The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
Eur J Pain. 2021 Oct;25(9):1898-1911. doi: 10.1002/ejp.1796. Epub 2021 Jun 8.
BACKGROUND: There is a lack of evidence of the relative effects of different exercise modes on pain sensitization and pain intensity in individuals with knee osteoarthritis (KOA). METHODS: Ninety individuals with radiographic and symptomatic KOA, ineligible for knee replacement surgery, were randomized to 12 weeks of twice-weekly strength training in addition to neuromuscular exercise and education (ST+NEMEX-EDU) or neuromuscular exercise and education alone (NEMEX-EDU). Outcomes were bilateral, lower-leg, cuff pressure pain- and tolerance thresholds (PPT, PTT), temporal summation (TS), conditioned pain modulation (CPM), self-reported knee pain intensity and number of painful body sites. RESULTS: After 12 weeks of exercise, we found significant differences in increases in PPT (-5.01 kPa (-8.29 to -1.73, p = .0028)) and PTT (-8.02 kPa (-12.22 to -3.82, p = .0002)) in the KOA leg in favour of ST+NEMEX-EDU. We found no difference in effects between groups on TS, CPM or number of painful body sites. In contrast, there were significantly greater pain-relieving effects on VAS mean knee pain during the last week (-8.4 mm (-16.2 to -0.5, p = .0364) and during function (-16.0 mm (-24.8 to -7.3, p = .0004)) in favour of NEMEX-EDU after 12 weeks of exercise. CONCLUSION: Additional strength training reduced pain sensitization compared to neuromuscular exercise and education alone, but also attenuated the reduction in pain intensity compared to neuromuscular exercise and education alone. The study provides the first dose- and type-specific insight into the effects of a sustained exercise period on pain sensitization in KOA. Future studies are needed to elucidate the role of different exercise modes. SIGNIFICANCE: This study is an important step towards better understanding the effects of exercise in pain management of chronic musculoskeletal conditions. We found that strength training in addition to neuromuscular exercise and education compared with neuromuscular exercise and education only had a differential impact on pain sensitization and pain intensity, but also that regardless of the exercise mode, the positive effects on pain sensitization and pain intensity were comparable to the effects of other therapeutic interventions for individuals with knee osteoarthritis.
背景：对于膝骨关节炎（KOA）患者，不同运动模式对痛觉敏感和疼痛强度的相对影响缺乏证据。
方法：90 名影像学和症状性 KOA 患者，不符合膝关节置换手术条件，随机分为两组，每周两次进行 12 周的力量训练，外加神经肌肉锻炼和教育（ST+NEMEX-EDU）或仅进行神经肌肉锻炼和教育（NEMEX-EDU）。结果为双侧小腿袖压力疼痛和耐受阈值（PPT、PTT）、时间总和（TS）、条件性疼痛调制（CPM）、自我报告的膝关节疼痛强度和疼痛部位数量。
结果：经过 12 周的运动，我们发现 ST+NEMEX-EDU 组 KOA 腿的 PPT（-5.01kPa[-8.29 至-1.73，p=0.0028]）和 PTT（-8.02kPa[-12.22 至-3.82，p=0.0002]）显著增加，而 NEMEX-EDU 组无差异。两组在 TS、CPM 或疼痛部位数量方面的效果无差异。相反，在 12 周运动后，NEMEX-EDU 在最后一周（VAS 平均膝关节疼痛缓解 8.4mm[-16.2 至-0.5，p=0.0364]和功能时[-16.0mm[-24.8 至-7.3，p=0.0004]）的疼痛缓解效果明显更好。
结论：与单独进行神经肌肉锻炼和教育相比，额外的力量训练可降低痛觉敏感，但与单独进行神经肌肉锻炼和教育相比，也降低了疼痛强度的降低。该研究首次提供了关于持续运动期对 KOA 痛觉敏感影响的剂量和类型特异性见解。需要进一步的研究来阐明不同运动模式的作用。
意义：这项研究是更好地理解运动在慢性肌肉骨骼疾病疼痛管理中的作用的重要一步。我们发现，与单独进行神经肌肉锻炼和教育相比，力量训练加神经肌肉锻炼和教育对痛觉敏感和疼痛强度有不同的影响，但无论运动模式如何，对痛觉敏感和疼痛强度的积极影响与其他治疗干预措施对膝骨关节炎患者的影响相当。
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