Does Pain Phenotype Influence Clinical Outcomes After Genicular Artery Embolization? Movement-evoked Pain Versus Pain at Rest: A Retrospective Comparative Study
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Makoto Taninokuchi Tomassoni1, Azzurra Paolucci2,3, Lorenzo Braccischi4
1Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Padiglione 2, Bologna, Italy.
Purpose:
Pain in knee osteoarthritis is heterogeneous and may influence clinical response to genicular artery embolization (GAE). This study aimed to compare pain reduction after GAE between patients with substantial pain at rest (SPAR) and those with predominantly movement-evoked pain (PMEP).
Materials And Methods:
This retrospective study included patients who underwent GAE for chronic knee pain and completed follow-up evaluations at 1 and 3 months. Patients were classified as SPAR when baseline VAS pain at rest was > 3 and as PMEP when VAS pain at rest was ≤ 3. Outcomes included changes in overall VAS pain score and patient-reported clinical improvement.
Results:
Fifty-three patients were included. Individuals with SPAR showed significantly greater overall VAS reduction than those with PMEP at both 1 month (- 4.30 ± 2.85 vs. - 2.21 ± 3.49; p = 0.023) and 3 months (- 3.68 ± 2.92 vs. - 1.68 ± 3.33; p = 0.035). On univariable regression, SPAR predicted greater 3-month VAS reduction (coefficient - 1.99; 95% CI - 3.85 to - 0.14; p = 0.035). In multivariable analysis, SPAR remained an independent predictor of pain reduction at 3 months (coefficient - 3.74; 95% CI - 6.63 to - 0.85; p = 0.014). Higher baseline WOMAC score was also independently associated with greater improvement (p = 0.004), whereas Kellgren-Lawrence grade was not significant (p = 0.187).
Conclusion:
Pain phenotype may influence response to GAE. Patients with substantial pain at rest appear to benefit more than those with predominantly movement-evoked pain, supporting phenotype-based patient selection for GAE.