Central Sensitization Mechanism in Chronic Knee Osteoarthritis
EF Turovskaya1,2, LI Alekseeva1*, EG Filatova2, EL Nasonov1 and Cara Chimienti3
1Federal State Budgetary Institution “V.A. Nasonova Research Institute of Rheumatology”, Moscow, Russian Federation
2I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
3Registered Kinesiologist Tel., Canada
*Corresponding Author: LI Alekseeva, Federal State Budgetary Institution “V.A. Nasonova Research Institute of Rheumatology”, Moscow, Russian Federation.
November 17, 2021; Published: December 23, 2021
Pain is the main symptom of osteoarthritis (OA). Currently, there are few mechanism-based treatments that provide adequate and satisfactory pain control. Hence, there is a need to investigate pain mechanisms in OA.
Objective: To assess key mechanisms for pain in chronic OA.
Subjects and Method: 89 women aged 45-65 years with chronic knee OA pain were included in a prospective observational study. The study included clinical rheumatologic and neurological examinations, screening neuropathic pain scales (DN4 and Pain DETECT). Functional status and disability was assessed by WOMAC scale. Emotional disturbances (depression and anxiety) were examined by Hospital Anxiety and Depression scale. Knee joint instrumental examination involved radiographic and ultrasound studies.
Results: Neuropathic pain scales data demonstrated neuropathic descriptors present in OA patients such as: an electric shock, burning, numbness, and pins and needles. Neurological examination revealed no somatosensory deficit. Examination of the sensitive sphere indicated hyperalgesia in 53.7% of patients with OA.
Patients were divided in accordance with presence or absence of secondary hyperalgesia (41.5% and 58.5%). The presence of secondary hyperalgesia was characterized by more pronounced pain on VAS - 5.9 ± 1.5 cm (р = 0.013), a significantly higher level of depression - 8.9 ± 2.9 (р = 0.003), and more pronounced disturbance of joint function (WOMAC 1184 ± 365mm (р = 0.009)). Examination of mood also revealed an increased level of anxiety in patients with secondary hyperalgesia - 8.9 ± 2.9, but no significant differences were recorded (р = 0.082). Secondary hyperalgesia was not associated with structural changes in a joint.
Conclusion: Our findings have demonstrated that in the pathogenesis of chronic pain in knee OA, two mechanisms take place: nociceptive and central sensitization. In one-third of patients central sensitization is predominant and determines the neuropathic pattern of pain. CS is characterized by the absence of neurological deficit and absence of pain intensity associated with structural changes in a joint. Therefore, one of the main ways of controlling pain should also target CNS mechanisms, including anticonvulsant, and antidepressant agents.
Keywords: Osteoarthritis; Chronic Pain; Neuropathic Descriptors; Central Sensitization
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