School of Physiotherapy, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
Physiotherapy Department, St Vincent's University Hospital, Dublin 4, Ireland.
Semin Arthritis Rheum. 2017 Aug;47(1):1-8. doi: 10.1016/j.semarthrit.2017.02.008. Epub 2017 Feb 20.
Discordance between radiographic and pain severity in osteoarthritis (OA) has led researchers to investigate other pain mechanisms, including neuropathic pain. Accurate identification of any neuropathic pain in hip or knee OA is important for appropriate management, but neuropathic pain prevalence is unknown. We aimed to obtain an overall prevalence estimate by systematically reviewing and meta-analysing the prevalence of neuropathic pain in people with hip or knee OA.
Observational studies which measured neuropathic pain in people aged 18 years and older with hip or knee OA were considered for inclusion. Electronic databases were searched up to February 2016. Two reviewers independently identified eligible studies and assessed methodological quality. Prevalence estimates and 95% confidence intervals were calculated using random effects meta-analytic techniques.
Nine studies met the inclusion criteria. Study samples were from general population, hospital and community settings and all used self-report questionnaires to determine neuropathic pain. The overall prevalence estimate was 23% (95% CI: 10-39%), with considerable heterogeneity (I = 97.9%, p < 0.001). This estimate was largely unchanged with subgroup analyses based on index joint, questionnaire type, setting and consideration of other potential causes of neuropathic pain. However, the estimate for two studies that excluded other potential causes of neuropathic pain was substantially higher (32%, 95% CI: 29-35%).
Neuropathic pain prevalence in people with knee or hip OA is considerable at 23%, and may be higher after other potential causes of neuropathic pain are excluded. Concerns regarding the validity of neuropathic pain questionnaires, selection bias, methodological quality and study heterogeneity suggest caution with interpretation of these findings. Prevalence studies using standardised criteria for neuropathic pain are required.
骨关节炎（OA）的影像学与疼痛严重程度之间的差异促使研究人员研究其他疼痛机制，包括神经性疼痛。准确识别髋或膝关节 OA 患者的任何神经性疼痛对于恰当的管理很重要，但神经性疼痛的患病率尚不清楚。我们旨在通过系统地综述和荟萃分析髋或膝关节 OA 患者神经性疼痛的患病率，获得总体患病率估计值。
纳入评估年龄在 18 岁及以上、髋或膝关节 OA 患者神经性疼痛的观察性研究。检索了截至 2016 年 2 月的电子数据库。两位评审员独立确定了合格的研究并评估了方法学质量。使用随机效应荟萃分析技术计算了患病率估计值和 95%置信区间。
有 9 项研究符合纳入标准。研究样本来自一般人群、医院和社区环境，均使用自我报告问卷来确定神经性疼痛。总体患病率估计值为 23%（95%CI：10-39%），存在较大的异质性（I = 97.9%，p < 0.001）。基于索引关节、问卷类型、环境以及对其他潜在神经性疼痛原因的考虑，进行亚组分析后，该估计值变化不大。然而，在排除其他潜在神经性疼痛原因的两项研究中，该估计值要高得多（32%，95%CI：29-35%）。
膝关节或髋关节 OA 患者的神经性疼痛患病率相当高，为 23%，在排除其他潜在神经性疼痛原因后可能会更高。神经性疼痛问卷的有效性、选择偏倚、方法学质量和研究异质性等问题令人担忧，提示在解释这些发现时应谨慎。需要使用神经性疼痛标准进行患病率研究。
