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Pain sensitisation in osteoarthritis
1SMI (Sensory-Motor Interaction), School of Medicine, Aalborg University, Denmark. LAN@hst.aau.dk.
Abstract:
Treating chronic musculoskeletal pain, and chronic joint pain (osteoarthritis (OA)) in particular, is challenging as the peripheral and central pain mechanisms are not fully discovered, and safe and as efficient analgesic drugs are not available. In general, the preclinical models of OA are limited to provide fundamental understanding of the pain mechanisms involved in patients with chronic joint pain (1). The pain associated with joint discomfort is highly variable, often underestimated by clinicians, and shows only modest association with crude radiological scorings. One reason for the disconnect between the extent of structural damage and pain is neuroplastic changes occurring in the peripheral and central nervous system resulting in pain sensitisation impacting the patient's experience of pain. In recent years, a variety of human quantitative and mechanistic pain assessment tools (Quantitative Sensory Testing, QST) have been developed, providing new opportunities for diagnostic phenotyping of OA patients and the associated degree of sensitisation. Mechanistic phenotyping has revealed specific subgroups of specifically sensitised OA patients, and been used as a predictive guideline to evaluate which patients are most likely to experience continued chronic pain after an otherwise technically successful knee replacement (chronic postoperative pain). Furthermore, such techniques may be used to profile new or existing drugs together with other e.g. cognitive or behavioural therapies with the potential to manage joint pain.
Insights
Understanding chronic joint pain, like osteoarthritis (OA), is difficult due to unknown pain mechanisms and lack of effective treatments. Quantitative Sensory Testing (QST) helps identify pain subgroups and predict outcomes for better OA management.
Area of Science:
- Pain research
- Rheumatology
- Neuroscience
Background:
- Chronic joint pain, particularly osteoarthritis (OA), presents significant treatment challenges due to incompletely understood pain mechanisms and limited availability of safe, effective analgesics.
- Current preclinical OA models offer insufficient insight into the pain experienced by patients.
- Joint pain variability and its weak correlation with radiological findings highlight the role of neuroplasticity and pain sensitization.
Purpose of the Study:
- To explore advanced diagnostic phenotyping for osteoarthritis (OA) patients using mechanistic pain assessment tools.
- To investigate the potential of Quantitative Sensory Testing (QST) in identifying patient subgroups with specific pain sensitization.
- To assess the utility of QST in predicting chronic postoperative pain after knee replacement and profiling therapeutic interventions.
Main Methods:
- Development and application of human quantitative and mechanistic pain assessment tools, specifically Quantitative Sensory Testing (QST).
- Utilizing QST for diagnostic phenotyping of osteoarthritis (OA) patients to determine the degree of pain sensitization.
- Employing mechanistic phenotyping to identify subgroups of OA patients with specific sensitization patterns.
Main Results:
- Mechanistic phenotyping identified distinct subgroups of OA patients with specific pain sensitization.
- QST served as a predictive guideline for identifying patients at risk of chronic postoperative pain following knee replacement.
- The study demonstrated the potential of QST in profiling drug efficacy and other therapies for joint pain management.
Conclusions:
- Quantitative Sensory Testing (QST) offers a valuable tool for the mechanistic phenotyping of osteoarthritis (OA) patients.
- Identifying specific pain sensitization profiles can improve the prediction of chronic pain outcomes and guide personalized treatment strategies.
- QST has the potential to advance the development and evaluation of novel therapies for chronic joint pain.
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