Impact of Nervous System Hyperalgesia on Pain, Disability, and Quality of Life in Patients With Knee Osteoarthritis: A Controlled Analysis
Impact of Nervous System Hyperalgesia on Pain, Disability, and Quality of Life in Patients With Knee Osteoarthritis: A Controlled Analysis
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DOI：
10.1002/art.24120
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发表时间：
2008-10-15
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影响因子：
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通讯作者：
Camanho, Gilberto Luis
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作者：
Imamura, Marta;Imamura, Satiko Tomikawa;Camanho, Gilberto Luis
目标。顽固性、致残性疼痛与膝骨关节炎（OA）相关，通常采用全膝关节置换术治疗。然而，这些患者的疼痛可能与中枢神经致敏有关，而不是外周炎症和损伤。我们评估了因膝关节骨性关节炎伴难治性疼痛而计划行全膝关节置换术的患者痛觉过敏的存在，并评估了压力疼痛阈值测量（PPT）对这些患者疼痛、残疾和生活质量的影响。62名女性患者与22名年龄匹配的健康对照组进行了比较，这些对照组去年没有报告疼痛。在下肢皮下皮瓣、股内侧肌、长内收肌、股直肌、股外侧肌、胫前肌、腓骨长肌、髂肌、腰方肌和腘肌、L1-L5的棘上韧带、L5-S1和S1-S2骶区、鹅足滑囊和髌骨肌腱处测量PPT。与健康对照组相比，膝关节OA患者在所有评估结构中的PPT均显著降低（P < 0.001）。较低的PPT值与较高的疼痛强度、较高的残疾评分和较差的生活质量相关，但角色情绪和一般健康状况除外。髌腱、S2皮下皮节和长内收肌的联合PPT值是视觉模拟量表和西安大略和麦克马斯特大学骨关节炎指数疼痛评分的最佳预测指标。计划进行全膝关节置换术的骨关节炎患者表现出神经系统源性痛觉过敏，这对疼痛、膝关节功能能力和生活质量的大多数方面产生了负面影响。
Objective. Refractory, disabling pain associated with knee osteoarthritis (OA) is usually treated with total knee replacement. However, pain in these patients might be associated with central nervous sensitization rather than peripheral inflammation and injury. We evaluated the presence of hyperalgesia in patients scheduled for a total knee replacement due to knee osteoarthritis with refractory pain, and we assessed the impact of pressure pain threshold measurements (PPT) on pain, disability, and quality of life of these patients.Methods. Sixty-two female patients were compared with 22 age-matched healthy controls without reported pain for the last year. PPT was measured at the lower extremities subcutaneous dermatomes, over the vastus medialis, adductor longus, rectus femoris, vastus lateralis, tibialis anterior, peroneus longus, iliacus, quadratus lumborum and popliteus muscles and at the supraspinous ligaments from L1-L5, over the L5-S1 and S1-S2 sacral areas and at the pes anserinus bursae and patellar tendon.Results. Patients with knee OA had significantly lower PPT over all evaluated structures versus healthy control subjects (P < 0.001). Lower PPT values were correlated with higher pain intensity, higher disability scores, and with poorer quality of life, except for the role-emotional and general health status. Combined PPT values over the patellar tendon, at the S2 subcutaneous dermatome and at the adductor longus muscle were the best predictors for visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index pain scores.Conclusion. Patients with pain due to osteoarthritis who were scheduled for total knee replacement showed hyperalgesia of nervous system origin that negatively impacted pain, knee functional capacity, and most aspects of quality of life.