Altered Central Sensitization and Pain Modulation in the CNS in Chronic Joint Pain

Arendt‐Nielsen, Lars; Skou, Søren Thorgaard; Nielsen, Thomas Arendt; Petersen, Kristian Kjær

doi:10.1007/s11914-015-0276-x

Cited by 145 publications

(150 citation statements)

References 119 publications

Supporting

Mentioning

142

Contrasting

Order By: Relevance

“…Our suggested criteria are based on a consensus report by researchers from different professions [134] and are in line with other experts in neurophysiology [139–141]. Thus, although it has not been possible to report diagnostic value of the criteria, and only aspects of construct validity have been reported [142], they appear to have face validity.…”

Section: Resultsmentioning

confidence: 94%

“…The pathophysiological mechanisms are not fully understood, but there is increasing evidence that CS and chronic widespread musculoskeletal pain is associated with plasticity changes in of the central nervous system leading to hypersensitivity that can explain the clinical findings in chronic widespread LBP [133, 139, 141]. The main clinical manifestations are widespread lowered pain thresholds, exaggerated pain response to stimuli, and enlargement of pain referral areas.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Petersen¹,

Laslett²,

Juhl

2017

BMC Musculoskelet Disord

142

View full text Add to dashboard Cite

BackgroundClinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization.MethodsA sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR.ResultsSixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making.ConclusionsThis is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1549-6) contains supplementary material, which is available to authorized users.

show abstract

Section: Resultsmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Petersen¹,

Laslett²,

Juhl

2017

BMC Musculoskelet Disord

142

View full text Add to dashboard Cite

show abstract

“…In light of this significant unmet clinical need, several preclinical rodent models have been developed [3; 4; 7; 49; 54; 59; 65; 72; 82]. While many of these preclinical rodent models of skeletal pain mirror the bone or joint pathology that drives human skeletal pain, there are several major challenges in behaviorally assessing pain and analgesia in these models.…”

Section: Discussionmentioning

confidence: 99%

Anti–nerve growth factor therapy increases spontaneous day/night activity in mice with orthopedic surgery–induced pain

Majuta

Guedon

Mitchell

et al. 2016

PAIN

View full text Add to dashboard Cite

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are two of the most common and successful surgical interventions to relieve osteoarthritis pain. Control of postoperative pain is critical for patients to fully participate in the required physical therapy which is the most influential factor in effective postoperative knee rehabilitation. Currently opiates are a mainstay for managing postoperative orthopedic surgery pain including TKA/THA pain. Recently, issues including efficacy, dependence, overdose and death from opiates have made clinicians and researchers more critical of use of opioids for treating non-malignant skeletal pain. In the present report, a non-opiate therapy using a monoclonal antibody raised against nerve growth factor (anti-NGF) was assessed for its ability to increase the spontaneous activity of the operated knee joint in a mouse model of orthopedic surgery pain induced by drilling and coring the trochlear groove of the mouse femur. Horizontal activity & velocity and vertical rearing were continually assessed over a 20 hour day/night period using automated activity boxes in an effort to reduce observer bias and capture night activity when the mice are most active. At days 1 and 3 post-orthopedic surgery there was a marked reduction in spontaneous activity and vertical rearing; anti-NGF significantly attenuated this decline. The present data suggests that anti-NGF improves limb use in a rodent model of joint/orthopedic surgery and as such anti-NGF may be useful in controlling pain following orthopedic surgeries such as TKA/THA.

show abstract

“…miR-let7d has previously been found to be associated with chronic pain in patients with complex regional pain syndrome 38 and to affect the endogenous opioid system 39 , which is known to be impaired in, e.g. KOA 15 or fibromyalgia 40 . It is currently unknown if patients with KOA have reduced small nerve fiber density and what the underlying reason for this might be.…”

Section: Thermal Testing In Knee Osteoarthritismentioning

confidence: 99%

“…Quantitative sensory testing (QST) is used for mechanistic profiling of the underlying features of KOA pain 15 . Patients with chronic pain, e.g.…”

Section: Introductionmentioning

confidence: 99%

The Role of Preoperative Radiologic Severity, Sensory Testing, and Temporal Summation on Chronic Postoperative Pain Following Total Knee Arthroplasty

Petersen

Simonsen

Laursen

et al. 2018

The Clinical Journal of Pain

Self Cite

115

View full text Add to dashboard Cite

Objectives: Knee osteoarthritis (KOA) can be associated with local and central sensitization. As an indicator of the central gain, facilitated temporal summation of pain (TSP) has been found in KOA patients. This facilitation is predictive of the development of chronic postoperative pain after total knee arthroplasty (TKA). Other studies have suggested hypoesthesia/hypoalgesia to thermal stimuli as a feature in KOA. This study investigated associations between preoperative TSP, thermal sensitivity, and radiologic severity for the development of chronic postoperative pain after TKA. Methods: Radiologic KOA (Kellgren and Lawrence), TSP, and thermal stimuli were collected, preoperatively. Clinical knee pain intensity (VAS 0-10) was assessed before and 12 months following TKA. Patients were categorized into a chronic postoperative pain group if they experienced <30% pain reduction of the initial pain after 12 months. Results: In total, 19% of the patients were categorized as chronic pain patients and presented facilitated preoperative TSP (P<0.05) and a trend towards increased heat pain threshold (P=0.077) compared with patients with normal recovery. Pearson correlations found that preoperative TSP (R=0.193; P=0.013), Kellgren and Lawrence (R=−0.168; P=0.027), warm detection threshold (R=0.195; P=0.012), and heat pain threshold (R=0.196; P=0.012) were associated with pain intensity 12 months after TKA where TSP was identified as an independent factor. Discussion: This study showed that preoperatively facilitated TSP in KOA patients was predictive of the development of chronic postoperative pain following TKA. Furthermore, this study is the first to find an association between preoperative hypoalgesia to heat and the development of chronic postoperative pain following TKA.

show abstract

Altered Central Sensitization and Pain Modulation in the CNS in Chronic Joint Pain

Cited by 145 publications

References 119 publications

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews

Anti–nerve growth factor therapy increases spontaneous day/night activity in mice with orthopedic surgery–induced pain

The Role of Preoperative Radiologic Severity, Sensory Testing, and Temporal Summation on Chronic Postoperative Pain Following Total Knee Arthroplasty

Contact Info

Product

Resources

About