Pain Research & Intervention Center of Excellence, University of Florida, USA; Institute on Aging, University of Florida, USA; Cognitive Aging & Memory Clinical Translational Research Program, University of Florida, USA; Department of Aging & Geriatric Research, College of Medicine, University of Florida, USA; Department of Neuroscience, College of Medicine, University of Florida, USA; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, USA.
Pain Research & Intervention Center of Excellence, University of Florida, USA; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, USA.
Exp Gerontol. 2017 Nov;98:186-191. doi: 10.1016/j.exger.2017.08.026. Epub 2017 Aug 24.
Knee pain associated with osteoarthritis is a significant contributor to decreased physical function. Recent evidence supports the inter-individual heterogeneity associated with knee pain presentation, but whether there is similar heterogeneity in physical performance among these individuals has not been previously examined. The aim of the present study was to characterize the variability in physical performance profiles and the pain evoked by their performance (i.e., movement-evoked pain).
In a secondary analysis of the community-based study Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD), individuals (n=270) completed functional, pain, psychological, and somatosensory assessments. Hierarchical cluster analysis was used to derive physical function profiles that were subsequently compared across several clinical, psychological and experimental pain measures.
Our results support the hypothesis that among persons with knee OA pain, three different physical performance profiles exist with varying degrees of movement-evoked pain. Even as all three groups experienced moderate to severe levels of spontaneous knee pain, those individuals with the most severe movement-evoked pain and lowest physical functional performance also had the least favorable psychological characteristics along with increased mechanical pain sensitivity and temporal summation.
Our findings support the need for the assessment and consideration of movement-evoked pain during physical performance tasks as these have the potential to increase the value of functional and pain assessments clinically. The identification of the mechanisms driving pain burden within homogeneous groups of individuals will ultimately allow for targeted implementation of treatments consistent with a biopsychosocial model of pain.
与骨关节炎相关的膝关节疼痛是导致身体功能下降的一个重要原因。最近的证据支持膝关节疼痛表现的个体间异质性，但这些个体的身体表现是否存在类似的异质性尚未得到检验。本研究的目的是描述身体表现谱的可变性以及其表现（即运动诱发疼痛）引起的疼痛的可变性。
在基于社区的骨关节炎疾病理解疼痛和限制（UPLOAD）研究的二次分析中，个体（n=270）完成了功能、疼痛、心理和体感评估。使用层次聚类分析得出身体功能谱，然后将其与几种临床、心理和实验性疼痛测量指标进行比较。
我们的结果支持这样的假设，即在膝关节骨关节炎疼痛患者中，存在三种不同的身体表现谱，其运动诱发疼痛的程度不同。即使所有三组患者都经历了中到重度的自发性膝关节疼痛，但那些运动诱发疼痛最严重和身体功能表现最差的患者，其心理特征也最不理想，同时还伴有机械性疼痛敏感性增加和时间总和。
我们的研究结果支持在身体表现任务中评估和考虑运动诱发疼痛的必要性，因为这些疼痛有可能增加功能和疼痛评估在临床上的价值。确定同质个体群体中疼痛负担的驱动机制最终将允许根据疼痛的生物心理社会模型来实施有针对性的治疗。
