Pain sensitization in a trial of physical therapy for osteoarthritis and meniscal tear

膝骨性关节炎(OA)在美国影响着1400多万人。因为没有改变疾病的方法 治疗，治疗的重点是疼痛。几种机制是骨性关节炎疼痛的基础，包括伤害感、 受累组织对伤害性刺激的反应，以及中枢和丘脑的痛敏和调制 周围神经系统。敏化和调节可以通过定量感官测试来评估 (QST)。最常用的QST工具包括：疼痛压力阈值-疼痛敏感度 个体对标准压力刺激；条件性疼痛调制-下行抑制的程度 在条件性刺激存在的情况下，通路会钝化疼痛的主观体验；以及 总和-重复应用标准刺激时疼痛敏感度增加的程度。 有极大的兴趣发展不同的疼痛敏感型基于QST发现和 确定这些表型是否与治疗结果相关。 我们建议在TEMPO(半月板的治疗)中增加疼痛敏感型的评估 问题在骨关节炎)，一项多中心随机对照试验(RCT)的锻炼方案的受试者 症状性半月板撕裂和膝骨性关节炎。Tempo将在美国四个中心招收856名参与者。科目 在基线和三个月时进行肌肉骨骼评估；我们将在 肌肉骨骼评估。我们将在此基础上开发出不同的疼痛敏感型 测量和评估疼痛敏感化表型、坚持运动和 治疗结果。我们的工作将追求三个目标。 1.在基线和三个月的访视时对TEMPO受试者实施QST。我们将使用QST数据来 描述有症状性半月板撕裂的膝关节骨性关节炎患者明显的疼痛敏感型。 2.检查疼痛敏感型是否与更大的疼痛、肌肉无力和 在绩效指标上得分更低。 3.确定具有高疼痛敏感型的受试者是否对运动的依从性较低 运动后疼痛严重程度、力量和表现测试的改善较少。评估是否 较低的运动依从性解释了高疼痛人群对运动的次优反应 敏化表型。 从这一提议中产生的数据将促进我们对敏化在 康复治疗的结果，并将提供关于针对疼痛表型量身定做治疗的见解。

Knee osteoarthritis (OA) affects over 14 million persons in the US. Because there are no disease modifying therapies, treatment focuses on pain. Several mechanisms underlie pain in OA including nociception, the response to noxious stimuli in affected tissues, and pain sensitization and modulation in the central and peripheral nervous systems. Sensitization and modulation can be assessed with quantitative sensory testing (QST). The most frequently used QST tools include: pain pressure thresholds - the pain sensitivity of individuals to standard pressure stimuli; conditioned pain modulation - the extent that descending inhibitory pathways blunt the subjective experience of pain in the presence of a conditioning stimulus; and temporal summation - the extent that pain sensitivity is increased with repetitive application of a standard stimulus. There is great interest in developing distinct pain sensitization phenotypes based upon QST findings and determining if these phenotypes are associated with treatment outcomes. We propose to add an assessment of pain sensitization phenotypes to TeMPO (Treatment of Meniscal Problems in OA), a multicenter randomized controlled trial (RCT) of exercise regimens for subjects with symptomatic meniscal tear and knee OA. TeMPO will enroll 856 participants across four US centers. Subjects undergo a musculoskeletal assessment at baseline and at three months; we will add QST testing to the musculoskeletal assessment. We will develop distinct pain sensitization phenotypes based upon these measures and assess the associations between pain sensitization phenotypes, adherence to exercise, and treatment outcomes. Our work will pursue three aims. 1. Administer QST in TeMPO subjects at the baseline and three-month visits. We will use QST data to delineate distinct pain sensitization phenotypes in knee OA patients with symptomatic meniscal tears. 2. Examine whether pain sensitization phenotypes are associated with greater pain, muscle weakness and worse scores on performance measures. 3. Determine whether subjects with high pain sensitization phenotypes have lower adherence to exercise and less improvement in pain severity, strength, and performance tests following exercise. Assess whether lower exercise adherence explains suboptimal responses to exercise in persons with high pain sensitization phenotypes. The data emerging from this proposal will advance our mechanistic understanding of the role of sensitization in outcomes of rehabilitative OA treatment and will offer insights about tailoring treatment to pain phenotype.