Scoping Review of Pain and Patient Characteristics and Physical Function Associated with Intermittent and Constant Pain in People with Knee Osteoarthritis.

Purpose: We identified the pain and patient characteristics and physical function associated with intermittent and constant pain in people with knee osteoarthritis (OA). Method: The search strategy was conducted in MEDLINE, CINAHL, Embase, SPORTDiscus, Cochrane, and the Physiotherapy Evidence Database for articles published up to October 2018. We included observational studies, randomized controlled trials, reviews, qualitative studies, and case reports in English and French of adults with knee OA. Articles were screened by two independent reviewers, and disagreements were resolved by a third researcher. Results: Our search yielded 1,232 articles, and 4 articles were included in the review. Constant pain was related to limitations in daily activities, a higher Kellgren and Lawrence grade, a higher prevalence of comorbidities, and symptomatic knee OA and depressive symptoms. Intermittent pain was associated with limitations in high-impact activities, but greater time spent in moderate activities was reported. The evidence is contradictory as to whether intermittent or constant pain has a greater average severity. Conclusions: There was limited evidence available to determine the association of pain and patient characteristics and physical function with constant and intermittent pain in people with knee OA. Future research will help improve our understanding of these two pain patterns by examining their associations across a variety of pain and functional outcomes in people with knee OA.

Objectif : déterminer les caratéristique de la douleur et des patients ainsi que la fonction physique associées à une douleur intermittente et constante chez les personnes atteintes d'arthrose du genou. Méthodologie : les chercheurs ont fouillé les bases de données MEDLINE, CINAHL, Embase, SPORTDiscus, Cochrane et Physiotherapy Evidence Database jusqu'en octobre 2018. Ils ont inclus des études d'observation, des essais aléatoires et contrôlés, des analyses, des études qualitatives et des rapports de cas d'adultes atteints d'arthrose du genou, en anglais et en français. Deux réviseurs indépendants ont parcouru les articles et un troisième chercheur a résolu les désaccords. Résultats : la recherche a permis d'extraire 1 232 articles, dont quatre ont été retenus. La douleur chronique suscitait des limitations aux activités quotidiennes, un score de Kellgren et Lawrence plus élevé, une prévalence de morbidité plus élevée, une arthrose du genou symptomatique et des symptômes de dépression. La douleur intermittente était liée à des limitations lors d'activités à fort impact, mais à plus de temps consacré aux activités modérées. Les données sont contradictoires quant à la gravité moyenne accrue de la douleur constante ou intermittente. Conclusions : les données probantes sont limitées pour déterminer l'association entre, d'une part, les caractéristiques la douleur et des patients et la fonction physique et, d'autre part, les douleurs constantes et intermittentes causées par l'arthrose du genou. Pour mieux comprendre ces deux profils de douleur, de prochaines recherches porteront sur leur association avec divers résultats cliniques sur le plan de la douleur et de la fonction chez les personnes atteintes d'arthrose du genou.

Validity of the central sensitization inventory with measures of sensitization in people with knee osteoarthritis.

Our purpose was to determine the validity of the Central Sensitization Inventory (CSI) with psychophysical tests, psychological and physical factors in patients with Knee Osteoarthritis (KOA). Patients with KOA were recruited from three Montreal hospitals. Psychophysical tests (pressure pain threshold, conditioned pain modulation, temporal summation) were conducted and questionnaires administered to determine the presence of neuropathic pain, somatization, anxiodepressive symptoms, pain catastrophizing (PC), and widespread pain (WSP). Relations between the CSI, psychophysical tests, and questionnaires were assessed using correlations and chi-square analysis. Receiver Operating Characteristics (ROC) curves determined sensitivity and specificity scores. Multiple linear regression was performed to predict the association of CSI scores with somatization, anxiodepressive symptoms, PC, and WSP factors. One hundred thirty-three participants were assessed, 56.4% female, mean age 63.5 years. The CSI was weakly correlated with decreased pressure pain thresholds locally (rs - 0.264, p = 0.004) and remotely (rs - 0.235, p = 0.011) and with conditioned pain modulation (rs 0.187, p = 0.045). ROC curve analyses suggested an optimal CSI cut-point of 36 (Sn 75%, Sp 63.4%). Performance of the CSI used in combination with a neuropathic pain questionnaire was not significantly superior. After adjustment for covariates, a multivariable linear regression determined WSP (unstandardized ß 4.161(0.067, 8.255) p = 0.046), somatization (unstandardized ß 1.828 (1.368, 2.288) p < 0.005), and anxiodepressive symptoms (unstandardized ß 0.419 (0.107, 0.730) p = 0.009) significantly predicted CSI scores. The CSI is more strongly associated with psychological factors than psychophysical test results in a KOA population. Its moderate sensitivity and specificity suggest it should be used as part of a more comprehensive evaluative toolkit.