Enhanced Pain Sensitivity Among Individuals With Symptomatic Knee Osteoarthritis: Potential Sex Differences in Central Sensitization.
Enhanced Pain Sensitivity Among Individuals With Symptomatic Knee Osteoarthritis: Potential Sex Differences in Central Sensitization.
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DOI：
10.1002/acr.22712
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发表时间：
2016-04
影响因子：
4.7
通讯作者：
Fillingim RB
中科院分区：
文献类型：
--
作者：
Bartley EJ;King CD;Sibille KT;Cruz-Almeida Y;Riley JL 3rd;Glover TL;Goodin BR;Sotolongo AS;Herbert MS;Bulls HW;Staud R;Fessler BJ;Redden DT;Bradley LA;Fillingim RB
症状性膝关节骨关节炎（OA）是一种通常与疼痛增加、残疾和功能限制相关的疾病。鉴于影像学证据与临床疼痛之间的对应性较差，中枢致敏作用被认为是膝关节OA疼痛易化的潜在机制。性别可能是中枢介导的膝关节OA疼痛变化的调节剂;然而，很少有研究系统地评估这一点。因此，本研究的目的是检查症状性膝关节OA男性和女性外周和中枢致敏的差异，以及确定这些差异是否随年龄而变化（中年与老年）。参与者（N=288）年龄在45岁和85岁之间完成了一系列定量感觉疼痛程序，评估对接触热，冷加压，机械压力和点状刺激的敏感性。时间总和（TS）的差异进行了检查，以及临床疼痛和功能表现的措施。与男性相比，女性对多种疼痛方式表现出更大的敏感性（即，热、冷、压力阈值/耐受性较低，疼痛TS较大）;然而，除了在女性中观察到更广泛的疼痛外，临床疼痛无性别差异。尽管疼痛敏感性存在特定的年龄相关差异，但疼痛的性别差异在各年龄组中变化最小。总体而言，这些研究结果提供了证据，表明与男性相比，症状性膝关节骨关节炎（OA）女性对实验性疼痛的整体敏感性更高，这表明增强的中枢敏感性可能是该组疼痛的重要因素。
Symptomatic knee osteoarthritis (OA) is a condition commonly associated with increased pain, disability, and functional limitations. Given the poor correspondence between radiographic evidence and clinical pain, central sensitization has been implicated as a potential mechanism underlying pain facilitation in knee OA. Sex may be a moderator of centrally-mediated changes in knee OA pain; however, few studies have systematically assessed this. Therefore, the aim of this study was to examine differences in peripheral and central sensitization in men and women with symptomatic knee OA, as well as to determine whether these differences vary across age (middle-age vs. older-age). Participants (N=288) between the ages of 45 and 85 completed a battery of quantitative sensory pain procedures assessing sensitivity to contact heat, cold pressor, mechanical pressure, and punctate stimuli. Differences in temporal summation (TS) were examined, as well as measures of clinical pain and functional performance. When compared to men, women exhibited greater sensitivity to multiple pain modalities (i.e., lower heat, cold, pressure thresholds/tolerances, greater TS of pain); however, there were no sex differences in clinical pain with the exception of greater widespread pain observed in women. Although there were select age-related differences in pain sensitivity, sex differences in pain varied minimally across age cohort. Overall, these findings provide evidence for greater overall sensitivity to experimental pain in women with symptomatic knee osteoarthritis (OA), compared to men, suggesting that enhanced central sensitivity may be an important contributor to pain in this group.