Arendt-Nielsen L, Egsgaard L L, Petersen K K, Eskehave T N, Graven-Nielsen T, Hoeck H C, Simonsen O
Center for Sensory-Motor Interaction, Aalborg University, Denmark.
CCBR, Aalborg, Denmark.
Eur J Pain. 2015 Nov;19(10):1406-17. doi: 10.1002/ejp.651. Epub 2014 Dec 29.
In a cohort of well-characterized patients with different degrees of knee osteoarthritis (OA) and pain, the aims were to utilize mechanism-based quantitative sensory testing (QST) to (1) characterize subgroups of patients; (2) analyse the associations between clinical characteristics and QST; and (3) develop and apply a QST-based knee OA composite pain sensitivity index for patient classification.
Two hundred seventeen OA pain patients and 64 controls were included. Kellgren and Lawrence (KL) grading scores were obtained, and pressure pain thresholds (PPTs), temporal summation of pain to repeated painful pressure stimulation and conditioning pain modulation (CPM) were assessed. Associations between pain score/area/duration, radiological findings and QST-related parameters were analysed. A pain sensitivity index was developed and applied based on PPT, temporal summation and CPM. z-Score, as statistical tool, was calculated for statistically comparing the pain index of a single patient with a healthy control group.
High knee pain associated with low KL grade showed particular signs of pain sensitization. Patients showed significant associations between clinical knee pain intensity/duration and lowering of knee PPTs (p < 0.01), facilitation of temporal summation (p < 0.01), reduction of CPM function (p < 0.01) and high pain sensitivity index (p < 0.01). The index classified 27-38% of the OA patients and 3% of the controls as highly sensitive with no association to KL. The index increased for high knee pain intensities and long pain duration.
Radiological scores, contrary to clinical pain intensity/duration, were poorly associated with QST parameters. The pain sensitivity index could classify OA patients with different degrees of OA and pain.
在一组特征明确的不同程度膝关节骨关节炎（OA）和疼痛患者中，目的是利用基于机制的定量感觉测试（QST）来（1）对患者亚组进行特征描述；（2）分析临床特征与QST之间的关联；以及（3）开发并应用基于QST的膝关节OA复合疼痛敏感性指数进行患者分类。
纳入217例OA疼痛患者和64例对照。获得Kellgren和Lawrence（KL）分级评分，并评估压力疼痛阈值（PPT）、重复疼痛压力刺激下的疼痛时间总和以及条件性疼痛调制（CPM）。分析疼痛评分/面积/持续时间、影像学结果与QST相关参数之间的关联。基于PPT、时间总和和CPM开发并应用疼痛敏感性指数。计算z分数作为统计工具，用于将单个患者的疼痛指数与健康对照组进行统计学比较。
与低KL分级相关的高膝关节疼痛显示出疼痛敏化的特定迹象。患者的临床膝关节疼痛强度/持续时间与膝关节PPT降低（p<0.01）、时间总和增强（p<0.01）、CPM功能降低（p<0.01）和高疼痛敏感性指数（p<0.01）之间存在显著关联。该指数将27%-38%的OA患者和3%的对照分类为高度敏感，与KL无关。该指数随高膝关节疼痛强度和长疼痛持续时间而增加。
与临床疼痛强度/持续时间相反，影像学评分与QST参数的关联较弱。疼痛敏感性指数可对不同程度OA和疼痛的OA患者进行分类。
