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Central sensitisation in knee osteoarthritis: relating pre-surgical brainstem neuroimaging and paindetect based patient stratification to arthroplasty outcome

Central sensitisation in knee osteoarthritis: relating pre-surgical brainstem neuroimaging and paindetect based patient stratification to arthroplasty outcome
Central sensitisation in knee osteoarthritis: relating pre-surgical brainstem neuroimaging and paindetect based patient stratification to arthroplasty outcome
Objectives: the neural mechanisms of pain in knee OA are not fully understood: some patients have neuropathic‐like pain, associated with central sensitisation. We aimed to identify central sensitisation using neuroimaging and PainDETECT, and relate it to post‐arthroplasty outcome.

Methods: patients awaiting arthroplasty underwent quantitative sensory testing, psychological assessment and functional neuroimaging (fMRI). fMRI was conducted during punctate (n=24) and cold pain stimulation (n=20) to the affected knee. Post‐operative outcome was measured using: Oxford Knee Score; moderate to severe long‐term pain after arthroplasty and a range of pain‐related questionnaires.

Results: patients with neuropathic‐like pain pre‐surgery, identified using PainDETECT, reported significantly higher pain to punctate and cold stimuli, near the affected joint. In these patients and when compared to those without neuropathic‐like pain, neural activity was significantly lower in the rostral anterior cingulate cortex and higher in the rostral ventromedial medulla (RVM) during punctate stimulation, with significant functional connectivity between these two areas. Pre‐operative neuropathic‐like pain and higher neural activity in the RVM was associated with moderate to severe long‐term pain after arthroplasty.

Conclusion: the psychophysical and neuroimaging data suggest that a subset of OA patients have centrally mediated pain sensitisation. This is likely due to supraspinally mediated reductions in inhibition, and increases in facilitation of nociceptive signaling, and was associated with a worse outcome following arthroplasty. The neurobiological confirmation of central sensitisation in patients with features of neuropathic pain, identified using PainDETECT, provides further support for the investigation of such bed‐side measures for patient stratification to better predict post‐surgical outcome.
2326-5191
Soni, Anushka
5b9827c7-be82-42cf-b7d3-707d73c6da5a
Wanigasekera, Vishvarani
c8dc05a8-bab8-4c4d-9528-b29a5dddaa4f
Mezue, Melvin
e0134b2c-d35f-412a-998b-60602cfb0029
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Javaid, Muhammad K.
68b6dcd1-dacf-4891-96ee-c64e9c3d6f90
Price, Andrew J
3e1f1c5b-12d0-4173-995e-d9bba77b5562
Tracey, Irene
f873de18-d525-4de6-aafa-3dfaa5f69d90
Soni, Anushka
5b9827c7-be82-42cf-b7d3-707d73c6da5a
Wanigasekera, Vishvarani
c8dc05a8-bab8-4c4d-9528-b29a5dddaa4f
Mezue, Melvin
e0134b2c-d35f-412a-998b-60602cfb0029
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Javaid, Muhammad K.
68b6dcd1-dacf-4891-96ee-c64e9c3d6f90
Price, Andrew J
3e1f1c5b-12d0-4173-995e-d9bba77b5562
Tracey, Irene
f873de18-d525-4de6-aafa-3dfaa5f69d90

Soni, Anushka, Wanigasekera, Vishvarani, Mezue, Melvin, Cooper, Cyrus, Javaid, Muhammad K., Price, Andrew J and Tracey, Irene (2018) Central sensitisation in knee osteoarthritis: relating pre-surgical brainstem neuroimaging and paindetect based patient stratification to arthroplasty outcome. Arthritis & Rheumatology. (doi:10.1002/art.40749).

Record type: Article

Abstract

Objectives: the neural mechanisms of pain in knee OA are not fully understood: some patients have neuropathic‐like pain, associated with central sensitisation. We aimed to identify central sensitisation using neuroimaging and PainDETECT, and relate it to post‐arthroplasty outcome.

Methods: patients awaiting arthroplasty underwent quantitative sensory testing, psychological assessment and functional neuroimaging (fMRI). fMRI was conducted during punctate (n=24) and cold pain stimulation (n=20) to the affected knee. Post‐operative outcome was measured using: Oxford Knee Score; moderate to severe long‐term pain after arthroplasty and a range of pain‐related questionnaires.

Results: patients with neuropathic‐like pain pre‐surgery, identified using PainDETECT, reported significantly higher pain to punctate and cold stimuli, near the affected joint. In these patients and when compared to those without neuropathic‐like pain, neural activity was significantly lower in the rostral anterior cingulate cortex and higher in the rostral ventromedial medulla (RVM) during punctate stimulation, with significant functional connectivity between these two areas. Pre‐operative neuropathic‐like pain and higher neural activity in the RVM was associated with moderate to severe long‐term pain after arthroplasty.

Conclusion: the psychophysical and neuroimaging data suggest that a subset of OA patients have centrally mediated pain sensitisation. This is likely due to supraspinally mediated reductions in inhibition, and increases in facilitation of nociceptive signaling, and was associated with a worse outcome following arthroplasty. The neurobiological confirmation of central sensitisation in patients with features of neuropathic pain, identified using PainDETECT, provides further support for the investigation of such bed‐side measures for patient stratification to better predict post‐surgical outcome.

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More information

Accepted/In Press date: 1 October 2018
e-pub ahead of print date: 8 October 2018
Published date: 8 October 2018

Identifiers

Local EPrints ID: 425528
URI: https://eprints.soton.ac.uk/id/eprint/425528
ISSN: 2326-5191
PURE UUID: cf27686c-2cd9-4435-89f7-39e1d38b2b99
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 23 Oct 2018 16:30
Last modified: 10 Dec 2019 05:10

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