Department of Orthopaedic Surgery, Shiga University of Medical Science, Japan; Department of Orthopaedic Surgery, Jinseikai Kohnan Hospital, Japan.
Department of Orthopaedic Surgery, Shiga University of Medical Science, Japan.
J Orthop Sci. 2022 May;27(3):672-676. doi: 10.1016/j.jos.2021.03.006. Epub 2021 May 5.
Pain in knee osteoarthritis is considered to be nociceptive. Recently, involvement of neuropathic pain and psychosocial factors in knee osteoarthritis has been reported. However, the following details are unclear: 1) How often are neuropathic pain and psychosocial factors involved? And 2) Which patients are associated with neuropathic pain and psychosocial factors?
In 104 patients with knee osteoarthritis, we evaluated neuropathic pain factor with a painDETECT questionnaire and catastrophic thinking using the pain catastrophizing scale. Pain intensity was assessed using the visual analog scale; patients with scores below the median were defined as low-pain group and others as high-pain group. Radiographic severity was categorized according to the Kellgren-Lawrence classification, with grades I-II and III-IV defined as low- and high-grades, respectively. We compared the painDETECT and pain catastrophizing scale scores between the low- and high-pain groups and low- and high-grade groups. Furthermore, the painDETECT and pain catastrophizing scale scores were compared among the following four groups: low-grade/low-pain, low-grade/high-pain, high-grade/low-pain, and high-grade/high-pain.
Neuropathic pain factor and catastrophic thinking were found in 16% and 34% of patients, respectively. There were no significant differences in both painDETECT and pain catastrophizing scale scores between the two pain intensity groups. Between the two groups of radiographic severity, there was no significant difference in the painDETECT scores; however, the pain catastrophizing scale score was significantly high in the low-grade group. In addition, there was no significant difference in the painDETECT scores among the four groups; however, the pain catastrophizing scale scores were significantly higher in low-grade/high-pain than in high-grade/low-pain patients.
Therefore, 64% had only nociceptive pain factor. Catastrophic thinking was strong in patients with low radiographic severity, especially in those with high pain intensity. Patients with neuropathic pain factor could not be identified from radiographic severity and pain intensity.
膝关节骨关节炎的疼痛被认为是伤害性疼痛。最近，有报道称神经病理性疼痛和心理社会因素也与膝关节骨关节炎有关。然而，以下细节尚不清楚：1）神经病理性疼痛和心理社会因素的涉及频率是多少？2）哪些患者与神经病理性疼痛和心理社会因素有关？
我们评估了 104 例膝关节骨关节炎患者的神经病理性疼痛因素，使用疼痛 DETECT 问卷和疼痛灾难化量表评估；使用视觉模拟量表评估疼痛强度，评分低于中位数的患者定义为低疼痛组，其余为高疼痛组；根据 Kellgren-Lawrence 分类对放射学严重程度进行分类，I-II 级和 III-IV 级分别定义为低级别和高级别。我们比较了低疼痛组和高疼痛组、低级别组和高级别组之间的疼痛 DETECT 和疼痛灾难化量表评分。此外，我们还比较了低级别/低疼痛组、低级别/高疼痛组、高级别/低疼痛组和高级别/高疼痛组之间的疼痛 DETECT 和疼痛灾难化量表评分。
神经病理性疼痛因素和灾难化思维分别在 16%和 34%的患者中发现。在两组疼痛强度之间，疼痛 DETECT 和疼痛灾难化量表评分无显著差异。在两组放射学严重程度之间，疼痛 DETECT 评分无显著差异；然而，低级别组的疼痛灾难化量表评分显著较高。此外，在四组之间，疼痛 DETECT 评分无显著差异；然而，低级别/高疼痛组的疼痛灾难化量表评分明显高于高级别/低疼痛组。
因此，64%的患者只有伤害性疼痛因素。放射学严重程度较低的患者灾难化思维较强，尤其是疼痛强度较高的患者。从放射学严重程度和疼痛强度无法识别出有神经病理性疼痛因素的患者。
