Variability in conditioned pain modulation predicts response to NSAID treatment in patients with knee osteoarthritis

BMC Musculoskeletal Disorders

Research Article

Andrew J. Dolman¹  Marise Cornelius¹  Marc. O. Martel¹  Asimina Lazaridou¹  Ajay D. Wasan²  Robert R. Edwards³  Patrick H. Finan⁴ 

[1] Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, 850 Boylston St, Suite 302, 02467, Chestnut Hill, MA, USA;Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, 850 Boylston St, Suite 302, 02467, Chestnut Hill, MA, USA;Departments of Anesthesiology and Psychiatry, University of Pittsburgh School of Medicine, 400 Centre Ave, #400, 15206, Pittsburgh, PA, USA;Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, 850 Boylston St, Suite 302, 02467, Chestnut Hill, MA, USA;Pain Management Center, Brigham & Women’s Hospital, 850 Boylston St, 02467, Chestnut Hill, MA, USA;Department of Psychiatry, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Suite 100, 21224, Baltimore, MD, USA;

关键词: Pain;    Neuropathic;    Osteoarthritis;    NSAID;    Diclofenac;    Quantitative sensory testing;    Conditioned pain modulation;   

DOI  :  10.1186/s12891-016-1124-6

 received in 2016-02-23, accepted in 2016-06-25,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundPatients with painful knee osteoarthritis (OA) demonstrate hyperalgesia and altered pain-modulatory responses. While some prior work has demonstrated cross-sectional associations between laboratory and clinical pain measures, it is unknown whether individual variability in quantitative sensory testing (QST) responses at baseline can prospectively predict analgesic treatment responses.MethodPatients with knee OA (n = 35) were compared on QST responses to a demographically-matched pain-free control group (n = 39), after which patients completed a month-long treatment study of diclofenac sodium topical gel (1 %), applied up to 4 times daily.ResultsOA patients demonstrated reduced pain thresholds at multiple anatomic sites, as well as reduced conditioned pain modulation (CPM) and enhanced temporal summation of pain. The most pain-sensitive patients tended to report the most intense and neuropathic OA pain. Following diclofenac treatment, the knee OA cohort showed a roughly 30 % improvement in pain, regardless of the presence or absence of neuropathic symptoms. Baseline CPM scores, an index of endogenous pain-inhibitory capacity, were prospectively associated with treatment-related changes in clinical pain. Specifically, participants with higher CPM at baseline (i.e., better functioning endogenous pain-inhibitory systems) showed more reduction in pain at the end of treatment (p < .05).ConclusionsThese results support prior findings of amplified pain sensitivity and reduced pain-inhibition in OA patients. Moreover, the moderate to strong associations between laboratory-based measures of pain sensitivity and indices of clinical pain highlight the clinical relevance of QST in this sample. Finally, the prospective association between CPM and diclofenac response suggests that QST-based phenotyping may have utility in explaining inter-patient variability in long-term analgesic treatment outcomes.Trial registrationClinicalTrials.Gov Identifier: NCT01383954. Registered June 22, 2011.

【 授权许可】

CC BY   
© The Author(s). 2016