Yonsei Med J.  2012 Jul;53(4):801-805. 10.3349/ymj.2012.53.4.801.

Existence of a Neuropathic Pain Component in Patients with Osteoarthritis of the Knee

• Ohtori S
• Orita S
• Yamashita
• Ishikawa T
• Ito T
• Shigemura
• Nishiyama
• Konno S
• Ohta H
• Takaso M
• Inoue G
• Eguchi Y
• Ochiai N
• Kishida S
• Kuniyoshi
• Aoki Y
• Arai G
• Miyagi M
• Kamoda H
• Suzkuki M
• Nakamura J
• Furuya T
• Kubota G
• Sakuma Y
• Oikawa Y
• Suzuki M
• Sasho T
• Nakagawa K
• Toyone T
• Takahashi

• KMID: 1716881
• DOI: http://doi.org/10.3349/ymj.2012.53.4.801

Abstract

PURPOSE
Pain from osteoarthritis (OA) is generally classified as nociceptive (inflammatory). Animal models of knee OA have shown that sensory nerve fibers innervating the knee are significantly damaged with destruction of subchondral bone junction, and induce neuropathic pain (NP). Our objective was to examine NP in the knees of OA patients using painDETECT (an NP questionnaire) and to evaluate the relationship between NP, pain intensity, and stage of OA.
MATERIALS AND METHODS
Ninety-two knee OA patients were evaluated in this study. Pain scores using Visual Analogue Scales (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), painDETECT, duration of symptoms, severity of OA using the Kellgren-Lawrence (KL) system, and amount of joint fluid were evaluated and compared using a Spearman's correlation coefficient by rank test.
RESULTS
Our study identified at least 5.4% of our knee OA patients as likely to have NP and 15.2% as possibly having NP. The painDETECT score was significantly correlated with the VAS and WOMAC pain severity. Compared with the painDETECT score, there was a tendency for positive correlation with the KL grade, and tendency for negative correlation with the existence and amount of joint fluid, but these correlations were not significant.
CONCLUSION
PainDETECT scores classified 5.4% of pain from knee OA as NP. NP tended to be seen in patients with less joint fluid and increased KL grade, both of which corresponded to late stages of OA. It is important to consider the existence of NP in the treatment of knee OA pain.

Keyword

Knee; osteoarthritis; neuropathic pain; nociceptive pain

MeSH Terms

Aged
Aged, 80 and over
Female
Humans
Knee/pathology/physiopathology
Male
Middle Aged
Neuralgia/*physiopathology
Osteoarthritis, Knee/*physiopathology

Reference

1. Arthritis types: overview. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. 2008. http://www.cdc.gov/arthritis/osteoarthritis.htm.

2. Daousi C, MacFarlane IA, Woodward A, Nurmikko TJ, Bundred PE, Benbow SJ. Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes. Diabet Med. 2004. 21:976–982.

3. Siddall PJ, McClelland JM, Rutkowski SB, Cousins MJ. A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury. Pain. 2003. 103:249–257.

4. van der Kraan PM, Vitters EL, van de Putte LB, van den Berg WB. Development of osteoarthritic lesions in mice by "metabolic" and "mechanical" alterations in the knee joints. Am J Pathol. 1989. 135:1001–1014.

5. Ochiai N, Ohtori S, Sasho T, Nakagawa K, Takahashi K, Takahashi N, et al. Extracorporeal shock wave therapy improves motor dysfunction and pain originating from knee osteoarthritis in rats. Osteoarthritis Cartilage. 2007. 15:1093–1096.

6. Ivanavicius SP, Ball AD, Heapy CG, Westwood FR, Murray F, Read SJ. Structural pathology in a rodent model of osteoarthritis is associated with neuropathic pain: increased expression of ATF-3 and pharmacological characterisation. Pain. 2007. 128:272–282.

7. Fernihough J, Gentry C, Malcangio M, Fox A, Rediske J, Pellas T, et al. Pain related behaviour in two models of osteoarthritis in the rat knee. Pain. 2004. 112:83–93.

8. Pomonis JD, Boulet JM, Gottshall SL, Phillips S, Sellers R, Bunton T, et al. Development and pharmacological characterization of a rat model of osteoarthritis pain. Pain. 2005. 114:339–346.

9. Freynhagen R, Baron R, Gockel U, Tölle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006. 22:1911–1920.

10. Bennett M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain. 2001. 92:147–157.

11. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005. 114:29–36.

12. Portenoy R. Development and testing of a neuropathic pain screening questionnaire: ID Pain. Curr Med Res Opin. 2006. 22:1555–1565.

13. Krause SJ, Backonja MM. Development of a neuropathic pain questionnaire. Clin J Pain. 2003. 19:306–314.

14. Bennett MI, Attal N, Backonja MM, Baron R, Bouhassira D, Freynhagen R, et al. Using screening tools to identify neuropathic pain. Pain. 2007. 127:199–203.

15. Hochman JR, French MR, Bermingham SL, Hawker GA. The nerve of osteoarthritis pain. Arthritis Care Res (Hoboken). 2010. 62:1019–1023.

16. 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. 15:1833–1840.

17. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957. 16:494–502.

18. Mäntyselkä P, Kumpusalo E, Ahonen R, Kumpusalo A, Kauhanen J, Viinamäki H, et al. Pain as a reason to visit the doctor: a study in Finnish primary health care. Pain. 2001. 89:175–180.

19. Grönblad M, Korkala O, Liesi P, Karaharju E. Innervation of synovial membrane and meniscus. Acta Orthop Scand. 1985. 56:484–486.

20. Fortier LA, Nixon AJ. Distributional changes in substance P nociceptive fiber patterns in naturally osteoarthritic articulations. J Rheumatol. 1997. 24:524–530.

21. Saito T, Koshino T. Distribution of neuropeptides in synovium of the knee with osteoarthritis. Clin Orthop Relat Res. 2000. 172–182.

22. Suri S, Gill SE, Massena de Camin S, Wilson D, McWilliams DF, Walsh DA. Neurovascular invasion at the osteochondral junction and in osteophytes in osteoarthritis. Ann Rheum Dis. 2007. 66:1423–1428.

23. Ogino S, Sasho T, Nakagawa K, Suzuki M, Yamaguchi S, Higashi M, et al. Detection of pain-related molecules in the subchondral bone of osteoarthritic knees. Clin Rheumatol. 2009. 28:1395–1402.

24. Creamer P, Hunt M, Dieppe P. Pain mechanisms in osteoarthritis of the knee: effect of intraarticular anesthetic. J Rheumatol. 1996. 23:1031–1036.

25. Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004. 86-A:963–974.

26. Kosek E, Ordeberg G. Lack of pressure pain modulation by heterotopic noxious conditioning stimulation in patients with painful osteoarthritis before, but not following, surgical pain relief. Pain. 2000. 88:69–78.