Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Yonsei Med J. 2012 Jul 1;53(4):801-5. doi: 10.3349/ymj.2012.53.4.801.
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.
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.
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.
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.
骨关节炎（OA）引起的疼痛通常被归类为伤害感受性（炎症性）。膝骨关节炎的动物模型表明，支配膝关节的感觉神经纤维在软骨下骨交界处明显受损，并引起神经病理性疼痛（NP）。我们的目的是使用疼痛 DETECT（NP 问卷）检查 OA 患者膝关节中的 NP，并评估 NP、疼痛强度和 OA 分期之间的关系。
本研究评估了 92 例膝骨关节炎患者。使用视觉模拟量表（VAS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、疼痛 DETECT、症状持续时间、Kellgren-Lawrence（KL）系统评估和比较疼痛严重程度以及关节液量，并使用 Spearman 秩相关系数进行评估。
我们的研究发现，至少有 5.4%的膝骨关节炎患者可能存在 NP，15.2%的患者可能存在 NP。疼痛 DETECT 评分与 VAS 和 WOMAC 疼痛严重程度显著相关。与疼痛 DETECT 评分相比，KL 分级呈正相关趋势，与关节液的存在和量呈负相关趋势，但这些相关性无统计学意义。
疼痛 DETECT 评分将 5.4%的膝关节 OA 疼痛归类为 NP。NP 倾向于出现在关节液较少和 KL 分级增加的患者中，这两者都对应于 OA 的晚期。在治疗膝关节 OA 疼痛时，考虑 NP 的存在很重要。
