The nerve of osteoarthritis pain Hochman, Jacqueline R.; French, Melissa R.; Bermingham, Sarah L. ...
Arthritis care & research (2010),
July 2010, Letnik:
62, Številka:
7
Journal Article
Recenzirano
Odprti dostop
Objective
Cumulative data suggest that central sensitization may contribute to pain in osteoarthritis (OA) and present with symptoms typically associated with neuropathic pain (NP). We evaluated the ...responses from focus group participants on the knee OA pain experience for pain descriptions that suggest NP.
Methods
Focus group transcripts were analyzed by 2 independent assessors for unprompted use of pain descriptors that suggested NP. Items from validated NP symptom‐based questionnaires were used to guide the analysis. Data on sociodemographic factors, duration of knee OA, and OA disease and pain severity (using the Western Ontario and McMaster Universities Osteoarthritis Index and a numerical rating scale) were obtained from questionnaires administered after focus group completion. These factors were compared among participants who did and did not use descriptors that suggested NP.
Results
Transcripts from 80 knee OA participants were analyzed. A range of NP descriptors was used to characterize their knee symptoms, including burning, tingling, numbness, and pins and needles. The proportion of participants who used NP descriptors was 0.34 (95% confidence interval 0.24–0.45). Those who used NP descriptors were younger (P = 0.003) and, although not statistically different, more likely to be women, with higher pain intensity and OA severity and longer OA duration, than those who did not use NP descriptors.
Conclusion
During focus groups, a subset of adults with chronic, symptomatic knee OA used pain quality descriptors that were suggestive of NP. Elicitation of NP descriptors in people with OA may help identify those who could benefit from further evaluation and perhaps treatment for NP.
Background The rates of total joint arthroplasty (TJA) of the hip and knee have increased in North America over the last decade. While initially designed for elderly patients (>70 years of age), ...several reports suggest that an increasing number of younger patients are undergoing joint replacements. This suggests that more people are meeting the indication for TJA earlier in their lives. Alternatively, it might indicate a broadening of the indications for TJA. Methods We used the administrative databases available at the Healthcare Cost and Utilization Project (HCUP) and the Institute for Clinical Evaluative Sciences (ICES) to determine the rates of TJA of the hip and knee in the United States, and Ontario, Canada, respectively. We determined the crude rates of THA and TKA in both areas for four calendar years (2001, 2003, 2005 and 2007). We also calculated the age- and sex-standardised rates of THA and TKA in both areas for each time period. We compared the age distribution of TJA recipients between the US and Ontario, and within each area over time. Results The crude and standardised rates of THA and TKA increased over time in both the US and Ontario. The crude rates of THA were higher in the US in 2001 and 2003, but were not significantly different from the rate in Ontario in 2005 and 2007. The crude rates of TKA were consistently higher in the US for all time periods. In addition, the US consistently had more THA and TKA recipients in ‘younger’ age categories (<60 years of age). While the age- and sex-standardised rates of TKA were greater in the US in all time periods, the relative increase in rates from 2001 to 2007 was greater in Ontario (US – 59%, Ontario – 73%). For both the US and Ontario, there was a significant shift in the demographic of THA and TKA recipients to younger patients ( p < 0.0001). Conclusions The utilisation of primary hip and knee arthroplasty has increased substantially in both the US and Ontario in the period from 2001 to 2007. This increase has been predominantly in knee replacements. The demographics of joint replacement recipients has become younger, with substantial increases in the prevalence of patients <60 years old amongst TJA recipients, and significant increases in the incidence of TJA in these age groups in the general population, in both the US and Ontario.
Osteoporosis is associated with significant morbidity and mortality. Oral bisphosphonates have become a mainstay of treatment, but concerns have emerged that long-term use of these drugs may suppress ...bone remodeling, leading to unusual fractures.
To determine whether prolonged bisphosphonate therapy is associated with an increased risk of subtrochanteric or femoral shaft fracture.
A population-based, nested case-control study to explore the association between bisphosphonate use and fractures in a cohort of women aged 68 years or older from Ontario, Canada, who initiated therapy with an oral bisphosphonate between April 1, 2002, and March 31, 2008. Cases were those hospitalized with a subtrochanteric or femoral shaft fracture and were matched to up to 5 controls with no such fracture. Study participants were followed up until March 31, 2009.
The primary analysis examined the association between hospitalization for a subtrochanteric or femoral shaft fracture and duration of bisphosphonate exposure. To test the specificity of the findings, the association between bisphosphonate use and fractures of the femoral neck or intertrochanteric region, which are characteristic of osteoporotic fractures, was also examined.
We identified 716 women who sustained a subtrochanteric or femoral shaft fracture following initiation of bisphosphonate therapy and 9723 women who sustained a typical osteoporotic fracture of the intertrochanteric region or femoral neck. Compared with transient bisphosphonate use, treatment for 5 years or longer was associated with an increased risk of subtrochanteric or femoral shaft fracture (adjusted odds ratio, 2.74; 95% confidence interval, 1.25-6.02). A reduced risk of typical osteoporotic fractures occurred among women with more than 5 years of bisphosphonate therapy (adjusted odds ratio, 0.76; 95% confidence interval, 0.63-0.93). Among 52,595 women with at least 5 years of bisphosphonate therapy, a subtrochanteric or femoral shaft fracture occurred in 71 (0.13%) during the subsequent year and 117 (0.22%) within 2 years.
Among older women, treatment with a bisphosphonate for more than 5 years was associated with an increased risk of subtrochanteric or femoral shaft fractures; however, the absolute risk of these fractures is low.
Rising total knee arthroplasty (TKA) rates in younger patients raises concern about appropriateness. We asked: are younger individuals who seek consultation for TKA less likely to be appropriate for ...and, controlling for appropriateness, more likely to be recommended for surgery?
This cross-sectional study was nested within a prospective cohort study of knee osteoarthritis (OA) patients referred for TKA from 2014 to 2016 to centralized arthroplasty centers in Alberta, Canada. Pre-consultation, questionnaires assessed patients' TKA appropriateness (need, based on knee symptoms and prior treatment; readiness/willingness to undergo TKA; health status; and expectations) and contextual factors (for example, employment). Post-consultation, surgeons confirmed study eligibility and reported their TKA recommendation. Using generalized estimating equations to control for clustering by surgeon, we assessed relationships between patient age (<50, 50 to 59, ≥60 years) and TKA appropriateness and receipt of a surgeon TKA recommendation.
Of 2,037 participants, 3.3% and 22.7% were <50 and 50 to 59 years of age, respectively, 58.7% were female, and 35.5% were employed. Compared with older participants, younger participants reported significantly worse knee symptoms, higher use of OA therapies, higher TKA readiness, and similar willingness, but had higher body mass index and were more likely to smoke and to consider the ability to participate in vigorous activities, for example, sports, as very important TKA outcomes. TKA was offered to 1,500 individuals (73.6% overall; 52.2%, 71.0%, and 75.4% of those <50, 50 to 59, and ≥60 years, respectively). In multivariate analyses, the odds of receiving a TKA recommendation were higher with greater TKA need and willingness, in nonsmokers, and in those who indicated that improved ability to go upstairs and to straighten the leg were very important TKA outcomes. Controlling for TKA appropriateness, patient age was not associated with surgeons' TKA recommendations.
Younger individuals with knee OA referred for TKA had similar or greater TKA need, readiness, and willingness than older individuals. Incorporation of TKA appropriateness criteria into TKA decision-making may facilitate consideration of TKA benefits and risks in a growing population of young, obese individuals with knee OA.
Younger people seeking TKA for knee OA had significant OA pain and disability despite recommended OA therapies, suggesting appropriateness for surgical consideration. However, they were significantly more likely to have morbid obesity, to smoke, and to consider return to vigorous activities, like sport, as important TKA outcomes. Whether the short- and longer-term risks of TKA are outweighed by the benefits is unclear and warrants additional research.
Despite the central role of pain in osteoarthritis, until recently, relatively little attention was paid to the osteoarthritis pain experience, including the features of osteoarthritis pain that are ...most important to people living with this disease. The focus of this review is on recent advances in our understanding of the experience of osteoarthritis pain from the patient's perspective.
To gain an understanding of the experience of pain in osteoarthritis, researchers have largely relied on qualitative methodologies. This research indicates that the osteoarthritis pain experience is multidimensional, reflecting the influence of biological (e.g. pain mechanisms), psychological (e.g. mood and coping), and social factors (e.g. social support). Qualitative and quantitative research to date supports the need for measures that distinguish aspects of the pain itself (intensity, frequency, quality, location, etc.) from the consequences of the pain on activity limitations and participation restriction, mood, sleep, and health-related quality of life. This research has underscored the limitations of existing generic and osteoarthritis-specific pain measures, and is driving the development of new tools to better evaluate osteoarthritis-related pain, and thus assessment of its impact and response to various interventions.
Improved measurement of painful osteoarthritis, including attention to the words people with osteoarthritis use to describe their pain, will undoubtedly lead to an improved understanding of pain mechanisms in osteoarthritis and, in turn, mechanism-based and evidence-based treatment decision making.
Objective
To examine the relation of knee pain patterns to pain severity and to radiographic osteoarthritis (OA) severity and duration.
Methods
The Multicenter Osteoarthritis Study is a longitudinal ...cohort of older adults with or at risk of knee OA. Participants’ Intermittent and Constant Osteoarthritis Pain (ICOAP) scores were characterized as 1) no intermittent or constant pain, 2) intermittent pain only, 3) constant pain only, and 4) a combination of constant and intermittent pain. Knee pain severity was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and a visual analog scale (VAS). Radiographic knee OA (ROA) severity was defined as Kellgren/Lawrence grade ≥2, and ROA duration was defined according to the clinic visit at which ROA was first noted. We assessed the relation of ICOAP pain patterns to knee pain severity, ROA severity, and ROA duration using regression models with generalized estimating equations.
Results
There were 2,322 participants (mean age 68.8 years, body mass index 31.0 kg/m2, 60% female). Higher ICOAP pain patterns, i.e., a mix of constant and intermittent pain, were associated with greater WOMAC pain severity compared with those patients without either pain pattern (odds ratio OR 43.2 95% confidence interval (95% CI) 26.4–61.3). Results were similar for the VAS (OR 71.2 95% CI 45.7–110.9). Those patients with more severe and longer duration of ROA were more likely to have a mix of constant and intermittent pain compared with those without either pain (OR 3.7 95% CI 3.1–4.6 and OR 2.9 95% CI 2.5–3.5, respectively).
Conclusion
Knee pain patterns are associated with radiographic disease stage and duration, as well as pain severity, highlighting the fact that pain patterns are important for understanding symptomatic disease progression.
Objective
To assess the relationship between patients’ expectations for total knee arthroplasty (TKA) and satisfaction with surgical outcome.
Methods
This prospective cohort study recruited patients ...with knee osteoarthritis (OA) ages ≥30 years who were referred for TKA at 2 hip/knee surgery centers in Alberta, Canada. Those who received primary, unilateral TKA completed questionnaires pre‐TKA to assess TKA expectations (17‐item Hospital for Special Surgery HSS TKA Expectations questionnaire) and contextual factors (age, sex, Western Ontario and McMaster Universities Osteoarthritis Index pain score, Knee Injury and Osteoarthritis Outcome Score physical function short form KOOS‐PS, 8‐item Patient Health Questionnaire depression scale, body mass index BMI, comorbidities, and prior joint replacement), and 1‐year post‐TKA to assess overall satisfaction with TKA results. Using multivariate logistic regression, we examined the relationship between TKA expectations (HSS TKA outcomes considered to be very important) and postoperative satisfaction (very satisfied versus somewhat satisfied versus dissatisfied). Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.
Results
At 1 year, 1,266 patients with TKA (92.1%) reported their TKA satisfaction (mean ± SD age 67.2 ± 8.8 years, 60.9% women, and mean BMI 32.6 kg/m2); 74.7% of patients were very satisfied, 17.1% were somewhat satisfied, and 8.2% were dissatisfied. Controlling for other factors, an expectation of TKA to improve patients’ ability to kneel was associated with lower odds of satisfaction (adjusted OR 0.725 95% CI 0.54–0.98). An expectation of TKA to improve psychological well‐being was associated with lower odds of satisfaction for individuals in the lowest tertile of pre‐TKA KOOS‐PS scores (adjusted OR 0.49 95% CI 0.28–0.84), but higher odds for those in the highest tertile (adjusted OR 2.37 95% CI 1.33–4.21).
Conclusion
In patients with TKA, preoperative expectations regarding kneeling and psychological well‐being were significantly associated with the level of TKA satisfaction at 1 year. Ensuring that patients’ expectations are achievable may enhance appropriate provision of TKA.
Background Total joint arthroplasty is a highly efficacious and cost-effective procedure for moderate to severe arthritis in the hip and knee. Although patient characteristics are considered to be ...important determinants of who receives total joint arthroplasty, no systematic review has addressed how they affect the outcomes of total joint arthroplasty. This study addresses how patient characteristics influence the outcomes of hip and knee arthroplasty in patients with osteoarthritis. Methods We searched 4 bibliographic databases (MEDLINE 1980–2001, CINAHL 1982–2001, EMBASE 1980–2001, HealthStar 1998–1999) for studies involving more than 500 patients with osteoarthritis and 1 or more of the following outcomes after total joint arthroplasty: pain, physical function, postoperative complications (short-and long-term) and time to revision. Prognostic patient characteristics of interest included age, sex, race, body weight, socioeconomic status and work status. Results Sixty-four of 14 276 studies were eligible for inclusion and had extractable data. Younger age (variably defined) and male sex increased the risk of revision 3-fold to 5-fold for hip and knee arthroplasty. The influence of weight on the risk of revision was contradictory. Mortality was greatest in the oldest age group and among men. Function for older patients was worse after hip arthroplasty (particularly in women). Function after knee arthroplasty was worse for obese patients. Conclusion Although further research is required, our findings suggest that, after total joint arthroplasty, younger age and male sex are associated with increased risk of revision, older age and male sex are associated with increased risk of mortality, older age is related to worse function (particularly among women), and age and sex do not influence the outcome of pain. Despite these findings, all subgroups derived benefit from total joint arthroplasty, suggesting that surgeons should not restrict access to these procedures based on patient characteristics. In addition, future research needs to provide standardized measures of outcomes.
OBJECTIVE:--Compared with men and women without diabetes, individuals with type 2 diabetes have higher bone mineral density (BMD). However, they may still be at increased risk for hip fractures. ...Using population-based Ontario health care data, we compared the risk of hip fractures among men and women with and without diabetes. RESEARCH DESIGN AND METHODS--Using a retrospective cohort design, we identified Ontario residents aged >=66 years with diabetes from a validated registry from 1994 to 1995 (n = 197,412) and followed them for their first hip fracture until 31 March 2003 (mean 6.1-year follow-up). Hip fracture rates were compared with those of age-matched Ontario residents without diabetes (n = 401,400), and results were stratified by sex and adjusted for age and other covariates. RESULTS:--Compared with individuals without diabetes, individuals with diabetes had greater comorbidity, were less likely to have had a BMD test, and were more likely to be taking medications that increase risk of falling and decrease BMD. After adjusting for these differences and age, we found that diabetes increased fracture risk in both men (hazard ratio 1.18 95% CI 1.12-1.24, P < 0.0001) and women (1.11 1.08-1.15, P < 0.0001). CONCLUSIONS:--Men and women with diabetes have a higher risk of hip fractures compared with individuals without diabetes. Further research to elucidate the mechanisms underlying this increased risk of fracture is needed, as well as increased attention to fracture prevention strategies in patients with diabetes.
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