Lluch Enrique, Nijs Jo, Courtney Carol A, Rebbeck Trudy, Wylde Vikki, Baert Isabel, Wideman Timothy H, Howells Nick, Skou Søren T
a Department of Physical Therapy , University of Valencia , Valencia , Spain.
b Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy , Vrije Universiteit Brussel , Brussels , Belgium.
Disabil Rehabil. 2018 Nov;40(23):2836-2845. doi: 10.1080/09638288.2017.1358770. Epub 2017 Aug 2.
Despite growing awareness of the contribution of central pain mechanisms to knee osteoarthritis pain in a subgroup of patients, routine evaluation of central sensitization is yet to be incorporated into clinical practice.
The objective of this perspective is to design a set of clinical descriptors for the recognition of central sensitization in patients with knee osteoarthritis that can be implemented in clinical practice.
A narrative review of original research papers was conducted by nine clinicians and researchers from seven different countries to reach agreement on clinically relevant descriptors.
It is proposed that identification of a dominance of central sensitization pain is based on descriptors derived from the subjective assessment and the physical examination. In the former, clinicians are recommended to inquire about intensity and duration of pain and its association with structural joint changes, pain distribution, behavior of knee pain, presence of neuropathic-like or centrally mediated symptoms and responsiveness to previous treatment. The latter includes assessment of response to clinical test, mechanical hyperalgesia and allodynia, thermal hyperalgesia, hypoesthesia and reduced vibration sense.
This article describes a set of clinically relevant descriptors that might indicate the presence of central sensitization in patients with knee osteoarthritis in clinical practice. Although based on research data, the descriptors proposed in this review require experimental testing in future studies. Implications for Rehabilitation Laboratory evaluation of central sensitization for people with knee osteoarthritis is yet to be incorporated into clinical practice. A set of clinical indicators for the recognition of central sensitization in patients with knee osteoarthritis is proposed. Although based on research data, the clinical indicators proposed require further experimental testing of psychometric properties.
尽管越来越多的人认识到在一部分患者中，中枢性疼痛机制对膝骨关节炎疼痛有影响，但中枢敏化的常规评估尚未纳入临床实践。
本观点的目的是设计一套临床描述指标，用于识别膝骨关节炎患者的中枢敏化，以便在临床实践中应用。
来自七个不同国家的九名临床医生和研究人员对原始研究论文进行了叙述性综述，以就临床相关描述指标达成共识。
建议基于主观评估和体格检查得出的描述指标来识别中枢敏化性疼痛的主导地位。在主观评估方面，建议临床医生询问疼痛的强度和持续时间及其与关节结构变化、疼痛分布、膝关节疼痛表现、是否存在神经性或中枢介导症状以及对先前治疗的反应之间的关联。体格检查包括评估对临床测试的反应、机械性痛觉过敏和感觉异常、热痛觉过敏、感觉减退和振动觉减退。
本文描述了一组临床相关描述指标，这些指标可能表明临床实践中膝骨关节炎患者存在中枢敏化。尽管基于研究数据，但本综述中提出的描述指标在未来研究中需要进行实验测试。康复启示膝骨关节炎患者中枢敏化的实验室评估尚未纳入临床实践。提出了一套用于识别膝骨关节炎患者中枢敏化的临床指标。尽管基于研究数据，但所提出的临床指标需要对心理测量特性进行进一步的实验测试。
