Pain Treatment for Patients With Osteoarthritis and Central Sensitization

Abstract

Osteoarthritis is one of the most frequent, disabling, and costly pathologies of modern society. Among the main aims of osteoarthritis management are pain control and functional ability improvement. The exact cause of osteoarthritis pain remains unclear. In addition to the pathological changes in articular structures, changes in central pain processing or central sensitization appear to be involved in osteoarthritis pain. The latter calls for a broader approach to the management of patients with osteoarthritis. Yet, the scientific literature offers scant information addressing the treatment of central sensitization, specifically in patients with osteoarthritis. Interventions such as cognitive-behavioral therapy and neuroscience education potentially target cognitive-emotional sensitization (and descending facilitation), and centrally acting drugs and exercise therapy can improve endogenous analgesia (descending inhibition) in patients with osteoarthritis. Future studies should assess these new treatment avenues.

Use of Saline as a Placebo in Intra-articular Injections in Osteoarthritis: Potential Contributions to Nociceptive Pain Relief

“…This central sensitization in OA is the result of massive and repetitive nociceptive input originating from peripheral joint nociceptors and transmitted to neurons located on the dorsal horn of the spinal cord [34]. As this migration to the central nervous system is reinforced, new symptoms come to characterize this type of “centralized” pain.…”

Predictive factors and clinical biomarkers for treatment in patients with chronic pain caused by osteoarthritis with a central sensitisation component

“…Pain perception reflects a balance between the effects of ascending nociceptive and descending modulatory pathways that interact in the central nervous system. Modulation of pain signals can involve either the amplification or inhibition of pain and is known to occur at two key sites: (i) the spinal dorsal horn and (ii) cortical and subcortical regions of the brain .…”

“…First, patients with central sensitisation are significantly more likely to report more severe levels of pain, which are typically less responsive to traditional pain medication than patients with peripheral nociceptive pain . Second, central sensitisation can be seen as a consequence of ongoing peripheral nociceptive input and as a mechanism by which pain in OA is maintained . Once central sensitisation is established, it can persist even if new peripheral nociceptive input is absent .…”

“…Second, central sensitisation can be seen as a consequence of ongoing peripheral nociceptive input and as a mechanism by which pain in OA is maintained . Once central sensitisation is established, it can persist even if new peripheral nociceptive input is absent . Finally, the presence of established central sensitisation is predictive of a more complex clinical picture and reduced likelihood of achieving treatment success .…”

“…Osteoarthritis (OA) is the most common form of arthritis worldwide and one of the most frequent causes of musculoskeletal pain . Pain is commonly classified as nociceptive or neuropathic pain (previously called non‐nociceptive pain) based on mechanistic and clinical criteria.…”