Discordance between radiographic findings, pain, and superficial temperature in knee osteoarthritis.

INTRODUCTION: Knee pain is an imprecise marker of radiographic evidence of osteoarthritis (OA). These patients are more likely to develop central sensitisation to pain, a risk factor for chronic pain. OBJECTIVES: The aim of this study was to examine the associations among radiographic evidence of OA, self-reported pain, pressure pain thresholds (PPT), and superficial knee temperature in individuals with knee OA. MATERIAL AND METHODS: This cross-sectional study enrolled 25 patients with knee OA with clinic and radiographic diagnosis of bilateral OA (Kellgren-Lawrence grading scale 1-4 in X-ray images), but symptoms of pain and discomfort in only one of the knees, with pain perception in the symptomatic knee equal to or above 4 in a visual analogue scale. Volunteers underwent an evaluation including demographic data, superficial knee temperature (infrared thermography, mean superficial temperature of the region of the knee) and PPT (digital algometry at longus adductor, vastus lateralis, vastus medialis and tibialis anterior muscles, patellar tendon, and centre of the patella). RESULTS: Comparisons between symptomatic and asymptomatic knees revealed no differences regarding Kellgren-Lawrence classification, knee superficial temperature, or PPT. Significant weak and moderate associations were found between radiographic classification of OA and PPT of both knees in almost all sites evaluated. Nonetheless, superficial temperature of the knee was not associated with PPT or Kellgren-Lawrence grading scale. CONCLUSIONS: Patients with bilateral knee OA presented no differences in symptomatic and asymptomatic knees regarding radiographic evidence, knee temperature, and PPT, indicating that central sensitisation may be present in them. Radiographic classification of OA was significantly associated with PPT in both knees.

Relación entre el miedo a caer, la movilidad y el tiempo de lesión cerebrovacular en los ancianos / Relationship between fear of falling, mobility and time of stroke in the elderly

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Serum levels of proinflammatory cytokines in painful knee osteoarthritis and sensitization.

Osteoarthritis (OA) is the most common joint disorder in the world. Among the mechanisms involved in osteoarthritis, biomarkers (cytokines profile) may be related to pain and pain intensity, functional capacity, and pressure pain thresholds (PPT). Thus, the study of these relationships may offer useful information about pathophysiology and associated mechanisms involved in osteoarthritis. Therefore, the objective of this study was to investigate the seric concentration of pro (IL-6, IL-8, and TNF-α) and anti-inflammatory (IL-10) cytokines in patients with painful knee osteoarthritis and to correlate the levels of these biomarkers with the patients' functional capacity and pressure pain threshold (PPT) values.

Efficacy of transcranial direct current stimulation coupled with a multidisciplinary rehabilitation program for the treatment of fibromyalgia.

UNLABELLED: Pain control in fibromyalgia patients is limited no matter the therapeutic regimens used. Recent data have shown that daily sessions of anodal transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) in patients with fibromyalgia (FM) are associated with reduction of pain perception. OBJECTIVE: We aimed to test whether active tDCS, as compared with sham tDCS, combined with multidisciplinary rehabilitation is associated with significant clinical gains in fibromyalgia. DESIGN: This was a randomized, double-blinded controlled trial. SUBJECTS: 23 patients were randomized to receive weekly sessions of multidisciplinary rehabilitation approach combined with sham or anodal tDCS of M1. Patients were evaluated for pain with VAS and for quality of life with SF-36, fibromyalgia pain questionnaire and health assessment questionnaire by a blinded rater before and after the 4 month period of rehabilitation. RESULTS: Patients tolerated tDCS treatment well, without adverse effects. Patients who received active treatment had a significantly greater reduction of SF-36 pain domain scores (F((2,21))=6.57; p=0.006) and a tendency of higher improvement in Fibromyalgia Impact Questionnaire (FIQ) scores after (p=0.056) as compared with sham tDCS/standard treatment, but no differences were observed in the other domains. CONCLUSIONS: Although active tDCS was associated with superior results in one domain (SF-36 pain domain), the lack of significance in the other domains does not fully support this strategy (weekly tDCS) combined with a multidisciplinary approach.