Cold Pain Threshold Identifies a Subgroup of Individuals With Knee Osteoarthritis That Present With Multimodality Hyperalgesia and Elevated Pain Levels

Abstract

Objectives: Cold hyperalgesia has been established as an important marker of pain severity in a number of conditions. This study aimed to establish the extent to which patients with knee osteoarthritis (OA) demonstrate widespread cold, heat, and pressure hyperalgesia. OA participants with widespread cold hyperalgesia were compared with the remaining OA cohort to determine whether they could be distinguished in terms of hyperalgesia, pain report, pain quality, and physical function.Methods: A total of 80 participants with knee OA and 40 matched healthy, pain-free controls participated. OA participants completed a washout of their usual medication. Quantitative sensory testing was completed at 3 sites using standard methods. Cold pain threshold (CPT) and heat pain thresholds (HPT) were tested using a Peltier thermode and pressure pain thresholds (PPT) using a digital algometer. All participants completed the short-form health survey questionnaire and OA participants completed the PainDETECT, Western Ontario and McMaster Universities Osteoarthritis Index of the Knee (WOMAC), and pain quality assessment scale questionnaires.Results: OA participants demonstrated widespread cold hyperalgesia (P < 0.0001), had lower PPT at the index knee (P < 0.0001) compared with controls and reported decreased physical health on the SF-36 (P = 0.01). The OA subcohort with high global CPT (Z12.251C) exhibited multimodality sensitization compared with the remaining OA cohort (PPT P < 0.0001; CPT P < 0.0001; HPT P = 0.021 index knee). This group also reported increased pain, decreased function, and more features of neuropathic pain.Discussion: This study identified a specific subgroup of patients with knee OA who exhibited widespread, multimodality hyperalgesia, more pain, more features of neuropathic pain, and greater functional impairment. Identification of patients with this pain phenotype may permit more targeted and effective pain management.

Effect of Cold Application Versus Contrast Hydrotherapy on Patients Knee Osteoarthritis Outcomes

“…The result is consistent with daCosta DiBonaventura et al [40] reported that adults with OA report worse quality of life, greater number of hospitalizations and reduced productivity than those without also, Wright et al [46], demonstrated widespread cold, heat, and pressure hyperalgesia. OA participants with widespread cold hyperalgesia were compared with the remaining OA cohort to determine whether they could be distinguished in terms of hyperalgesia, pain report, pain quality, and physical function who attended the laboratory at Royal Perth Hospital in Australia mentioned that participants with knee OA exhibited reduced scores on the physical health subscale of the SF-36 (P= 0.01) Recent study done [47] evaluated health-related quality of life (HRQoL) in primary knee osteoarthritis (KOA) patients using the osteoarthritis knee hip quality of life (OAKHQoL) questionnaire recruited from the Rheumatology and Rehabilitation outpatient clinic, Cairo University concluded that Egyptian patients with primary KOA have relatively poor HRQoL.…”

Patients With Knee Osteoarthritis Who Score Highly on the PainDETECT Questionnaire Present With Multimodality Hyperalgesia, Increased Pain, and Impaired Physical Function

“…In a recent publication we have demonstrated that a subgroup of patients with increased CPTs also present with widespread multimodality hyperalgesia and increased PainDETECT scores. 27 …”

Fourteen days of etoricoxib 60 mg improves pain, hyperalgesia and physical function in individuals with knee osteoarthritis: a randomized controlled trial

“…5). A previous study has examined baseline data for this cohort 5 , finding that the 43.8% of participants who exhibited widespread cold hyperalgesia (CPT > 12.25 C, based on Zscores from a matched healthy group) also showed widespread mechanical and heat hyperalgesia, higher painDETECT scores, greater pain and disability, and lower quality of life scores. There were no significant differences between Placebo and Active groups for these measures of pain and sensitization, or for age, gender or BMI (Supplementary Data Table (A)).…”

“…Physical assessment of locomotion provides an objective measure of impact on function 16 . In cross-sectional studies, quantitative sensory testing (QST) has demonstrated the presence of widespread multi-modality hyperalgesia 17e19 which may be an indicator of centrally-driven pain 4,5,20 . Measuring change in hyperalgesia at local and distant test sites following a pharmaceutical intervention therefore enables evaluation of its impact on the nociceptive system.…”