Discordance between pain and radiographic severity in knee osteoarthritis: Findings from quantitative sensory testing of central sensitization
Patrick H. Finan
Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorLuis F. Buenaver
Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorSara C. Bounds
Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorShahid Hussain
Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorRaymond J. Park
Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorUzma J. Haque
Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorClaudia M. Campbell
Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorJennifer A. Haythornthwaite
Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorRobert R. Edwards
Brigham and Women's Hospital, Boston, Massachusetts
Search for more papers by this authorCorresponding Author
Michael T. Smith
Johns Hopkins University School of Medicine, Baltimore, Maryland
Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Suite 100, Baltimore, MD 21224Search for more papers by this authorPatrick H. Finan
Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorLuis F. Buenaver
Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorSara C. Bounds
Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorShahid Hussain
Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorRaymond J. Park
Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorUzma J. Haque
Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorClaudia M. Campbell
Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorJennifer A. Haythornthwaite
Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorRobert R. Edwards
Brigham and Women's Hospital, Boston, Massachusetts
Search for more papers by this authorCorresponding Author
Michael T. Smith
Johns Hopkins University School of Medicine, Baltimore, Maryland
Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Suite 100, Baltimore, MD 21224Search for more papers by this authorAbstract
Objective
Radiographic measures of the pathologic changes of knee osteoarthritis (OA) have shown modest associations with clinical pain. We sought to evaluate possible differences in quantitative sensory testing (QST) results and psychosocial distress profiles between knee OA patients with discordant versus congruent clinical pain reports relative to radiographic severity measures.
Methods
A total of 113 participants (66.7% women; mean ± SD age 61.05 ± 8.93 years) with knee OA participated in the study. Radiographic evidence of joint pathology was graded according to the Kellgren/Lawrence scale. Central sensitization was indexed through quantitative sensory testing, including heat and pressure–pain thresholds, tonic suprathreshold pain (cold pressor test), and repeated phasic suprathreshold mechanical and thermal pain. Subgroups were constructed by dichotomizing clinical knee pain scores (median split) and knee OA grade scores (grades 1–2 versus 3–4), resulting in 4 groups: low pain/low knee OA grade (n = 24), high pain/high knee OA grade (n = 32), low pain/high knee OA grade (n = 27), and high pain/low knee OA grade (n = 30).
Results
Multivariate analyses revealed significantly heightened pain sensitivity in the high pain/low knee OA grade group, while the low pain/high knee OA grade group was less pain-sensitive. Group differences remained significant after adjusting for differences on psychosocial measures, as well as age, sex, and race.
Conclusion
The results suggest that central sensitization in knee OA is especially apparent among patients with reports of high levels of clinical pain in the absence of moderate-to-severe radiographic evidence of pathologic changes of knee OA.
REFERENCES
- 1 Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Disord 2008; 9: 116.
- 2 Hannan MT, Felson DT, Pincus T. Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatol 2000; 27: 1513–7.
- 3 Lawrence JS, Bremner JM, Bier F. Osteo-arthrosis: prevalence in the population and relationship between symptoms and x-ray changes. Ann Rheum Dis 1966; 25: 1–24.
- 4 Laxafoss E, Jacobsen S, Gosvig KK, Sonne-Holm S. Case definitions of knee osteoarthritis in 4,151 unselected subjects: relevance for epidemiological studies: the Copenhagen Osteoarthritis Study. Skeletal Radiol 2010; 39: 859–66.
- 5 Neogi T, Felson D, Niu J, Nevitt M, Lewis CE, Aliabadi P, et al. Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies. BMJ 2009; 339: b2844.
- 6 Yusuf E, Kortekaas MC, Watt I, Huizinga TW, Kloppenburg M. Do knee abnormalities visualised on MRI explain knee pain in knee osteoarthritis? A systematic review. Ann Rheum Dis 2011; 70: 60–7.
- 7 Creamer P, Hochberg MC. The relationship between psychosocial variables and pain reporting in osteoarthritis of the knee [review]. Arthritis Care Res 1998; 11: 60–5.
- 8 Clauw DJ, Witter J. Pain and rheumatology: thinking outside the joint [editorial]. Arthritis Rheum 2009; 60: 321–4.
- 9 Lee YC, Nassikas NJ, Clauw DJ. The role of the central nervous system in the generation and maintenance of chronic pain in rheumatoid arthritis, osteoarthritis and fibromyalgia. Arthritis Res Ther 2011; 13: 211.
- 10 Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain 2009; 10: 895–926.
- 11 Zambreanu L, Wise RG, Brooks JC, Iannetti GD, Tracey I. A role for the brainstem in central sensitisation in humans: evidence from functional magnetic resonance imaging. Pain 2005; 114: 397–407.
- 12 Gebhart GF. Descending modulation of pain. Neurosci Biobehav Rev 2004; 27: 729–37.
- 13 Gwilym SE, Keltner JR, Warnaby CE, Carr AJ, Chizh B, Chessell I, et al. Psychophysical and functional imaging evidence supporting the presence of central sensitization in a cohort of osteoarthritis patients. Arthritis Rheum 2009; 61: 1226–34.
- 14 Arendt-Nielsen L, Nie H, Laursen MB, Laursen BS, Madeleine P, Simonsen OH, et al. Sensitization in patients with painful knee osteoarthritis. Pain 2010; 149: 573–81.
- 15 Graven-Nielsen T, Arendt-Nielsen L. Assessment of mechanisms in localized and widespread musculoskeletal pain. Nat Rev Rheumatol 2010; 6: 599–606.
- 16 Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain 2011; 152: S2–15.
- 17 Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum 1986; 29: 1039–49.
- 18 Power JD, Perruccio AV, Badley EM. Pain as a mediator of sleep problems in arthritis and other chronic conditions. Arthritis Rheum 2005; 53: 911–9.
- 19 Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15: 1833–40.
- 20 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16: 494–502.
- 21 Spielberger CD, Gorusch RC, Lushene RE, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory. Palo Alto (CA): Consulting Psychologists Press; 1983.
- 22 Radloff L. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977; 1: 385–401.
- 23 Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995; 7: 524–33.
- 24 Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193–213.
- 25 Pavlakovic G, Petzke F. The role of quantitative sensory testing in the evaluation of musculoskeletal pain conditions. Curr Rheumatol Rep 2010; 12: 455–61.
- 26 Edwards RR, Sarlani E, Wesselmann U, Fillingim RB. Quantitative assessment of experimental pain perception: multiple domains of clinical relevance. Pain 2005; 114: 315–9.
- 27 Edwards RR, Wasan AD, Bingham CO III, Bathon J, Haythornthwaite JA, Smith MT, et al. Enhanced reactivity to pain in patients with rheumatoid arthritis. Arthritis Res Ther 2009; 11: R61.
- 28 Yarnitsky D. Conditioned pain modulation (the diffuse noxious inhibitory control-like effect): its relevance for acute and chronic pain states. Curr Opin Anaesthesiol 2010; 23: 611–5.
- 29 Brennum J, Kjeldsen M, Jensen K, Jensen TS. Measurements of human pressure-pain thresholds on fingers and toes. Pain 1989; 38: 211–7.
- 30 Magerl W, Wilk SH, Treede RD. Secondary hyperalgesia and perceptual wind-up following intradermal injection of capsaicin in humans. Pain 1998; 74: 257–68.
- 31 Rolke R, Baron R, Maier C, Tolle TR, Treede RD, Beyer A, et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain 2006; 123: 231–43.
- 32 Vase L, Nikolajsen L, Christensen B, Egsgaard LL, Arendt-Nielsen L, Svensson P, et al. Cognitive-emotional sensitization contributes to wind-up–like pain in phantom limb pain patients. Pain 2011; 152: 157–62.
- 33 Vierck CJ Jr., Cannon RL, Fry G, Maixner W, Whitsel BL. Characteristics of temporal summation of second pain sensations elicited by brief contact of glabrous skin by a preheated thermode. J Neurophysiol 1997; 78: 992–1002.
- 34 Edwards RR, Smith MT, Stonerock G, Haythornthwaite JA. Pain-related catastrophizing in healthy women is associated with greater temporal summation of and reduced habituation to thermal pain. Clin J Pain 2006; 22: 730–7.
- 35 Fillingim RB. Individual differences in pain responses. Curr Rheumatol Rep 2005; 7: 342–7.
- 36 Cohen J, Coehn P, West SG, Aiken LS. Applied multiple regression/ correlation analysis for the behavioral sciences. 3rd ed. Mahwah (NJ): Lawrence Erlbaum Associates; 2003.
- 37 Dunnett CW. New tables for multiple comparisons with a control. Biometrics 1964; 20: 482–91.
- 38 Nakagawa S. A farewell to Bonferroni: the problems of low statistical power and publication bias. Behav Ecol 2004; 15: 1044–5.
- 39 Lumley MA, Cohen JL, Borszcz GS, Cano A, Radcliffe AM, Porter LS, et al. Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol 2011; 67: 942–68.
- 40 Villemure C, Schweinhardt P. Supraspinal pain processing: distinct roles of emotion and attention. Neuroscientist 2010; 16: 276–84.
- 41 Smith MT, Quartana PJ, Okonkwo RM, Nasir A. Mechanisms by which sleep disturbance contributes to osteoarthritis pain: a conceptual model. Curr Pain Headache Rep 2009; 13: 447–54.
- 42 Graven-Nielsen T, Wodehouse T, Langford RM, Arendt-Nielsen L, Kidd BL. Normalization of widespread hyperesthesia and facilitated spatial summation of deep-tissue pain in knee osteoarthritis patients after knee replacement. Arthritis Rheum 2012; 64: 2907–16.
- 43 Edwards RR, Grace E, Peterson S, Klick B, Haythornthwaite JA, Smith MT. Sleep continuity and architecture: associations with pain-inhibitory processes in patients with temporomandibular joint disorders. Eur J Pain 2009; 13: 1043–7.
- 44 Julien N, Goffaux P, Arsenault P, Marchand S. Widespread pain in fibromyalgia is related to a deficit of endogenous pain inhibition. Pain 2005; 114: 295–302.
- 45 Piche M, Arsenault M, Poitras P, Rainville P, Bouin M. Widespread hypersensitivity is related to altered pain inhibition processes in irritable bowel syndrome. Pain 2010; 148: 49–58.
- 46 Wood PB. Mesolimbic dopaminergic mechanisms and pain control. Pain 2006; 120: 230–4.
- 47 Zautra AJ, Johnson LM, Davis MC. Positive affect as a source of resilience for women in chronic pain. J Consult Clin Psychol 2005; 73: 212–20.
- 48 Wilcox S, Brenes GA, Levine D, Sevick MA, Shumaker SA, Craven T. Factors related to sleep disturbance in older adults experiencing knee pain or knee pain with radiographic evidence of knee osteoarthritis. J Am Geriatr Soc 2000; 48: 1241–51.
