Normalization of Widespread Hyperesthesia and Facilitated Spatial Summation of Deep-Tissue Pain in Knee Osteoarthritis Patients After Knee Replacement
Normalization of Widespread Hyperesthesia and Facilitated Spatial Summation of Deep-Tissue Pain in Knee Osteoarthritis Patients After Knee Replacement
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DOI：
10.1002/art.34466
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发表时间：
2012-09-01
影响因子：
--
通讯作者：
Kidd, B. L.
中科院分区：
文献类型：
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作者：
Graven-Nielsen, T.;Wodehouse, T.;Kidd, B. L.
目标。在骨性关节炎(OA)中，放射学关节损伤和疼痛之间的适度联系导致了促进中枢疼痛处理的建议。这项研究评估了正在进行的组织病理学在维持增强的中枢疼痛处理中的重要性。对48例有症状的膝骨性关节炎患者和21例性别、年龄相匹配的无痛健康对照组进行疼痛评估。其中20名OA患者随后接受了全膝关节置换术，并进行了重新评估。压力痛阈值(PPT)使用压力痛觉计(膝盖上方和远处)和安装在小腿周围的双腔充气袖带记录。空间总和是通过使用双腔袖带和单腔袖带关联PPTs来评估的。通过记录实验性臂痛后PPT的增加来评估条件性疼痛调制(CPM)。与健康的无痛对照组受试者相比，骨性关节炎患者膝部和远离膝部的PPT降低(P<；0.0001)。与健康对照组相比，骨性关节炎患者的袖带PPTs降低(P<；0.05)，并且表现出更大的空间总和程度(P<；0.05)。尽管在健康对照组中观察到实验性手臂疼痛时PPTS的升高(P<；0.0001)，但在OA患者中没有观察到这种CPM。关节置换术后，广泛存在的机械感觉过敏减少，空间总和比率正常化，CPM恢复。在OA患者中观察到的广泛的感觉过敏和增强的空间总和意味着敏化的中枢性疼痛机制和CPM的丧失。关节置换后结果的正常化意味着这些中枢疼痛过程是由外周输入维持的。
Objective. The modest association between radiographic joint damage and pain in osteoarthritis (OA) has led to the suggestion of facilitated central pain processing. This study evaluated the importance of ongoing tissue pathology in the maintenance of enhanced central pain processing.Methods. Pain assessment was performed on 48 patients with symptomatic knee OA and 21 sex-and age-matched pain-free healthy control subjects. Twenty of the OA patients subsequently underwent total knee replacement surgery and were reassessed. Pressure-pain thresholds (PPTs) were recorded using a pressure algometer (both over and distant from the knee) and a double-chamber inflatable cuff mounted around the calf. Spatial summation was assessed by relating PPTs using the dual- and single-chamber cuff. Conditioned pain modulation (CPM) was assessed by recording the increase in PPT in response to experimental arm pain.Results. PPTs at the knee and at sites away from the knee were reduced in OA patients as compared with healthy pain-free control subjects (P < 0.0001). Cuff PPTs were decreased in OA patients as compared with the healthy controls (P < 0.05), who also exhibited a greater degree of spatial summation (P < 0.05). Whereas an elevation of PPTs was noted in the healthy controls in response to experimental arm pain (P < 0.0001), no such CPM was observed in the OA patients. Following joint replacement in the OA patients, there was a reduction in the widespread mechanical hyperesthesia, along with normalization of spatial summation ratios and restoration of CPM.Conclusion. The widespread hyperesthesia and enhanced spatial summation observed in OA patients imply sensitized central pain mechanisms together with the loss of CPM. Normalization of the results following joint replacement implies that these central pain processes are maintained by peripheral input.