMD] = -1.00, 95% CI = -1.67 to -0.32, P = 0.007) and distant pressure pain threshold (SMD = -0.54, 95% CI = -0.76 to -0.31, P < 0.001). CONCLUSIONS Knee OA pain presents features that are consistent with a significant degree of pain sensitization. There is a high heterogeneity in the reported results, mainly based on the diagnostic tool used. The identification of the best methods to detect pain sensitization is warranted to correctly evaluate and manage symptoms of patients affected by knee OA. REGISTRATION PROSPERO CRD42019123347.
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Affiliation(s)
- Davide Previtali
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Gianluigi Capone
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland,Gianluigi Capone, Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Via Tesserete 46, 6900 Lugano, Switzerland.
| | - Paolo Marchettini
- Fisiopatologia e Terapia del Dolore, Dipartimento di Farmacologia, Careggi Università di Firenze, Florence, Italy,Terapia del Dolore, CDI Centro Diagnostico Italiano, Milan, Italy
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | | | - Giuseppe Filardo
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland,Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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17
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Traditional Chinese Acupressure Massage of the Quadriceps Femoris Can Relieve Flexion Pain after Undergoing Total Knee Arthroplasty. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1091174. [PMID: 35310022 PMCID: PMC8930215 DOI: 10.1155/2022/1091174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/27/2022] [Accepted: 02/05/2022] [Indexed: 11/17/2022]
Abstract
Objective To reduce the pain of quadriceps during knee flexion after total knee arthroplasty and increase range motion of knee flexion. Design Three-month prospective before/after quality improvement project. Setting. Department of Bone and Joint Surgery. Participants. A total of 80 patients who met the surgical indications were admitted to the outpatient department for surgery. They were randomly grouped by computer in advance, and the patients were divided into two groups according to the time of admission, each with 40 cases. Intervention. The intervention group performed routine rehabilitation exercises and received quadriceps acupoint massages for 20 minutes twice a day for two consecutive weeks. The control group performed routine rehabilitation exercises, such as gentle quadriceps massage for 20 minutes twice a day for two consecutive weeks. Main Outcome Measures. PPT (pressure pain threshold) of quadriceps femoris/VAS (visual analog scale) of knee flexion and motion of knee flexion. Results The VAS score, range of motion, and tenderness threshold during flexion were significantly better in the intervention group than in the control group at 1, 2, and 4 weeks after surgery. But the VAS score, range of motion, and tenderness threshold did not significantly differ between groups at 12 weeks after surgery. Conclusion Acupoint massage of the quadriceps femoris can relieve early flexion pain in patients after total knee arthroplasty. The trial was registered at clinical trials.gov.
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18
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Arant KR, Katz JN, Neogi T. Quantitative sensory testing: identifying pain characteristics in patients with osteoarthritis. Osteoarthritis Cartilage 2022; 30:17-31. [PMID: 34597800 PMCID: PMC8712382 DOI: 10.1016/j.joca.2021.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This review outlines the most commonly used quantitative sensory tests to identify pain sensitization. We examine cross-sectional associations between quantitative sensory testing (QST) measures and OA symptoms and severity, along with longitudinal associations between QST findings and response to surgical and non-surgical treatments for OA. DESIGN We conducted a search in PubMed for English language papers including 'osteoarthritis' and 'quantitative sensory testing' as search terms. Papers that did not pertain specifically to OA or QST were excluded. RESULTS Pressure Pain Threshold (PPT), Conditioned Pain Modulation (CPM), and Temporal Summation (TS) are the QST measures used most frequently to identify pain sensitization. Findings indicate that persons with knee OA often exhibit lower PPT thresholds, inefficient CPM, and facilitated TS as compared with controls who do not have OA, supporting the discriminant validity of QST. Pre-treatment QST has shown some success in identifying persons who experience less pain relief from surgical and non-surgical treatments for knee OA. Post-treatment QST has shown that sometimes PPT and CPM can normalize (PPT thresholds increase, and CPM becomes efficient) in patients for whom joint replacement is successful. Recent studies indicate that QST measures are more closely associated with pain severity than OA radiographic severity, suggesting that sensitization may be a trait rather than a state. CONCLUSIONS QST may have a role in identifying persons who are susceptible to chronic pain and may offer an opportunity for personalized, more effective treatment of OA.
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Affiliation(s)
- K R Arant
- The Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA.
| | - J N Katz
- The Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School and Chan Harvard School of Public Health, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
| | - T Neogi
- Section of Rheumatology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
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Lindberg MF, Aamodt A, Badawy M, Bergvad IB, Borchgrevink P, Furnes O, Gay C, Heir S, Holm I, Indrekvam K, Kise N, Lau B, Magnussen J, Nerhus TK, Rognsvåg T, Rudsengen DE, Rustøen T, Skou ST, Stubberud J, Småstuen MS, Lerdal A. The effectiveness of exercise therapy and education plus cognitive behavioral therapy, alone or in combination with total knee arthroplasty in patients with knee osteoarthritis - study protocol for the MultiKnee trial. BMC Musculoskelet Disord 2021; 22:1054. [PMID: 34930194 PMCID: PMC8690622 DOI: 10.1186/s12891-021-04924-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/29/2021] [Indexed: 11/12/2022] Open
Abstract
Background One in five patients report chronic pain following total knee arthroplasty (TKA) and are considered non-improvers. Psychological interventions such as cognitive behavioral therapy (CBT), combined with exercise therapy and education may contribute to reduced pain an improved function both for patients with OA or after TKA surgery, but the evidence for the effectiveness of such interventions is scarce. This randomized controlled trial with three arms will compare the clinical effectiveness of patient education and exercise therapy combined with internet-delivered CBT (iCBT), evaluated either as a non-surgical treatment choice or in combination with TKA, in comparison to usual treatment with TKA in patients with knee OA who are considered candidates for TKA surgery. Methods The study, conducted in three orthopaedic centers in Norway will include 282 patients between ages 18 and 80, eligible for TKA. Patients will be randomized to receive the exercise therapy + iCBT, either alone or in combination with TKA, or to a control group who will undergo conventional TKA and usual care physiotherapy following surgery. The exercise therapy will include 24 one hour sessions over 12 weeks led by a physiotherapist. The iCBT program will be delivered in ten modules. The physiotherapists will receive theoretical and practical training to advise and mentor the patients during the iCBT program. The primary outcome will be change from baseline to 12 months on the pain sub-scale from the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes include the remaining 4 sub-scales from the KOOS (symptoms, function in daily living, function in sports and recreation, and knee-related quality of life), EQ-5D-5L, the Pain Catastrophizing Scale, the 30-s sit-to-stand test, 40-m walking test and ActiGraph activity measures. A cost-utility analysis will be performed using QALYs derived from the EQ-5D-5L and registry data. Discussion This is the first randomized controlled trial to investigate the effectiveness of exercise therapy and iCBT with or without TKA, to optimize outcomes for TKA patients. Findings from this trial will contribute to evidence-based personalized treatment recommendations for a large proportion of OA patients who currently lack an effective treatment option. Trial registration Clinicaltrials.gov: NCT03771430. Registered: Dec 11, 2018.
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Affiliation(s)
- Maren Falch Lindberg
- Department of Surgery, Lovisenberg Diaconal Hospital, Pb 4970 Nydalen, 0440, Oslo, Norway. .,Department of Nursing Science, Faculty of Medicine, University of Oslo, Pb 1072 Blindern, 0316, Oslo, Norway.
| | - Arild Aamodt
- Department of Surgery, Lovisenberg Diaconal Hospital, Pb 4970 Nydalen, 0440, Oslo, Norway
| | - Mona Badawy
- Coastal Hospital in Hagevik, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ingvild B Bergvad
- Department of Surgery, Lovisenberg Diaconal Hospital, Pb 4970 Nydalen, 0440, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, PB 1072 Blindern, 0316, Oslo, Norway
| | - Petter Borchgrevink
- Department of Pain and Complex Disorders, St Olavs Hospital, Prinsesse Kristinas gate 3, 7030, Trondheim, Norway.,Norwegian University of Science and Technology, Høgskoleringen 1, 1491, Trondheim, Norway
| | - Ove Furnes
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Caryl Gay
- Department of Surgery, Lovisenberg Diaconal Hospital, Pb 4970 Nydalen, 0440, Oslo, Norway.,Department of Family Health Care Nursing, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94122, USA
| | - Stig Heir
- Martina Hansens Hospital, Dønskiveien 8, 1346, Gjettum, Norway
| | - Inger Holm
- Institute of Health and Society, Faculty of Medicine, University of Oslo, PB 1072 Blindern, 0316, Oslo, Norway.,Department of Acute Medicine, Oslo University Hospital, Pb 4956 Nydalen, 0424, Oslo, Norway
| | - Kari Indrekvam
- Coastal Hospital in Hagevik, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Nina Kise
- Martina Hansens Hospital, Dønskiveien 8, 1346, Gjettum, Norway
| | - Bjørn Lau
- Department of Psychology, Faculty of Medicine, University of Oslo, PB 1072 Blindern, 0316, Oslo, Norway
| | - Jon Magnussen
- Norwegian University of Science and Technology, Høgskoleringen 1, 1491, Trondheim, Norway
| | | | - Turid Rognsvåg
- Coastal Hospital in Hagevik, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Daniil E Rudsengen
- Department of Surgery, Lovisenberg Diaconal Hospital, Pb 4970 Nydalen, 0440, Oslo, Norway
| | - Tone Rustøen
- Department of Nursing Science, Faculty of Medicine, University of Oslo, Pb 1072 Blindern, 0316, Oslo, Norway.,Department of Acute Medicine, Oslo University Hospital, Pb 4956 Nydalen, 0424, Oslo, Norway
| | - Søren T Skou
- Department of Surgery, Lovisenberg Diaconal Hospital, Pb 4970 Nydalen, 0440, Oslo, Norway.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved, Slagelse and Ringsted Hospital, 4200, Slagelse, Denmark
| | - Jan Stubberud
- Department of Surgery, Lovisenberg Diaconal Hospital, Pb 4970 Nydalen, 0440, Oslo, Norway.,Department of Psychology, Faculty of Medicine, University of Oslo, PB 1072 Blindern, 0316, Oslo, Norway
| | - Milada S Småstuen
- Department of Surgery, Lovisenberg Diaconal Hospital, Pb 4970 Nydalen, 0440, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PB 1072 Blindern, 0316, Oslo, Norway
| | - Anners Lerdal
- Department of Surgery, Lovisenberg Diaconal Hospital, Pb 4970 Nydalen, 0440, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, PB 1072 Blindern, 0316, Oslo, Norway
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Pedersini P, Gobbo M, Bishop MD, Arendt-Nielsen L, Villafañe JH. Functional and structural neuroplastic changes related to sensitization proxies in patients with Osteoarthritis: a systematic review. PAIN MEDICINE 2021; 23:488-498. [PMID: 34633466 DOI: 10.1093/pm/pnab301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 09/08/2021] [Accepted: 10/06/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Several reports in literature have identified sensitization as a possible basis for the enhanced pain reactions associated with Osteoarthritis (OA). The aim of this current systematic review is to summarize functional and structural brain changes associated with surrogate sensitization parameters assessed in patients with OA-related pain. DESIGN Systematic review. SUBJECTS Patients with OA related pain. METHODS A literature search was conducted systematically in MEDLINE, CINAHL, EMBASE databases for human studies up to December 2019. Articles were included if they assessed brain imaging and senzitisation parameters (quantitative sensory testing and questionnaires) in adults with OA related pain. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) score. RESULTS Five studies reporting on 138 patients were included in this review. The MINORS scale yielded mean scores of 8.5/16 and 12.3/24, for the cohort and case-control studies respectively. Four low-quality studies suggest a greater pain matrix activation associated with clinical measures of sensitization in patients with OA, while another study underlined the presence of structural changes (reduced gray matter volume) in the cortical areas involved in the nociceptive processing possible also related to sensitization. CONCLUSION This review shows conflicting evidence for structural and functional neuroplastic brain changes related to sensitization proxies in patients with OA.
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Affiliation(s)
- P Pedersini
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - M Gobbo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - M D Bishop
- Department of Physical Therapy, University of Florida, USA
| | - L Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
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Pain and Disability in Low Back Pain Can be Reduced Despite No Significant Improvements in Mechanistic Pain Biomarkers. Clin J Pain 2021; 37:330-338. [PMID: 33830092 DOI: 10.1097/ajp.0000000000000927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/28/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Altered balance in nociception in response to noxious stimuli is commonly reported in chronic low back pain (LBP). However, it is unclear whether an improvement in the clinical presentation is contingent on a reduction in pain sensitivity. This study investigated whether the quantitative sensory testing (QST) profile changes in people undergoing rehabilitation for LBP. DESIGN A prospective, observational case-control study. METHODS Forty males and females, 18 to 40 years' old (20 with LBP) participated in 2 sessions. QST was performed at baseline and after discharge from rehabilitation (LBP) or after 3 to 8 weeks (controls). The QST battery consisted of determining pressure-pain thresholds at the low back and shoulder, temporal summation of pain, and conditioned pain modulation. Questionnaire data was used to determine pain (Numeric Rating Scale [NRS]), disability (Roland-Morris Questionnaire [RMQ]), Fear Avoidance Beliefs (FABQ), and The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) at baseline and discharge. The treatment effect was determined by calculating the Cohen d. RESULTS No significant group×time interactions or main factor effect was found for any of the QST measures. The LBP group reported a significant reduction in NRS (P<0.0002, d=1.23), RMQ (P<0.0001, d=1.58), FABQ (P<0.001, d=0.87), and in the ÖMPSQ (P<0.00001, d=1.44). CONCLUSIONS The results indicate that an improvement of clinical LBP is not contingent upon changes in the pain sensory profile. The value of screening pain sensitivity in LBP patients in primary care, needs to be investigated further, due to the patient population heterogeneity and the sensitivity of assessment methods.
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The Relationship Between Clinical and Quantitative Measures of Pain Sensitization in Knee Osteoarthritis. Clin J Pain 2021; 36:336-343. [PMID: 31977373 DOI: 10.1097/ajp.0000000000000798] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Pain sensitization in knee osteoarthritis (OA) is associated with greater symptom severity and poorer clinical outcomes. Measures that identify pain sensitization and are accessible to use in clinical practice have been suggested to enable more targeted treatments. This merits further investigation. This study examines the relationship between quantitative sensory testing (QST) and clinical measures of pain sensitization in people with knee OA. METHODS A secondary analysis of data from 134 participants with knee OA was performed. Clinical measures included: manual tender point count (MTPC), the Central Sensitization Inventory (CSI) to capture centrally mediated comorbidities, number of painful sites on a body chart, and neuropathic pain-like symptoms assessed using the modified PainDetect Questionnaire. Relationships between clinical measures and QST measures of pressure pain thresholds (PPTs), temporal summation, and conditioned pain modulation were investigated using correlation and multivariable regression analyses. RESULTS Fair to moderate correlations, ranging from -0.331 to -0.577 (P<0.05), were identified between MTPC, the CSI, number of painful sites, and PPTs. Fair correlations, ranging from 0.28 to 0.30 (P<0.01), were identified between MTPC, the CSI, number of painful sites, and conditioned pain modulation. Correlations between the clinical and self-reported measures and temporal summation were weak and inconsistent (0.09 to 0.25). In adjusted regression models, MTPC was the only clinical measure consistently associated with QST and accounted for 11% to 12% of the variance in PPTs. DISCUSSION MTPC demonstrated the strongest associations with QST measures and may be the most promising proxy measure to detect pain sensitization clinically.
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Casado-Adam P, Jiménez-Vílchez AJ, Güler-Caamaño I, Cuevas-Pérez AJ, Quevedo-Reinoso RA, Mayordomo-Riera FJ. [Pain evolution in patients with central sensitization and osteoarthritis after knee arthroplasty]. Rehabilitacion (Madr) 2021; 56:47-55. [PMID: 34256947 DOI: 10.1016/j.rh.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 05/13/2021] [Accepted: 06/09/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In patients with knee osteoarthritis, a group of 30% has been identified with central pain sensitization (CPS). The aim is to analyze the persistence of CPS in patients after knee arthroplasty and its correlation with pain intensity, functionality, determining factors and to evaluate physical examination as an assessment instrument. MATERIAL AND METHODS Quasi-experimental before-after study of patients operated on total knee arthroplasty. The evolution of subjective variables (pain characteristics, painDETECT questionnaire, WOMAC and Numerical Rating Scale) and physical examination (thermal hyperalgesia, allodynia, hypoesthesia, algometry and goniometry) 3 months before and 3 and 6 months after surgery are analysed using repeated measures ANOVA test for the quantitative ones and Cochran's Q for the qualitative ones. Spearmen test was used for the correlation of the questionnaires, the PD-Q and exploration variables and for the multivariate model of the PD-Q with clinical determinants. RESULTS Sixty-seven patients completed the study. The evolution of the quantitative and qualitative variables was significant, with a correlation between questionnaires. In the linear multivariate model of PD-Q, a significant relationship was obtained from personal history of flexion limitation, chronic musculoskeletal pain and the association between depression and time. CONCLUSIONS A significant percentage of patients with knee osteoarthritis after arthroplasty persisted with probable CPS, correlating with intensity and functionality. The limitation of mobility and previous chronic comorbidity could be determinants of CPS, with anamnesis and exploration being useful tools in consultation.
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Affiliation(s)
- P Casado-Adam
- UGC Medicina Física y Rehabilitación Interniveles, Hospital Universitario Reina Sofía, Córdoba, España.
| | - A J Jiménez-Vílchez
- UGC Aparato Locomotor, Hospital Valle de los Pedroches, Pozoblanco, Córdoba, España
| | - I Güler-Caamaño
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
| | - A J Cuevas-Pérez
- UGC Cirugía Ortopédica y Traumatología, Hospital Universitario Reina Sofía, Córdoba, España
| | - R A Quevedo-Reinoso
- UGC Cirugía Ortopédica y Traumatología, Hospital Universitario Reina Sofía, Córdoba, España
| | - F J Mayordomo-Riera
- UGC Medicina Física y Rehabilitación Interniveles, Hospital Universitario Reina Sofía, Córdoba, España
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Riel H, Plinsinga ML, Mellor R, Boudreau SA, Vuvan V, Vicenzino B. Local hyperalgesia, normal endogenous modulation with pain report beyond its origin: a pilot study prompting further exploration into plantar fasciopathy. Scand J Pain 2021; 20:375-385. [PMID: 31541604 DOI: 10.1515/sjpain-2019-0109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/31/2019] [Indexed: 01/10/2023]
Abstract
Background and aims Persistent tendinopathies were previously considered solely as peripheral conditions affecting the local tendinous tissue until quantitative sensory testing identified involvement of altered pain processing. In similar fashion, pain in patients with persistent plantar fasciopathy may also involve more than local tissue. The aim of this pilot study was to investigate potential differences in conditioned pain modulation and pressure and thermal pain thresholds, between individuals with PF and healthy pain-free controls, as a precursor to a larger-scale study. Methods We assessed 16 individuals with plantar fasciopathy and 11 pain-free controls. Plantar fasciopathy diagnosis was: palpation pain of the medial calcaneal tubercle or the proximal plantar fascia, duration ≥3 months, pain intensity ≥2/10, and ultrasound-measured plantar fascia thickness ≥4 mm. Quantitative sensory tests were performed locally at the plantar heel and remotely on the ipsilateral elbow. Assessments included pain thresholds for pressure, heat and cold, and conditioned pain modulation measured as change in local resting pressure pain threshold with cold water hand immersion. Participants rated pain intensity at pain threshold. Additionally, the area and distribution of plantar fasciopathy pain was drawn on a digital body chart of the lower limbs. Descriptive analyses were performed and between-group differences/effects expressed as standardised mean differences (d). Results There was no conditioned pain modulation difference between participants with plantar fasciopathy and controls (d = 0.1). Largest effects were on local pressure pain threshold and reported pain intensity on pressure pain threshold (d > 1.8) followed by pain intensity for heat and cold pain thresholds (d = 0.3-1.5). According to the digital body chart, pain area extended beyond the plantar heel. Conclusions The unlikelihood of a difference in conditioned pain modulation yet a pain area extending beyond the plantar heel provide a basis for exploring altered pain processing in a larger-scale study. Implications This was the first study to investigate the presence of altered pain processing in individuals with plantar fasciopathy using a conditioned pain modulation paradigm and thermal pain thresholds. We found no indication of an altered pain processing based on these measures, however, patients rated pain higher on thresholds compared to controls which may be important to clinical practice and warrants further exploration in the future.
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Affiliation(s)
- Henrik Riel
- Center for General Practice at Aalborg University, Fyrkildevej 7, Aalborg East, Denmark
| | - Melanie L Plinsinga
- The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy: Sports Injury Rehabilitation and Prevention for Health, St. Lucia QLD, Australia
| | - Rebecca Mellor
- The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy: Sports Injury Rehabilitation and Prevention for Health, St. Lucia QLD, Australia
| | - Shellie A Boudreau
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7D, Aalborg East, Denmark
| | - Viana Vuvan
- The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy: Sports Injury Rehabilitation and Prevention for Health, St. Lucia QLD, Australia
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy: Sports Injury Rehabilitation and Prevention for Health, St. Lucia QLD, Australia
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Palsson TS, Doménech-García V, Boudreau SS, Graven-Nielsen T. Pain referral area is reduced by remote pain. Eur J Pain 2021; 25:1804-1814. [PMID: 33987881 DOI: 10.1002/ejp.1792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 05/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Endogenous pain inhibitory mechanisms are known to reduce pain intensity, but whether they influence the size and distribution of pain referral is unclear. This study aimed to determine if referred pain is reduced by applying a remote, conditioning painful stimulus. METHODS Twenty-four healthy men participated in this randomized, crossover study with a control and conditioning session. Referred pain was induced from the infraspinatus muscle (dominant side) by a painful pressure for 60 s. When applying pressure, the intensity was adjusted to a local pain intensity of 7/10 on a numerical rating scale. In the conditioning session, tonic painful pressure was simultaneously applied to the non-dominant leg during induction of referred pain. The area of referred pain was drawn onto a digital body chart and size extracted for data analysis. RESULTS For the total group and in a subgroup with distinct patterns of referred pain (n = 15/24), the pain area perceived in the back and front+back was smaller during the conditioning compared with the control (p < 0.05). No significant difference was found between sessions in a subgroup only demonstrating local pain (n = 9/24). CONCLUSIONS Engaging the descending noxious inhibitory control reduced the size of pain areas predominately when distinct pain referral was present. Assuming a conditioning effect of descending inhibitory control acting on dorsal horn neurons, these findings may indicate that mechanisms underlying pain referral can be modulated by endogenous control. The findings may indicate that referred pain may be a useful proxy to evaluate sensitivity of central pain mechanisms as previously suggested. SIGNIFICANCE The current results indicate a link between endogenous inhibition and pain referral. Descending inhibitory control effects on pain referral support a spinal mechanism involved in pain referral. Future studies should investigate whether the spatial characteristics of referred pain (e.g. size, frequency of affected body regions and distribution away from the primary nociceptive stimulus) can useful to evaluate the efficiency of endogenous pain modulation.
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Affiliation(s)
- Thorvaldur S Palsson
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Victor Doménech-García
- Department of Physiotherapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Shellie S Boudreau
- Center For Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Graven-Nielsen
- Center For Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Conditioned pain modulation predicts persistent pain after knee replacement surgery. Pain Rep 2021; 6:e910. [PMID: 33817538 PMCID: PMC8009638 DOI: 10.1097/pr9.0000000000000910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/26/2021] [Accepted: 02/03/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Persistent pain after total knee replacement is an underestimated outcome leading to significant health burden. Sensory testing has been explored to help surgeons in decision making and better patient selection. Patients with different chronic pain syndromes exhibit a poor descending pain inhibition that can be quantified through experimental paradigms (conditioned pain modulation). A poor preoperative descending pain inhibition response predicted persistence of pain after surgery in previous studies. Methods This study investigated the correlation between a preoperative inefficient endogenous analgesia and a bad postoperative pain outcome (painful prosthesis). One hundred forty-six patients were studied preoperatively by quantitative sensory testing. Conditioned pain modulation was calculated as the relative decrease in pain intensity (thermal stimulus) during heterotopic painful stimulation. Results Approximately 21.2% of patients had a bad pain outcome (painful prosthesis), 6 months after surgery. Preoperatively, 47.9% of patients exhibited an insufficient endogenous analgesia. The probability to develop persistent pain after surgery in that group was higher than that in patients with a sufficient endogenous analgesia (31.4% [20.9-43.6, 95% CI] vs 11.8% [5.5-21.3, 95% CI], respectively; P < 0.004). Correlation between conditioned pain modulation values and postoperative intensity of pain was also established. Besides, a preoperative lower quality of life (mental component) predicted a worse pain outcome, too. Conclusions This cohort study shows that preoperative sensory testing predicts a bad pain outcome after total knee replacement. This tool could help clinicians in a better indication of patients with advanced knee osteoarthritis for replacement surgery. Registration Details ClinicalTrials.gov: NCT01811888 (prospective).
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Laubach M, Hellmann JT, Dirrichs T, Gatz M, Quack V, Tingart M, Betsch M. Anterior knee pain after total knee arthroplasty: A multifactorial analysis. J Orthop Surg (Hong Kong) 2021; 28:2309499020918947. [PMID: 32338135 DOI: 10.1177/2309499020918947] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Dissatisfaction and an impaired quality of life after total knee arthroplasty (TKA) is often associated with postsurgical anterior knee pain (AKP). The underlying pathological mechanisms are not yet fully understood. Therefore, a multifactorial approach encompassing clinical and radiological parameters seemed reasonable and promising to investigate postsurgical AKP. METHODS In this cross-sectional study, 25 patients without and 25 patients with postsurgical AKP after unilateral TKA were randomly recruited from a larger cohort of patients. Multiple clinical and radiological parameters-including real-time shear wave elastography (SWE) to measure the patellar and quadriceps tendon elasticity-were acquired and subsequently associated with AKP. For statistical analysis, SPSS (IBM, version 25) was used. RESULTS In total 50 participants (58.0% men, mean age 63.42 years, mean body mass index 29.75 kg/m2), having different prosthetic designs implanted, were included. Independently of key covariates, the strength of the quadriceps muscle (p = 0.021), a thinner inlay (p = 0.041), and a lower position of the patella (p = 0.041) were associated with AKP. Although no correlation with AKP was found (p = 0.346, resp. p = 0.154), we observed significantly decreased Young's modulus of the patellar and quadriceps tendons for the involved knee compared to the uninvolved knee (p < 0.001). CONCLUSION In conclusion, quadriceps muscle strength, inlay thickness, and the patella position might be of particular relevance in avoiding postsurgical AKP. Future studies with larger sample sizes are needed to clarify the impact of quadriceps muscle strength and the postoperative patella position as well as the role of SWE as a personalized modifiable prediction marker.
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Affiliation(s)
- Markus Laubach
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Julian Tr Hellmann
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Matthias Gatz
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Valentin Quack
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
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Lee HG, An J, Lee BH. The Effect of Progressive Dynamic Balance Training on Physical Function, The Ability to Balance and Quality of Life Among Elderly Women Who Underwent a Total Knee Arthroplasty: A Double-Blind Randomized Control Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052513. [PMID: 33802559 PMCID: PMC7967306 DOI: 10.3390/ijerph18052513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/12/2021] [Accepted: 02/25/2021] [Indexed: 01/22/2023]
Abstract
Total knee arthroplasty (TKA) is used to treat end-stage osteoarthritis. However, this surgical procedure affects the mechanical receptor function and impairs the ability to balance. Dynamic balance training has been reported to improve stability and self-confidence and safely yield increased physical activity. This study aimed to investigate the effect of dynamic balance training on physical function, the ability to balance and quality of life among patients who underwent TKA. Thirty-eight participants were assigned to either the progressive dynamic balance training (PDBT) with physical therapy group (n = 19) or the control group (n = 19). The experimental group undertook a dynamic balance program with physical therapy for 30 minutes per day, five times per week for six weeks, while the control group undertook physical therapy only. A continuous passive motion exercise was performed for 20 minutes after training by both groups. The outcomes were evaluated using the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, pain pressure threshold (PPT), range of motion (ROM), Knee Outcome Survey-Activities of Daily Living (KOS-ADLS), Multifunction Force Measuring Plate, timed up and go (TUG) test and Short-Form Health Survey 36 (SF-36). Physical function (WOMAC Osteoarthritis Index, ROM and KOS-ADLS score) and the ability to balance (TUG test score, confidence ellipse area, path length and average velocity) significantly improved (p < 0.05) in the experimental group compared with the control group. In contrast, the physical component summary score for the SF-36 regarding quality of life significantly improved (p < 0.05); however, the mental component summary score for the SF-36 and PPT did not significantly differ between the groups. Therefore, we suggest that PDBT with physical therapy has positive effects on physical function, the ability to balance and quality of life among patients who underwent TKA.
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Affiliation(s)
- Heon-Gyu Lee
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
| | - Jungae An
- Department of Physical Therapy, Seoul Now Hospital, Seongnam 13591, Korea;
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea
- Correspondence: ; Tel.: +82-2-3399-1634
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Hoegh M, Poulsen JN, Petrini L, Graven-Nielsen T. The Effect of Stress on Repeated Painful Stimuli with and Without Painful Conditioning. PAIN MEDICINE 2021; 21:317-325. [PMID: 31241135 DOI: 10.1093/pm/pnz115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Stress and pain have been interrelated in clinical widespread pain conditions. Studies indicate that acute experimental stress in healthy volunteers has a negative effect on the descending inhibitory pain control system and thus the ability to inhibit one painful stimulus with another (conditioned pain modulation [CPM]) although without effect on general pain sensitivity. CPM effects can be assessed immediately after the stress induction, whereas some physiological stress responses (e.g., cortisol release) are delayed and longer lasting. It is unclear whether CPM may relate to stress-induced increases in cortisol. DESIGN Twenty-five healthy men had CPM effects measured over a period of 10 minutes. Pain detection thresholds (PDTs) were assessed by repeated test stimuli with cuff algometry on one leg, with and without painful cuff pressure conditioning on the contralateral leg. CPM effects, assessed as the increase in PDT during conditioning stimulation compared with without, were measured before and after experimental stress and a control condition (Montreal Imaging Stress Task [MIST]). Saliva cortisol levels and self-perceived stress were collected. RESULTS Participants reported the MIST to be more stressful compared with the MIST control, but cortisol levels did not change significantly from baseline. In all sessions, PDT increased during conditioning (P = 0.001), although the MIST compared with the MIST control had no significant effect on PDT or CPM effects. A negative correlation between changes in cortisol and conditioned PDT was found when applying the MIST (P < 0.03). CONCLUSIONS No significant effect of stress was found on CPM compared with a matched control condition. Individual changes in experimental stress and in conditioned pain sensitivity may be linked with cortisol.
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Affiliation(s)
- Morten Hoegh
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark
| | - Jeppe N Poulsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark
| | - Laura Petrini
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark
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Abstract
There is tremendous interpatient variability in the response to analgesic therapy
(even for efficacious treatments), which can be the source of great frustration
in clinical practice. This has led to calls for “precision
medicine” or personalized pain therapeutics (ie, empirically based
algorithms that determine the optimal treatments, or treatment combinations, for
individual patients) that would presumably improve both the clinical care of
patients with pain and the success rates for putative analgesic drugs in phase 2
and 3 clinical trials. However, before implementing this approach, the
characteristics of individual patients or subgroups of patients that increase or
decrease the response to a specific treatment need to be identified. The
challenge is to identify the measurable phenotypic characteristics of patients
that are most predictive of individual variation in analgesic treatment
outcomes, and the measurement tools that are best suited to evaluate these
characteristics. In this article, we present evidence on the most promising of
these phenotypic characteristics for use in future research, including
psychosocial factors, symptom characteristics, sleep patterns, responses to
noxious stimulation, endogenous pain-modulatory processes, and response to
pharmacologic challenge. We provide evidence-based recommendations for core
phenotyping domains and recommend measures of each domain.
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Briones-Cantero M, Fernández-de-Las-Peñas C, Lluch-Girbés E, Osuna-Pérez MC, Navarro-Santana MJ, Plaza-Manzano G, Martín-Casas P. Effects of Adding Motor Imagery to Early Physical Therapy in Patients with Knee Osteoarthritis who Had Received Total Knee Arthroplasty: A Randomized Clinical Trial. PAIN MEDICINE 2020; 21:3548-3555. [PMID: 32346743 DOI: 10.1093/pm/pnaa103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the effects of the inclusion of motor imagery (MI) principles into early physical therapy on pain, disability, pressure pain thresholds (PPTs), and range of motion in the early postsurgical phase after total knee arthroplasty (TKA). METHODS A randomized clinical trial including patients with knee osteoarthritis who have received TKA was conducted. Participants were randomized to receive five treatment sessions of either physical therapy with or without MI principles in an early postsurgical phase after a TKA (five days after surgery). Pain intensity (visual analog scale [VAS], 0-100), pain-related disability (short-form Western Ontario McMaster Universities Osteoarthritis Index [WOMAC], 0-32), pressure pain thresholds (PPTs), and knee range of motion were assessed before and after five daily treatment sessions by an assessor blinded to the subject's condition. RESULTS Twenty-four participants completed data collection and treatment. The adjusted analysis revealed significant group*time interactions for WOMAC (F = 17.29, P = 0.001, η2 = 0.48) and VAS (F = 14.56, P < 0.001, η2 = 0.45); patients receiving physiotherapy and MI principles experienced greater improvements in pain (Δ -28.0, 95% confidence interval [CI] = -43.0 to -13.0) and pain-related disability (Δ -6.0, 95% CI = -8.3 to -3.7) than those receiving physiotherapy alone. No significant group*time interactions for knee range of motion and PPTs were observed (all, P > 0.30). CONCLUSIONS The application of MI to early physiotherapy was effective for improving pain and disability, but not range of motion or pressure pain sensitivity, in the early postsurgical phase after TKA in people with knee osteoarthritis.
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Affiliation(s)
- María Briones-Cantero
- Unidad de Fisioterapia, Servicio de Rehabilitación, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca, y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Enrique Lluch-Girbés
- Department of Physical Therapy, Universidad de Valencia, Valencia, Spain; Pain in Motion Research Group.,Department of Human Physiology (Chropiver), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel
| | | | | | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
| | - Patricia Martín-Casas
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
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Lindberg MF, Miaskowski C, Rustøen T, Cooper BA, Aamodt A, Lerdal A. Preoperative risk factors associated with chronic pain profiles following total knee arthroplasty. Eur J Pain 2020; 25:680-692. [PMID: 33259681 PMCID: PMC7986219 DOI: 10.1002/ejp.1703] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/22/2020] [Indexed: 12/16/2022]
Abstract
Background One in five patients experience chronic pain 12 months following total knee arthroplasty (TKA). This longitudinal study used a person‐centred approach to identify subgroups of patients with distinct chronic pain profiles following TKA and identified preoperative characteristics associated with these profiles. Methods On the day before surgery, 202 patients completed questionnaires that assessed pain, interference with functioning, fatigue, anxiety, depression and illness perceptions. Average and worst pain were assessed prior to surgery, on postoperative day 4, at 6 week and at 3 and 12 months following surgery. Using growth mixture modelling, two subgroups with distinct average and worst pain profiles were identified. Results Patients in the “lower average” and “lower worst” pain classes had moderate preoperative pain scores that decreased over the remaining 9 months following TKA. Patients in the “higher average” and “higher worst” pain classes had relatively higher preoperative pain scores that increased during the first three months and then decreased slightly over the remaining 9 months. Patients in the higher pain classes had higher interference with function scores; used opioids prior to surgery more often, were more likely to receive a continuous nerve block and ketamine; had higher preoperative fatigue severity and interference scores; and had worse perceptions of illness than patients in the lower pain classes. Conclusions These risk factors may be used to identify subgroups of patients at higher risk for more severe pain after TKA. Future studies should test whether modifying these risk factors can improve patients’ outcomes after TKA. Significance statement The present study provides a novel and original analysis of pain profiles following total knee arthroplasty that may contribute to our understanding of the transition from acute to chronic pain. Our results may be used to identify patients at higher risk for poorer outcomes based on preoperative risk factors.
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Affiliation(s)
- Maren F Lindberg
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Tone Rustøen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Bruce A Cooper
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Arild Aamodt
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anners Lerdal
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Paccione CE, Diep LM, Stubhaug A, Jacobsen HB. Motivational nondirective resonance breathing versus transcutaneous vagus nerve stimulation in the treatment of fibromyalgia: study protocol for a randomized controlled trial. Trials 2020; 21:808. [PMID: 32967704 PMCID: PMC7510318 DOI: 10.1186/s13063-020-04703-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic widespread pain (CWP), including fibromyalgia (FM), affects one in every ten adults and is one of the leading causes of sick leave and emotional distress. Due to an unclear etiology and a complex pathophysiology, FM is a condition with few, if any, effective and safe treatments. However, current research within the field of vagal nerve innervation suggests psychophysiological and electrical means by which FM may be treated. This study will investigate the efficacy of two different noninvasive vagal nerve stimulation techniques for the treatment of FM. METHODS The study will use a randomized, single-blind, sham-controlled design to investigate the treatment efficacy of motivational nondirective resonance breathing (MNRB™) and transcutaneous vagus nerve stimulation (Nemos® tVNS) on patients diagnosed with FM. Consenting FM patients (N = 112) who are referred to the Department of Pain Management and Research at Oslo University Hospital, in Oslo, Norway, will be randomized into one of four independent groups. Half of these participants (N = 56) will be randomized to either an experimental tVNS group or a sham tVNS group. The other half (N = 56) will be randomized to either an experimental MNRB group or a sham MNRB group. Both active and sham treatment interventions will be delivered twice per day at home, 15 min/morning and 15 min/evening, for a total duration of 2 weeks (14 days). Participants are invited to the clinic twice, once for pre- and once for post-intervention data collection. The primary outcome is changes in photoplethysmography-measured heart rate variability. Secondary outcomes include self-reported pain intensity on a numeric rating scale, changes in pain detection threshold, pain tolerance threshold, and pressure pain limit determined by computerized pressure cuff algometry, blood pressure, and health-related quality of life. DISCUSSION The described randomized controlled trial aims to compare the efficacy of two vagal nerve innervation interventions, MNRB and tVNS, on heart rate variability and pain intensity in patients suffering from FM. This project tests a new and potentially effective means of treating a major public and global health concern where prevalence is high, disability is severe, and treatment options are limited. TRIAL REGISTRATION ClinicalTrials.gov NCT03180554 . Registered on August 06, 2017.
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Affiliation(s)
- Charles Ethan Paccione
- Doctoral Fellow in Medicine and Health Sciences, Faculty of Medicine, University of Oslo, Klaus Torgårds 3, 0372 Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Ullevål, Kirkeveien 166, 0853 Oslo, Norway
| | - Lien My Diep
- Oslo Center for Biostatistics and Epidemiology, Sognsvannsveien 9, 0372 Oslo, Norway
| | - Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Ullevål, Kirkeveien 166, 0853 Oslo, Norway
| | - Henrik Børsting Jacobsen
- Department of Pain Management and Research, Oslo University Hospital, Ullevål, Kirkeveien 166, 0853 Oslo, Norway
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Conditioned Pain Modulation Efficiency Is Associated With Pain Catastrophizing in Patients With Chronic Low Back Pain. Clin J Pain 2020; 36:825-832. [DOI: 10.1097/ajp.0000000000000878] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lape EC, Selzer F, Collins JE, Losina E, Katz JN. Stability of Measures of Pain Catastrophizing and Widespread Pain Following Total Knee Replacement. Arthritis Care Res (Hoboken) 2020; 72:1096-1103. [PMID: 31173484 DOI: 10.1002/acr.24000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 06/04/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Pain catastrophizing and widespread pain are predictors of pain chronicity/severity. Gaps remain in our understanding of the extent to which each is a stable (trait) or dynamic (state) variable. We undertook this study to assess the stability of each variable from before to after total knee replacement (TKR) and whether changes are explained by pain improvements. METHODS We used data from a prospective study of TKR recipients ages ≥40 years. Questionnaires included body pain diagrams assessing widespread pain, the Pain Catastrophizing Scale (PCS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. We divided subjects into widespread pain groups (0 versus 1-2 versus ≥3 pain regions) and into low and high PCS score groups (<16 versus ≥16). We assessed changes in group membership from pre-TKR to 12 months post-TKR, then compared these changes between subjects with most and least WOMAC pain improvement. RESULTS A total of 176 subjects completed scales at both time points; 64% were female, the mean age was 66 years, and baseline median WOMAC pain score was 40. In all, 71% of subjects in the high PCS score group improved to join the low PCS score group at follow-up. While 73 subjects (41%) changed widespread pain group, they were similarly likely to worsen and to improve. We found a statistically significant positive association of improvement in WOMAC pain score with improvement in PCS score (r = 0.31), but not widespread pain (r = -0.004). CONCLUSION The PCS score reflects state-like aspects of catastrophizing that diminish along with pain. In contrast, widespread pain scores worsened and improved equally often, regardless of knee pain relief. The findings urge caution in interpreting PCS score and widespread pain as trait measures in musculoskeletal research.
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Affiliation(s)
- Emma C Lape
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Faith Selzer
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jamie E Collins
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elena Losina
- Brigham and Women's Hospital, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts
| | - Jeffrey N Katz
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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De Vroey H, Claeys K, Shariatmadar K, Weygers I, Vereecke E, Van Damme G, Hallez H, Staes F. High Levels of Kinesiophobia at Discharge from the Hospital May Negatively Affect the Short-Term Functional Outcome of Patients Who Have Undergone Knee Replacement Surgery. J Clin Med 2020; 9:jcm9030738. [PMID: 32182895 PMCID: PMC7141217 DOI: 10.3390/jcm9030738] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Kinesiophobia is a psycho-cognitive factor that hampers recovery after orthopedic surgery. No evidence exists on the influence of kinesiophobia on the short-term recovery of function in patients with knee replacement (KR). Therefore, the aim of the present study is to investigate the impact of kinesiophobia on short-term patient-reported outcomes (PROMs) and performance-based measures (PBMs). Methods: Forty-three KR patients filled in the Tampa scale for kinesiophobia (TSK) at time of discharge. Patients with TSK ≥ 37 were allocated to the kinesiophobia group (n = 24), others to the no-kinesiophobia group (n = 19). Patients were asked to complete PROMs and to execute PBMs at discharge and at 6-weeks follow-up. An independent samples t-test was used to compare group differences for PROMs and PBMs at both measurement sessions. Multiple linear regression analysis models were used to model PBM outcomes from age, pain and TSK scores. Results: Significant differences were observed between groups for PROMs and PBMs. Kinesiophobia significantly contributed to the reduced functional outcomes. Conclusion: At discharge from the hospital, 55.8% of KR patients demonstrated high levels of kinesiophobia (TSK ≥ 37). This may negatively influence short-term recovery of these patients, by putting them at higher risk for falling and reduced functionality.
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Affiliation(s)
- Henri De Vroey
- KU Leuven, Campus Bruges, Department of Rehabilitation Sciences, Spoorwegstraat 12, 8200 Bruges, Belgium; (K.C.); (I.W.)
- Correspondence: ; Tel.: +32-473-41-58-71
| | - Kurt Claeys
- KU Leuven, Campus Bruges, Department of Rehabilitation Sciences, Spoorwegstraat 12, 8200 Bruges, Belgium; (K.C.); (I.W.)
| | - Keivan Shariatmadar
- KU Leuven, Campus Bruges, Department of Mechanical Engineering, Spoorwegstraat 12, 8200 Bruges, Belgium;
| | - Ive Weygers
- KU Leuven, Campus Bruges, Department of Rehabilitation Sciences, Spoorwegstraat 12, 8200 Bruges, Belgium; (K.C.); (I.W.)
| | - Evie Vereecke
- KU Leuven, Campus Kulak Kortrijk, Department of Development and Regeneration, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium;
| | - Geert Van Damme
- AZ Sint Lucas Hospital, Department of Orthopedic Surgery, Sint-Lucaslaan 29, 8310 Bruges, Belgium;
| | - Hans Hallez
- KU Leuven, Campus Bruges, Department of Computer Science, Spoorwegstraat 12, 8200 Bruges, Belgium;
| | - Filip Staes
- KU Leuven, Campus Leuven, Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Leuven, Belgium;
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Ferrer-Peña R, Muñoz-García D, Calvo-Lobo C, Fernández-Carnero J. Pain Expansion and Severity Reflect Central Sensitization in Primary Care Patients with Greater Trochanteric Pain Syndrome. PAIN MEDICINE 2020; 20:961-970. [PMID: 30312451 DOI: 10.1093/pm/pny199] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aims of this study were twofold: 1) to evaluate the differences in pain sensitivity of patients with greater trochanteric pain syndrome (GTPS) and 2) to examine the association between pain expansion, pain severity, and pain-related central sensitization somatosensory variables in patients with GTPS. STUDY DESIGN A cross-sectional study. SETTING Primary health care centers. SUBJECTS The sample consisted of 49 participants with a mean age of 48.28 ± 8.13 years and included eight males (16.3%) and 41 females (83.7%). METHODS Conditioned pain modulation (CPM), pain location, temporal summation, pressure pain detection threshold (PPDT), and pain intensity were recorded. Pain severity was determined with the Graded Chronic Pain Scale (GCPS). RESULTS Several participants (34.7%) showed a negative conditioned pain modulation and a statistically significant negative moderate correlation (P < 0.05; r = -0.316) between conditioned pain modulation and right view percentage of pain location. Temporal summation at the major trochanter showed a statistically significant low negative correlation (P < 0.05; r = -0.298). The GCPS exhibited a statistically significant moderately positive correlation (P < 0.01; r = 0.467) with the PPDT at the trochanter and a significant correlation with the postero-superior iliac spine (P < 0.01; r = 0.515) and epicondyle (P < 0.01; r = 0.566). CONCLUSIONS Patients with GTPS presented altered CPM, a relationship with more pain areas associated with negative CPM, and a positive association between pain severity and mechanical hyperalgesia at remote sites. Thus, physicians could apply these outcome measurements to assess primary care patients with GTPS and determine the central sensitization presence to prescribe adequate multimodal treatment approaches.
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Affiliation(s)
- Raúl Ferrer-Peña
- Physical Therapy Department, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Salud Entrevías, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain.,Universidad Rey Juan Carlos, Escuela internacional de doctorado, Madrid, Spain
| | - Daniel Muñoz-García
- Physical Therapy Department, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de León, Ponferrada, León, Spain
| | - Josué Fernández-Carnero
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.,Hospital La Paz Institute for Health Research, IdiPAz, Madrid, Spain
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Khalid V, Schønheyder HC, Larsen LH, Nielsen PT, Kappel A, Thomsen TR, Aleksyniene R, Lorenzen J, Ørsted I, Simonsen O, Jordal PL, Rasmussen S. Multidisciplinary Diagnostic Algorithm for Evaluation of Patients Presenting with a Prosthetic Problem in the Hip or Knee: A Prospective Study. Diagnostics (Basel) 2020; 10:diagnostics10020098. [PMID: 32053936 PMCID: PMC7168188 DOI: 10.3390/diagnostics10020098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/28/2020] [Accepted: 02/04/2020] [Indexed: 12/17/2022] Open
Abstract
The predominant indications for revision surgery after total hip (THA) or knee arthroplasty (TKA) are an aseptic failure (AF) and prosthetic joint infection (PJI). Accurate diagnosis is crucial. Therefore, we evaluated prospectively a multidisciplinary diagnostic algorithm including multi-modal radionucleid imaging (RNI) and extended microbiological diagnostics. If the surgeon suspected PJI or AF, revision surgery was performed with multiple samples obtained in parallel for special culture procedures and later molecular analyses. Alternatively, if the underlying cause was not evident, RNI was scheduled comprising 99Tc—HDP SPECT/CT, 111In-labeled white blood cells combined with 99Tc-nanocoll bone marrow SPECT/CT, and 18F-FDG PET/CT. A multidisciplinary clinical team made a recommendation on the indication for a diagnostic procedure guided by RNI images or revision surgery. A total of 156 patients with 163 arthroplasties were included. Fifty-five patients underwent RNI. In all, 118 revision surgeries were performed in 112 patients: 71 on the indication of AF and 41 revision of PJI. Thirty-four patients were concluded with chronic pain, and revision surgery refrained. The effective median follow-up period was 13 months. A structured approach offered by the algorithm was useful for the clinician in the evaluation of patients with a failing TKA or THA. Surgical revision was possibly obviated in approximately 20% of patients where an explanation or cause of failure was not found. The algorithm served as an effective tool.
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Affiliation(s)
- Vesal Khalid
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark (A.K.); (O.S.); (S.R.)
- Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
- Correspondence: ; Tel.: +45-31336988
| | - Henrik Carl Schønheyder
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
- Department of Clinical Microbiology, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Lone Heimann Larsen
- Department of Clinical Microbiology, Aalborg University Hospital, 9000 Aalborg, Denmark;
- Center for Microbial Communities, Department of Biotechnology, Chemistry and Environmental Engineering, Aalborg University, 9000 Aalborg, Denmark;
| | - Poul Torben Nielsen
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark (A.K.); (O.S.); (S.R.)
- Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
| | - Andreas Kappel
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark (A.K.); (O.S.); (S.R.)
- Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
| | - Trine Rolighed Thomsen
- Center for Microbial Communities, Department of Biotechnology, Chemistry and Environmental Engineering, Aalborg University, 9000 Aalborg, Denmark;
- Danish Technological Institute, Medical Biotechnology, 8000 Aarhus C, Denmark; (J.L.); (P.L.J.)
| | - Ramune Aleksyniene
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Jan Lorenzen
- Danish Technological Institute, Medical Biotechnology, 8000 Aarhus C, Denmark; (J.L.); (P.L.J.)
| | - Iben Ørsted
- Department of Infectious Disease, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Ole Simonsen
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark (A.K.); (O.S.); (S.R.)
- Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
| | - Peter Lüttge Jordal
- Danish Technological Institute, Medical Biotechnology, 8000 Aarhus C, Denmark; (J.L.); (P.L.J.)
| | - Sten Rasmussen
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark (A.K.); (O.S.); (S.R.)
- Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
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Hoeger Bement M, Petersen KK, Sørensen LB, Andersen HH, Graven‐Nielsen T. Temporal aspects of endogenous pain modulation during a noxious stimulus prolonged for 1 day. Eur J Pain 2020; 24:752-760. [DOI: 10.1002/ejp.1523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 01/29/2023]
Affiliation(s)
- Marie Hoeger Bement
- Center for Neuroplasticity and Pain (CNAP) Aalborg University Aalborg Denmark
- Department of Physical Therapy Marquette University Milwaukee WI USA
| | | | - Line B. Sørensen
- Center for Neuroplasticity and Pain (CNAP) Aalborg University Aalborg Denmark
| | - Hjalte H. Andersen
- Laboratory of Cutaneous Experimental Pain SMIAalborg University Aalborg Denmark
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Argaman Y, Kisler LB, Granovsky Y, Coghill RC, Sprecher E, Manor D, Weissman-Fogel I. The Endogenous Analgesia Signature in the Resting Brain of Healthy Adults and Migraineurs. THE JOURNAL OF PAIN 2020; 21:905-918. [PMID: 31904502 DOI: 10.1016/j.jpain.2019.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022]
Abstract
Altered pain modulation and resting state functional connectivity (rsFC) were found to be related to migraine pathology and clinical manifestation. We examined how pain modulation psychophysical measures are related to resting-state networks and rsFC between bottom-up and top-down pain modulation areas. Thirty-two episodic migraineurs and 23 age-matched healthy individuals underwent temporal summation of pain (TSOP) and conditioned pain modulation (CPM) tests, followed by a resting-state imaging scan. No differences in temporal summation of pain and CPM were found between groups. However, in healthy individuals, more efficient CPM was correlated with 1) stronger rsFCs of the posterior cingulate cortex, with the ventromedial prefrontal cortex and with the pregenual anterior cingulate cortex; 2) weaker rsFC of the anterior insula with the angular gyrus. Conversely, in migraineurs, the association between CPM and rsFC was altered. Our results suggest that the functional connectivity within the default mode network (DMN) components and the functional coupling between the DMN and pain inhibitory brain areas is linked with pain inhibition efficiency. In migraineurs, this interplay is changed, yet enables normal pain inhibition. Our findings shed light on potential functional adaptation of the DMN and its role in pain inhibition in health and migraine. PERSPECTIVE: This article establishes evidence for the relationship between the resting-state brain and individual responses in psychophysical pain modulation tests, in both migraine and healthy individuals. The results emphasize the significant role of the default mode network in maintaining pain inhibition efficiency in health and in the presence of chronic pain.
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Affiliation(s)
- Yuval Argaman
- Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
| | - Lee B Kisler
- Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
| | - Yelena Granovsky
- Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel; Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Robert C Coghill
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Elliot Sprecher
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - David Manor
- MRI Unit, Rambam Health Care Campus, Haifa, Israel; Faculty of Natural Sciences, University of Haifa, Haifa, Israel
| | - Irit Weissman-Fogel
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
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41
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Bartholomew C, Lack S, Neal B. Altered pain processing and sensitisation is evident in adults with patellofemoral pain: a systematic review including meta-analysis and meta-regression. Scand J Pain 2019; 20:11-27. [DOI: 10.1515/sjpain-2019-0079] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/15/2019] [Indexed: 01/05/2023]
Abstract
Abstract
Background and aims
Previous systematic reviews have reported manifestations of pain sensitisation as a feature of painful knee disorders, in particular osteoarthritis, with moderate evidence for pain sensitisation in patellofemoral pain (PFP). However, despite past studies recruiting female mostly adolescent PFP patients, it is unclear if sex or age plays a role. Investigation is required to determine if altered pain processing is a key feature of PFP and if a subgroup of patients is at an increased risk to help provide targeted management. The primary aim of this systematic review was to examine evidence investigating pain processing in PFP. Secondary aims were to evaluate the relationship between pain processing and (1) sex, (2) age and (3) symptom duration.
Methods
The protocol was prospectively registered with PROSPERO (CRD42019129851). PubMed, CINAHL, Web of Science and EMBASE were systematically searched from inception to April 2019 for studies investigating pain processing in PFP patients compared to controls using quantitative sensory testing. Each included paper was assessed for methodological quality using a modified version of Downs and Black. Means and standard deviations were extracted to calculate standardised mean differences (SMD) and 95% confidence intervals (95% CI). Where possible meta-analysis and meta-regression were performed using a random effects model.
Results
Eleven studies were identified, two medium and nine high quality. Meta-analysis indicates moderate evidence for decreased pressure pain thresholds (SMD −0.68, 95% CI −0.93 to −0.43), increased tactile detection thresholds (SMD 1.35, 95% CI 0.49–2.22) and increased warmth detection thresholds (SMD 0.61, 95% CI 0.30–0.92) in PFP patients compared to controls. Secondary analysis indicates moderate evidence for decreased pressure pain thresholds in female compared to male patients (SMD −0.75, 95% CI −1.34 to −0.16). Meta-regression indicates a moderate correlation between decreasing local and distal pressure pain thresholds and decreasing patient age (local R2 = 0.556, p = 0.0211; distal R2 = 0.491, p = 0.0354) but no correlation with symptom duration (p > 0.05).
Conclusions
Evidence from this systematic review with meta-analysis and meta-regression appears to suggest the presence of altered pain processing and sensitisation in patients with PFP with increased sensitivity indicated in female patients and younger patients.
Implications
With evidence of altered pain processing and sensitisation in PFP, it may be beneficial for clinicians to consider management approaches that aim specifically at adressing neuropathic pain, for example neuroscience education, to improve patients outcomes. With female patients and younger patients indicated as experiencing greater degree of sensitivity, this may be a good demographic to start screening for sensitisation, in order to better identify and treat those most affected.
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Affiliation(s)
- Clare Bartholomew
- Centre for Sports and Exercise Medicine , Queen Mary University of London , London , UK
| | - Simon Lack
- Centre for Sports and Exercise Medicine , Queen Mary University of London , London , UK
- Pure Sports Medicine , London , UK
| | - Bradley Neal
- Centre for Sports and Exercise Medicine , Queen Mary University of London , London , UK
- Pure Sports Medicine , London , UK
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Abrecht CR, Cornelius M, Wu A, Jamison RN, Janfaza D, Urman RD, Campbell C, Smith M, Haythornthwaite J, Edwards RR, Schreiber KL. Prediction of Pain and Opioid Utilization in the Perioperative Period in Patients Undergoing Primary Knee Arthroplasty: Psychophysical and Psychosocial Factors. PAIN MEDICINE 2019. [PMID: 29522115 DOI: 10.1093/pm/pny020] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective To identify factors associated with pain severity and opioid consumption in the early perioperative period. Design Prospective observational cohort study. Setting Tertiary academic medical center. Subjects Patients with osteoarthritis older than age 45 years undergoing primary total knee replacement at Brigham and Women's Hospital. A total of 126 patients enrolled. Methods Preoperatively, pain questionnaires and quantitative sensory testing were performed on patients to develop a psychosocial and psychophysical profile. Postoperatively, pain scores and opioid consumption were measured as primary end points. Univariate and multiple linear regression analyses were performed to determine the predictive value of these characteristics on perioperative pain scores and opioid consumption. Results Regression analysis revealed several predictors of acute postoperative pain scores including temporal summation of pain (TSP; P = 0.001), body mass index (BMI; P = 0.044), number of previous knee surgeries (P = 0.006), and female gender (P = 0.023). Similarly, predictors of opioid utilization included TSP (P = 0.011), BMI (P = 0.02), age (P = <0.001), and tourniquet time (P = 0.003). Conclusions The only significant, unique predictors of both pain and opioid consumption were TSP, an index of central pain facilitatory processes, and BMI. Interestingly, psychosocial factors, such as catastrophizing and somatization, although correlated with postoperative pain scores and opioid consumption, generally did not independently explain substantial variance in these measures. This study suggests that BMI and quantitative sensory testing, specifically the temporal summation of pain, may provide value in the preoperative assessment of patients undergoing total knee arthroplasty and other surgeries via predicting their level of risk for adverse pain outcomes.
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Affiliation(s)
- Christopher R Abrecht
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
| | - Marise Cornelius
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Albert Wu
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert N Jamison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - David Janfaza
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard D Urman
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Claudia Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Drewes AM, Kempeneers MA, Andersen DK, Arendt-Nielsen L, Besselink MG, Boermeester MA, Bouwense S, Bruno M, Freeman M, Gress TM, van Hooft JE, Morlion B, Olesen SS, van Santvoort H, Singh V, Windsor J. Controversies on the endoscopic and surgical management of pain in patients with chronic pancreatitis: pros and cons! Gut 2019; 68:1343-1351. [PMID: 31129569 PMCID: PMC6691929 DOI: 10.1136/gutjnl-2019-318742] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/01/2019] [Accepted: 05/07/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Asbjørn Mohr Drewes
- Centre for Pancreatic Diseases, Department of Gastroenterology, Aalborg University Hospital & Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Marinus A Kempeneers
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interactions (SMI), Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Marc G Besselink
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefan Bouwense
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marco Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Martin Freeman
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnessota Medical School, Minneapolis, Minnesota, USA
| | - Thomas M Gress
- Department of Gastroenterology, Philipps University & University Hospital of Marburg, Marburg, Germany
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bart Morlion
- The Leuven Centre for Algology & Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Søren Schou Olesen
- Centre for Pancreatic Diseases, Department of Gastroenterology, Aalborg University Hospital & Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Hjalmar van Santvoort
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands,Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vikesh Singh
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - John Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Kim MS, Koh IJ, Sohn S, Kang BM, Kwak DH, In Y. Central Sensitization Is a Risk Factor for Persistent Postoperative Pain and Dissatisfaction in Patients Undergoing Revision Total Knee Arthroplasty. J Arthroplasty 2019; 34:1740-1748. [PMID: 30992238 DOI: 10.1016/j.arth.2019.03.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/06/2019] [Accepted: 03/20/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The objective of this study is to investigate whether central sensitization (CS) was associated with patient dissatisfaction after revision total knee arthroplasty (TKA). METHODS Between 2012 and 2016, 68 cases (68 patients) of revision TKA performed by a single surgeon were included in this study with a minimum follow-up of 2 years. Patients were categorized into 2 groups by 40-point preoperative Central Sensitization Inventory (CSI) scores. The control group consisted of 48 patients (48 knees) with CSI scores of less than 40 points, while the CS group consisted of 20 patients (20 knees) with CSI scores of 40 points or more. Clinical outcomes were evaluated using an 11-point visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index scores. Patient satisfaction was evaluated using the satisfaction items of the new Knee Society Scores, where scores ≥20 indicated satisfaction. RESULTS Higher preoperative pain VAS scores in the CS group were maintained 3, 6, 12, and 24 months postoperatively (all P < .05). The CS group showed significantly worse pain, function subscores, and total scores of the Western Ontario and McMaster Universities Osteoarthritis Index preoperatively and at 2 years postoperatively. Forty-four (91.7%) patients in the control group and 3 (15.0%) patients in the CS group were satisfied with their revision TKAs (P < .001). Multivariate logistic regression analysis demonstrated that the odds of dissatisfaction after revision TKAs were increased 39.081 times (95% confidence interval 6.926-220.504, P < .001) in patients with CSI scores ≥40. Higher VAS intensity 2 years postoperatively also predicted dissatisfaction following revision TKA (odds ratio 1.864, 95% confidence interval 1.086-3.199, P = .024). CONCLUSION CS is a risk factor for persistent postoperative pain and dissatisfaction in patients undergoing revision TKAs. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Man S Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - In J Koh
- Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sueen Sohn
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Byung M Kang
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dong H Kwak
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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45
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Conditioned pain modulation as a biomarker of chronic pain: a systematic review of its concurrent validity. Pain 2019; 160:2679-2690. [DOI: 10.1097/j.pain.0000000000001664] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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46
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Bartholomew C, Edwards L, Lack S. Pressure pain thresholds in adults with patellofemoral pain and patellofemoral joint osteoarthritis: a case-control study. Scand J Pain 2019; 19:713-723. [PMID: 31199779 DOI: 10.1515/sjpain-2019-0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/25/2019] [Indexed: 12/24/2022]
Abstract
Abstract
Background and aims
Patellofemoral pain (PFP) and patellofemoral joint osteoarthritis (PFJOA) are common non-self-limiting conditions causing significant pain and disability. The underlying pain pathologies lack consensus with evidence suggesting reduced pressure pain thresholds (PPTs) in adolescent females with PFP and individuals with knee osteoarthritis. A paucity of evidence exists for mixed-sex adults with PFP and PFJOA in isolation. Exploring if pain sensitisation is a dominant feature of PFP and PFJOA may have important implications for the delivery of a patient centred management approach. The primary aim was to measure local and remote PPTs in PFP and PFJOA patients compared to matched controls. Secondary aims were to evaluate the relationship between PPTs and (1) condition severity and (2) knee function.
Methods
13 PFP patients plus 20 matched controls and 15 PFJOA patients plus 34 matched controls were recruited from a UK mixed-sex adult population. Controls were matched on age, sex and activity level. Demographic details, Tegner activity level score, symptom duration, condition severity (Kujala and KOOS-PF scores for PFP and PFJOA, respectively) and knee function (Modified Whatman score rating of five single leg squats) were recorded. PPTs were measured at six sites: five local around the knee, one remote on the contralateral leg. Between-group differences were tested using a two-way mixed model analysis of variance with repeated measures. Strength of association between PPTs and condition severity and knee function were tested using Spearman’s rank order correlation.
Results
No statistically significant difference in PPTs were observed between the PFP patients [F(1,31) = 0.687, p = 0.413, η2 = 0.022] or PFJOA patients [F(1,47) = 0.237, p = 0.629, η2 = 0.005] and controls. Furthermore, no correlation was found between PPTs and condition severity or knee function in PFP or PFJOA (p > 0.05).
Conclusions
Results suggest mechanical pain sensitisation is not a dominant feature of UK mixed-sex adults with PFP or PFJOA.
Implications
PFP and PFJOA remain persistent pain complaints which may not be well explained by objective measures of sensitivity such as PPTs. The findings suggest that peripheral pain processing changes leading to pain sensitisation is not a key feature in PFP or PFJOA. Instead the underlying pain pathway is likely to remain primary nociceptive, possibly with a subgroup of patients who experience pain sensitisation and might benefit from a more targeted management approach.
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Affiliation(s)
- Clare Bartholomew
- Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Laura Edwards
- Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Simon Lack
- Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Pure Sports Medicine, London, UK
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47
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Goubert D, Meeus M, Willems T, De Pauw R, Coppieters I, Crombez G, Danneels L. The association between back muscle characteristics and pressure pain sensitivity in low back pain patients. Scand J Pain 2019; 18:281-293. [PMID: 29794309 DOI: 10.1515/sjpain-2017-0142] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/24/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Some low back pain (LBP) patients recover after every pain episode whereas others develop chronicity. Research indicates that the amount of atrophy and fat infiltration differs between patients with LBP. Also enhanced pain sensitivity is present only in a subgroup of LBP patients. The relationship between pain sensitivity and muscular deformations in LBP, is however unexplored. This study examined the association between pressure pain sensitivity and the structural characteristics of the lumbar muscles in three different groups of non-specific LBP patients. METHODS This cross-sectional study examined the total cross-sectional area (CSA), fat CSA, muscle CSA and muscle fat index (MFI) of the lumbar multifidus (MF) and erector spinae (ES) at level L4 by magnetic resonance imaging in 54 patients with non-specific LBP (23 recurrent LBP, 15 non-continuous chronic LBP and 16 continuous chronic LBP). Pressure pain thresholds were measured at four locations (lower back, neck, hand and leg) by a manual pressure algometer and combined into one "pain sensitivity" variable. As a primary outcome measure, the association between pain sensitivity and muscle structure characteristics was investigated by multiple independent general linear regression models. Secondly, the influence of body mass index (BMI) and age on muscle characteristics was examined. RESULTS A positive association was found between pain sensitivity and the total CSA of the MF (p=0.006) and ES (p=0.001), and the muscle CSA of the MF (p=0.003) and ES (p=0.001), irrespective of the LBP group. No association was found between pain sensitivity and fat CSA or MFI (p>0.01). Furthermore, a positive association was found between BMI and the fat CSA of the MF (p=0.004) and ES (p=0.006), and the MFI of the MF (p<0.01) and ES (p=0.003). Finally, a positive association was found between age with the fat CSA of the MF (p=0.008) but not with the fat CSA of the ES (p>0.01), nor the MFI of the MF (p>0.01) and ES (p>0.01). CONCLUSIONS A higher pain sensitivity is associated with a smaller total and muscle CSA in the lumbar MF and ES, and vice versa, but results are independent from the LBP subgroup. On the other hand, the amount of fat infiltration in the lumbar muscles is not associated with pain sensitivity. Instead, a higher BMI is associated with more lumbar fat infiltration. Finally, older patients with LBP are associated with higher fat infiltration in the MF but not in the ES muscle. IMPLICATIONS These results imply that reconditioning muscular tissues might possibly decrease the pain sensitivity of LBP patients. Vice versa, therapy focusing on enhancement of pain sensitivity might also positively influence the CSA and that way contribute to the recovery of LBP. Furthermore, the amount of lumbar muscle fat seems not susceptible to pain sensitivity or vice versa, but instead a decrease in BMI might decrease the fat infiltration in the lumbar muscles and therefore improve the muscle structure quality in LBP. These hypothesis apply for all non-specific LBP patients, despite the type of LBP.
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Affiliation(s)
- Dorien Goubert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent Campus Heymans (UZ) 3 B3, Corneel Heymanslaan 10, Ghent, Belgium, Phone: +3293325374, Fax: +32 9 332 38 11; andPain in Motion International Research Group
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium;Pain in Motion International Research Group.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tine Willems
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Robby De Pauw
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Iris Coppieters
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; andPain in Motion International Research Group
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Larsen JB, Madeleine P, Arendt-Nielsen L. Development of a new bed-side-test assessing conditioned pain modulation: a test-retest reliability study. Scand J Pain 2019; 19:565-574. [DOI: 10.1515/sjpain-2018-0353] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/04/2019] [Indexed: 01/08/2023]
Abstract
Abstract
Background and aims
Conditioned pain modulation (CPM) is of considerable interest within pain research. Often CPM testing is conducted in experimental settings using complicated instrumentation, thus challenging the implementation in clinical settings. Being able to assess CPM in a fast and reliable way in clinical settings could lead to a new diagnostic tool allowing improved profiling of pain patients.
Methods
A test-retest reliability study and a methodological development study were conducted based on different populations. The reliability study included 22 healthy subjects, mean age 23.6 years (SD: 2.4) and the methodological study included 29 healthy subjects, mean age 21.5 years (SD: 1.6). As painful phasic test stimulus, a 6–10 kg handheld, spring-based pressure algometer was applied perpendicularly to the muscle belly of the tibialis anterior muscle for 10 s and as painful tonic conditioning stimulus, 1–2 standard clamps, inducing a force of 1.3 kg, were applied extra-segmentally at the ipsilateral earlobe for 60–120 s. Four different test protocols were evaluated, of which one protocol was investigated for reliability. Test protocol 1 used a 6 kg pressure algometer as painful phasic test stimulus and a single clamp applied for 60 s as painful tonic conditioning stimulus. Test protocol 2 used a 10 kg pressure algometer as painful phasic test stimulus, and two clamps applied for 60 s as painful tonic conditioning stimulus. Test protocol 3 used a 10 kg pressure algometer as painful phasic test stimulus and a single clamp applied for 120 s as painful tonic conditioning stimulus. Test protocol 4 used a 6 kg pressure algometer as painful phasic test stimulus and a single clamp applied for 120 s as painful tonic conditioning stimulus.
Results
None of the stimuli caused any adverse events, e.g. bruises. In the reliability study (test protocol (1), non-significant CPM effects of 0.3 (SD: 1.6) and 0.2 (SD: 1.0) were observed in session 1 and 2, respectively. The intra-class correlations were 0.67 and 0.72 (p = < 0.01) and limits of agreement (LoA) ranged from −2.76 to 3.31. Non-significant CPM effects of 0.2 (SD: 1.0), −0.1 (SD: 1.1), and 0.0 (SD: 1.2) were observed for test protocol 2, 3, and 4, respectively).
Conclusions
The bedside test developed for investigating CPM was feasible and easy to use in healthy volunteers. No significant CPM effects were measured and a large variation in CPM effect ranging from −0.14 to 0.32 was observed. Intra-class correlation (ICC) values for the pressure algometer were interpreted as “good relative reliability” (test protocol 1), and LoA revealed a somewhat low absolute reliability.
Implications
The pressure algometer provided reproducible measurements and was useful for inducing phasic test stimuli. Since no significant CPM effects were detected, no recommendations for the bedside test can yet be made. Further examinations will have to establish if the “one size fits all” application of both test and conditioning stimuli is useful. Future bedside studies involving patient populations are warranted to determine the usefulness of the method.
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Affiliation(s)
- Jesper Bie Larsen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine , Aalborg University , Aalborg East , Denmark
- Sports Sciences, Department of Health Science and Technology, School of Medicine , Aalborg University , Aalborg East , Denmark
| | - Pascal Madeleine
- Sports Sciences, Department of Health Science and Technology, School of Medicine , Aalborg University , Aalborg East , Denmark
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine , Aalborg University , Fredrik Bajers Vej 7, Bld. D3 , DK-9220 Aalborg East , Denmark
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Larsen P, Vedel JO, Vistrup S, Elsoe R. Long-Lasting Hyperalgesia Is Common in Patients Following Patella Fractures. PAIN MEDICINE 2019; 19:429-437. [PMID: 29566207 DOI: 10.1093/pm/pnx144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The objective was to investigate the long-term development of pain and hyperalgesia after patella fractures. The secondary objective was to report the association between tibiofemoral and patellofemoral osteoarthritis, pain, and hyperalgesia. Methods The study used a cohort design. Patients who were treated for patella fractures between January 2006 and December 2009 were identified. Patients age 20 to 78 years were included. The main outcome was the pain pressure threshold (PPT). Moreover, visual analog scale (VAS) for pain, radiological outcomes of patellofemoral and tibiofemoral osteoarthritis, and the pain subscale of the WOMAC and EQ-5D questionnaires were used. Results Forty-nine patients were included, with a mean age of 53.9 years and a mean follow-up time of 8.5 years. The injured knee region showed significantly decreased PPT levels (P < 0.046), but decreases in PPT were not found for the forearm region (P = 0.24). The VAS score for the worst pain during the last 24 hours was reported, with a mean of 2.9 ± 2.4 cm. The EQ-5D-5L-pain scale was reported, with a mean score of 2.4 (95% confidence interval [CI] = 2.0-2.7). The WOMAC Pain score was reported, with a mean score of 3.9 (95% CI = 2.8-4.9). Moderate correlations were found between the VAS scores and PPT levels (R = 0.428, P = 0.002). Weak correlations were found between VAS scores and PPT levels for site 7 (forearm; R = 0.313, P = 0.03). Conclusions The present study suggests that long-lasting local hyperalgesia following a patella fracture is common. No side-to-side difference at the forearms were observed, indicating that the observed local hyperalgesia was not part of a generalized sensitization.
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Affiliation(s)
- Peter Larsen
- Department of Occupational Therapy and Physiotherapy
| | - Julie Odgaard Vedel
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Sabina Vistrup
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Rasmus Elsoe
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
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Predictive Factors for Developing Chronic Pain After Total Knee Arthroplasty. J Arthroplasty 2018; 33:3372-3378. [PMID: 30143334 DOI: 10.1016/j.arth.2018.07.028] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/28/2018] [Indexed: 02/01/2023] Open
Abstract
Total knee arthroplasty offers substantial improvements for patients as measured by functional status and quality of life; however, 8% to 34% of patients experience chronic postsurgical pain following surgery (CPSP). In addition to disruption in daily activities of life caused by the pain itself, CPSP has been associated with an overall reduction in quality of life following surgery. Risk factors for CPSP can be broadly defined as potentially modifiable or unlikely modifiable. Unlikely modifiable risks include gender, age, medical comorbidities, and socioeconomic status. Potentially modifiable risks include perioperative pain, physical function, psychological state, surgical factors, and possibly genomics. Understanding risks and the magnitude of their effect on outcomes such as CPSP is desirable because interventions designed to affect these factors may be able to dramatically improve outcomes.
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