The sources of pain in knee osteoarthritis

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Abstract

To review the mechanisms for the production of pain in knee osteoarthritis. Nociception is produced by stimulation of unmyelinated and small myelinated fibers in the joint and surrounding tissue. To produce pain, the stimuli must be either repeated or spatially clustered. When they reach the spinal cord, stimuli are subject to two inhibitory effectors: interneurons and descending central neurons. Inflammation lowers the threshold for nociception. In the joint, tissues containing nociceptors include primarily the joint capsule, ligaments, synovium, bone, and in the knee, the outer edge of the menisci. Nociceptive stimuli are likely to emanate from one or more of these locations in people with knee pain. This review does not cover psychological aspects of pain. Nociception in the knee is complex, and the nociceptive stimuli are related to but fundamentally different from those producing cartilage loss. Better appreciation for these processes will facilitate the development of new treatments.

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The association of bone marrow lesions with pain in knee osteoarthritis.

D Felson, C Chaisson, C. Hill … (2001)

The cause of pain in osteoarthritis is unknown. Bone has pain fibers, and marrow lesions, which are thought to represent edema, have been noted in osteoarthritis. To determine whether bone marrow lesions on magnetic resonance imaging (MRI) are associated with pain in knee osteoarthritis. Cross-sectional observational study. Veterans Affairs Medical Center. 401 persons (mean age, 66.8 years) with knee osteoarthritis on radiography who were drawn from clinics in the Veterans Administration health care system and from the community. Of these persons, 351 had knee pain and 50 had no knee pain. Knee radiography and MRI of one knee were performed in all participants. Those with knee pain quantified the severity of their pain. On MRI, coronal T(2)-weighted fat-saturated images were used to score the size of bone marrow lesions, and each knee was characterized as having any lesion or any large lesion. The prevalence of lesions and large lesions in persons with and without knee pain was compared; in participants with knee pain, the presence of lesions was correlated with severity of pain. Bone marrow lesions were found in 272 of 351 (77.5%) persons with painful knees compared with 15 of 50 (30%) persons with no knee pain (P < 0.001). Large lesions were present almost exclusively in persons with knee pain (35.9% vs. 2%; P < 0.001). After adjustment for severity of radiographic disease, effusion, age, and sex, lesions and large lesions remained associated with the occurrence of knee pain. Among persons with knee pain, bone marrow lesions were not associated with pain severity. Bone marrow lesions on MRI are strongly associated with the presence of pain in knee osteoarthritis.

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Psychological aspects of persistent pain: current state of the science.

Francis Keefe, Meredith Rumble, Cindy D Scipio … (2004)

This article provides an overview of current research on psychological aspects of persistent pain. It is divided into 3 sections. In section 1, recent studies are reviewed that provide evidence that psychological factors are related to adjustment to persistent pain. This section addresses research on factors associated with increased pain and poorer adjustment to pain (ie, pain catastrophizing, pain-related anxiety and fear of pain, and helplessness) and factors associated with decreased pain and improved adjustment to pain (ie, self-efficacy, pain coping strategies, readiness to change, and acceptance). In section 2, we review recent research on behavioral and psychosocial interventions for patients with persistent pain. Topics addressed include early intervention, tailoring treatment, telephone/Internet-based treatment, caregiver-assisted treatment, and exposure-based protocols. In section 3, we conclude with a general discussion that highlights steps needed to advance this area of research including developing more comprehensive and integrative conceptual models, increasing attention to the social context of pain, examining the link of psychological factors to pain-related brain activation patterns, and investigating the mechanisms underlying the efficacy of psychological treatments for pain. This is one of several invited commentaries to appear in The Journal of Pain in recognition of The Decade of Pain Research. This article provides an overview of current research on psychological aspects of persistent pain, and highlights steps needed to advance this area of research. Copyright 2004 American Pain Society