Hattori Takafumi, Shimo Kazuhiro, Niwa Yuto, Tokiwa Yuji, Matsubara Takako
Faculty of Rehabilitation, Kobe Gakuin University Graduate School, Kobe, Hyogo, Japan.
Department of Rehabilitation, Maehara Orthopedics Rehabilitation Clinic, Obu, Aichi, Japan.
J Pain Res. 2021 Apr 22;14:1153-1160. doi: 10.2147/JPR.S296273. eCollection 2021.
Pain and joint deformity are the most common symptoms of hip osteoarthritis (OA). However, no significant association between pain and severity of radiographic lesions has been reported. Recently, central sensitization has been suggested as an underlying mechanism of pain in OA. We investigated the involvement of radiologic severity or central sensitization in the clinical manifestation of hip OA with various degrees of joint deformity.
We included 39 patients with hip OA and divided them into two groups according to the severity of the hip pain: strong/severe (numerical rating scale, NRS≥6) and mild/moderate (NRS<6). We assessed the radiologic severity of OA using the Kellgren-Lawrence (K-L) scale and minimum joint space width (mJSW). We conducted quantitative sensory testing (QST) that included pressure pain threshold (PPT) and temporal summation of pain (TSP) at hip, tibialis anterior (leg), and extensor carpi radialis longus (arm) on the affected side. We examined the difference of radiologic assessment and QST results between each group and the correlation of the NRS with the radiologic assessment and QST results.
There was no significant difference in the K-L scale and mJSW between patients with strong/severe and mild/moderate joint pain. Strong/severe pain patients demonstrated a lower PPT at all measurement sites and higher TSP at the hip and leg than the mild/moderate pain patients. In addition, NRS was significantly negatively correlated with PPT and positively correlated with TSP at all measurement sites, but not with the K-L scale and mJSW.
We reported no significant difference in radiologic severity between patients with strong/severe and mild/moderate joint pain. By contrast, we found a significant difference in central sensitization represented by QST between strong/severe and mild/moderate joint pain groups. These results suggest that central sensitization may be involved in the joint pain of patients with hip OA who complain of severe pain despite less severe joint deformity.
疼痛和关节畸形是髋骨关节炎（OA）最常见的症状。然而，尚未有报道表明疼痛与放射学病变严重程度之间存在显著关联。最近，中枢敏化被认为是OA疼痛的潜在机制。我们研究了放射学严重程度或中枢敏化在不同程度关节畸形的髋OA临床表现中的作用。
我们纳入了39例髋OA患者，并根据髋部疼痛的严重程度将他们分为两组：重度/剧痛（数字评分量表，NRS≥6）和轻度/中度（NRS<6）。我们使用Kellgren-Lawrence（K-L）量表和最小关节间隙宽度（mJSW）评估OA的放射学严重程度。我们进行了定量感觉测试（QST），包括患侧髋部、胫前肌（腿部）和桡侧腕长伸肌（手臂）的压痛阈值（PPT）和疼痛时间总和（TSP）。我们检查了每组之间放射学评估和QST结果的差异，以及NRS与放射学评估和QST结果的相关性。
重度/剧痛和轻度/中度关节疼痛患者之间的K-L量表和mJSW没有显著差异。与轻度/中度疼痛患者相比，重度/剧痛患者在所有测量部位的PPT较低，在髋部和腿部的TSP较高。此外，NRS在所有测量部位与PPT显著负相关，与TSP显著正相关，但与K-L量表和mJSW无关。
我们报告重度/剧痛和轻度/中度关节疼痛患者之间的放射学严重程度没有显著差异。相比之下，我们发现重度/剧痛和轻度/中度关节疼痛组之间以QST表示的中枢敏化存在显著差异。这些结果表明，中枢敏化可能参与了髋OA患者的关节疼痛，这些患者尽管关节畸形不太严重，但仍抱怨疼痛剧烈。
