Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Pain. 2023 Dec;24(12):2175-2185. doi: 10.1016/j.jpain.2023.07.002. Epub 2023 Jul 11.
The study aimed to characterize the natural history of the pain experience, concurrently considering intermittent and constant pain over 4 years, and determine baseline factors associated with unfavorable trajectories in individuals with chronic knee pain. The Osteoarthritis Initiative (OAI) is a prospective, observational study of people with or at higher risk for knee osteoarthritis. The Intermittent and Constant Osteoarthritis Pain (ICOAP) was assessed annually at 48-to-96-month OAI visits. Twenty-eight baseline sociodemographic, knee-specific, and health-related characteristics were assessed. Group-based dual-trajectory modeling identified pain experience patterns indicated by ICOAP intermittent and constant pain scores over 4 years. Multivariable multinomial logistic regression models determined baseline factors associated with membership in each dual-trajectory group. Four longitudinal pain experience patterns were identified (n = 3,584, mean age = 64.8 [standard deviation 9.0] years, BMI = 28.6 [5.0] kg/m; 57.9% women). Group 1 (37.7%) had minimal intermittent and no constant pain; Group 2 (35.1%) had mild intermittent and no constant pain; Group 3 (18.5%) had mild intermittent and low-grade constant pain; and Group 4 (8.7%) had moderate intermittent and constant pain. Baseline widespread pain, knee stiffness, back pain, hip pain, ankle pain, obesity, depressive symptoms, more advanced radiographic disease, and analgesic use were each associated with an increased risk of membership in less favorable Groups 2, 3, and 4. These distinct courses of pain experience may be driven by different underlying pain mechanisms. The benchmarked ICOAP scores could be used to stratify patients and tailor management. Addressing and preventing the development of modifiable risks (eg, widespread pain and knee joint stiffness) may reduce the chance of belonging to unfavorable dual-trajectory groups. PERSPECTIVE: Concurrently tracking intermittent versus constant pain experience, group-based dual-trajectory modeling identified 4 distinct pain experience patterns over 4 years. The benchmarked ICOAP scores in these dual trajectories could aid in stratifying patients for tailored management strategies and intensity of care.
本研究旨在描述疼痛体验的自然史，同时考虑 4 年内间歇性和持续性疼痛，并确定与慢性膝痛患者不利轨迹相关的基线因素。骨关节炎倡议（OAI）是一项针对有或有更高膝关节骨关节炎风险的人群的前瞻性、观察性研究。间歇性和持续性骨关节炎疼痛（ICOAP）在 OAI 48 至 96 个月的访问中每年评估一次。评估了 28 个基线社会人口统计学、膝关节特异性和与健康相关的特征。基于群组的双重轨迹建模确定了 ICOAP 间歇性和持续性疼痛评分在 4 年内的疼痛体验模式。多变量多项逻辑回归模型确定了与每个双重轨迹组相关的基线因素。确定了 4 种纵向疼痛体验模式（n=3584，平均年龄 64.8[9.0]岁，BMI=28.6[5.0]kg/m；57.9%为女性）。第 1 组（37.7%）间歇性疼痛轻微且无持续性疼痛；第 2 组（35.1%）间歇性疼痛轻微且无持续性疼痛；第 3 组（18.5%）间歇性疼痛轻微且低度持续性疼痛；第 4 组（8.7%）间歇性和持续性中度疼痛。基线广泛性疼痛、膝关节僵硬、背痛、髋关节疼痛、踝关节疼痛、肥胖、抑郁症状、更严重的放射学疾病和使用镇痛药与更不利的第 2、3 和 4 组的成员风险增加相关。这些不同的疼痛体验过程可能是由不同的潜在疼痛机制驱动的。经过基准测试的 ICOAP 评分可用于对患者进行分层并调整管理。解决和预防可改变的风险（例如，广泛性疼痛和膝关节僵硬）的发展可能会降低属于不利双重轨迹组的机会。观点：同时跟踪间歇性和持续性疼痛体验，基于群组的双重轨迹建模确定了 4 种不同的疼痛体验模式，持续 4 年。这些双重轨迹中的基准 ICOAP 评分可用于帮助分层患者，以便为他们制定定制的管理策略和护理强度。
