Tanaka So, Nishigami Tomohiko, Ohishi Koji, Nishikawa Kazutaka, Wand Benedict M, Stanton Tasha R, Yamashita Hirofumi, Mibu Akira, Tokunaga Masami, Yoshimoto Takaaki, Ushida Takahiro
Department of Rehabilitation, Fukuoka Orthopaedic Hospital, Fukuoka, Japan.
Department of Unifying Pain Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan.
Pain Rep. 2021 Nov 8;6(4):e971. doi: 10.1097/PR9.0000000000000971. eCollection 2021 Nov-Dec.
There are complex interactions between pain and perceptions of the painful body part in musculoskeletal disorders, and disruption of various body representations in people with chronic pain.
The purpose of this study was to investigate how frequently people with knee osteoarthritis (OA) complain of swelling without objective evidence of swelling, and describe the clinical characteristics of this population.
Forty-six people with knee OA (68.1 ± 8.8 years) participated in this cross-sectional study. Subjective and objective swelling was evaluated by knee-specific body perception questionnaire and ultrasonography, respectively. Pain intensity, disability, pain-related beliefs, 2-point discrimination threshold, and quadriceps muscle strength were also evaluated.
Approximately 1/3 of participants (n = 15) had subjective feelings of knee swelling in the absence of objective swelling (S only). Fifteen participants had both subjective and objective knee swelling (S + O group) and 16 had neither subjective nor objective knee swelling (No S/O group). Participants in the S only group had similar pain or disability as those in the S + O group but had more severe pain or disability than those with in the No S/O group. Those in the S only group also had larger 2-point discrimination distance threshold at the medial knee (impaired tactile acuity) than those in the S + O group and had more dysfunctional pain catastrophizing and pain-related self-efficacy than both other groups.
Our results suggest that about 30% of people with knee OA perceive swelling of the knee in the absence of any objective swelling and that this is accompanied by severe pain and functional disability. Considering altered body image of the knee may reveal relevant treatment-based subgroups in people with knee OA.
在肌肉骨骼疾病中，疼痛与对疼痛身体部位的感知之间存在复杂的相互作用，慢性疼痛患者的各种身体表征会受到干扰。
本研究旨在调查膝骨关节炎（OA）患者在无肿胀客观证据的情况下抱怨肿胀的频率，并描述该人群的临床特征。
46名膝OA患者（68.1±8.8岁）参与了这项横断面研究。分别通过膝关节特异性身体感知问卷和超声检查评估主观和客观肿胀情况。还评估了疼痛强度、功能障碍、疼痛相关信念、两点辨别阈值和股四头肌力量。
约1/3的参与者（n = 15）在无客观肿胀的情况下有膝关节肿胀的主观感受（仅主观组）。15名参与者同时有主观和客观膝关节肿胀（主观+客观组），16名参与者既无主观也无客观膝关节肿胀（无主观/客观组）。仅主观组的参与者与主观+客观组的参与者有相似的疼痛或功能障碍，但比无主观/客观组的参与者有更严重的疼痛或功能障碍。仅主观组在内侧膝关节处的两点辨别距离阈值也比主观+客观组更大（触觉敏锐度受损），并且比其他两组有更多功能失调的疼痛灾难化和与疼痛相关的自我效能感。
我们的结果表明，约30%的膝OA患者在无任何客观肿胀的情况下感觉到膝关节肿胀，并且这伴随着严重疼痛和功能障碍。考虑到膝关节身体形象的改变可能会揭示膝OA患者中基于治疗的相关亚组。
