Central pain contributions in osteoarthritis: next steps for improving recognition and treatment?

Abstract

There is increasing recognition that central pain sensitivity plays an important role in pain severity among patients with osteoarthritis. Murphy and colleagues identified clusters of patients with osteoarthritis according to pain severity and accompanying symptoms, and one of these groups appeared to have a greater degree of centrally mediated pain. This observation provides some evidence that patients with greater central pain contributions can be identified in routine clinical settings, but brief, evidence-based strategies are still needed to more readily and systematically identify these patients. There is also a need to develop new strategies and to further evaluate existing therapies (pharmacological and nonpharmacological) that target central aspects of osteoarthritis pain.

Temporal Summation of Pain as a Prospective Predictor of Clinical Pain Severity in Adults Aged 45 Years and Older With Knee Osteoarthritis

“…Recently, it has been suggested that altered central processing of nociceptive information is also an important contributor to painful knee OA (1). Specifically, knee OA appears to be characterized by an altered pain modulatory balance reflecting an enhancement of pain facilitation (1-3).…”

“…Recently, it has been suggested that altered central processing of nociceptive information is also an important contributor to painful knee OA (1). Specifically, knee OA appears to be characterized by an altered pain modulatory balance reflecting an enhancement of pain facilitation (1-3). Evidence of enhanced pain facilitation in knee OA has emerged from laboratory research using quantitative sensory testing to assess central pain processes (3).…”

High Prevalence of Pain Sensitization in Knee Osteoarthritis: A Meta-Analysis with Meta-Regression

“… 90 However, it is still not clear if the advantages of these approaches rely on their overall good results as analgesic treatments or on their specific effectiveness in sensitized patients, as the improvement of the evidence in this field is hindered by the difficulties in detecting pain sensitization in musculoskeletal conditions. 90 , 91 …”

“…90 However, it is still not clear if the advantages of these approaches rely on their overall good results as analgesic treatments or on their specific effectiveness in sensitized patients, as the improvement of the evidence in this field is hindered by the difficulties in detecting pain sensitization in musculoskeletal conditions. 90,91 The diagnosis of pain sensitization, in the absence of a gold standard, is based on physical exam, questionnaires, and QST protocols. 92 Questionnaires evaluate the presence of signs and symptoms, such as dull pain, tingling, prickling, and widespread diffusion of pain with allodynia, that differ from those present in patients suffering from nociceptive musculoskeletal pain.…”