Pragmatic approach to quantitative sensory testing in knee osteoarthritis: measures of mechanical pain sensitivity predict concordant pain and structural status

AbstractBackground and aimsSex differences in clinical pain severity and response to experimental pain are commonly reported, with women generally showing greater vulnerability. Affect, including state (a single rating) and stable (average daily ratings over two weeks) positive affect and negative affect has also been found to impact pain sensitivity and severity, and research suggests that affect may modulate pain differentially as a function of sex. The current study aimed to examine sex as a moderator of the relationships between affect and pain-related outcomes among participants with knee osteoarthritis (KOA).MethodsOne hundred and seventy-nine participants (59 men) with KOA completed electronic diaries assessing clinical pain, positive affect, and negative affect. A subset of participants (n = 120) underwent quantitative sensory testing, from which a single index of central sensitization to pain was derived. We used multiple regression models to test for the interactive effects of sex and affect (positive versus negative and stable versus state) on pain-related outcomes. We used mixed effects models to test for the moderating effects of sex on the relationships between state affect and pain over time.ResultsSex differences in affect and pain were identified, with men reporting significantly higher stable positive affect and lower central sensitization to pain indexed by quantitative sensory testing, as well as marginally lower KOA-specific clinical pain compared to women. Moreover, there was an interaction between stable positive affect and sex on KOA-specific clinical pain and average daily non-specific pain ratings. Post hoc analyses revealed that men showed trends towards an inverse relationship between stable positive affect and pain outcomes, while women showed no relationship between positive affect and pain. There was also a significant interaction between sex and stable negative affect and sex on KOA-specific pain such that men showed a significantly stronger positive relationship between stable negative affect and KOA-specific pain than women. Sex did not interact with state affect on pain outcomes.ConclusionsFindings suggest that men may be particularly sensitive to the effects of stable positive affect and negative affect on clinical pain. Future work with larger samples is needed in order to identify potential mechanisms driving the sex-specific effects of affect on pain.ImplicationsThe current study provides novel data that suggesting that the association of positive affect, negative affect, and pain are different in men versus women with KOA. Further understanding of the difference in affective expression between men and women may lead to the development of novel therapeutic interventions and help to identify additional modifiable factors in the prevention and management of pain.

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Quantitative Sensory Testing in Vulvodynia Patients and Increased Peripheral Pressure Pain Sensitivity

Obstetrics and Gynecology ◽

10.1097/01.aog.0000129238.49397.4e ◽

2004 ◽

Vol 104 (1) ◽

pp. 126-133 ◽

Cited By ~ 132

Author(s):

Jutta Giesecke ◽

Barbara D. Reed ◽

Hope K. Haefner ◽

Thorsten Giesecke ◽

Daniel J. Clauw ◽

...

Keyword(s):

Quantitative Sensory Testing ◽

Pain Sensitivity ◽

Sensory Testing ◽

Pressure Pain

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Increased sensitivity to physical activity among individuals with knee osteoarthritis: Relation to pain outcomes, psychological factors, and responses to quantitative sensory testing

Pain ◽

10.1016/j.pain.2013.12.028 ◽

2014 ◽

Vol 155 (4) ◽

pp. 703-711 ◽

Cited By ~ 45

Author(s):

Timothy H. Wideman ◽

Patrick H. Finan ◽

Robert R. Edwards ◽

Phillip J. Quartana ◽

Luis F. Buenaver ◽

...

Keyword(s):

Physical Activity ◽

Knee Osteoarthritis ◽

Psychological Factors ◽

Quantitative Sensory Testing ◽

Sensory Testing ◽

Pain Outcomes ◽

Increased Sensitivity

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Does Long-Term Opioid Therapy Reduce Pain Sensitivity of Patients with Chronic Low Back Pain? Evidence from Quantitative Sensory Testing

January 2018 - Pain Physician ◽

10.36076/ppj.2012/15/es135 ◽

2012 ◽

Vol 3S;15 (3S;7) ◽

pp. ES135-ES143

Author(s):

Haili Wang

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Quantitative Sensory Testing ◽

Pain Sensitivity ◽

Opioid Therapy ◽

Low Back ◽

Sensory Testing ◽

Opioid Treatment

Background: Long-term opioid treatment has been used extensively in treatment of chronic low back pain (cLBP) in the last decades. However, there are serious limitations to the long-term efficacy of opioids and related side effects. Objectives: In this study we investigated whether long-term opioid treatment changes pain sensitivity of patients with cLBP. Study Design: A prospective, nonrandomized, cross-sectional study. Setting: Multidisciplinary pain management clinic, specialty referral center, university hospital in Germany. Methods: Using quantitative sensory testing (QST), we compared the pain sensitivity of the low back bilaterally among 3 groups: 35 patients with cLBP undergoing a long-term opioid therapy (OP); 35 patients with cLBP administered no opioids (ON), and 28 subjects with neither pain nor opioid intake (HC). Results: OP patients showed significantly higher bilateral thermal detection thresholds to warm stimuli on the back as compared to both ON (P = 0.009 for left low back, P = 0.008 for right low back) and HC subjects (P = 0.004 for left low back, P = 0.003 for right low back). Pain thresholds for cold and heat on the hand were similar in OP and ON groups; both showed, however, significantly reduced heat pain thresholds in comparison with HC participants (P = 0.012 for OP, P = 0.001 for ON). Factors such as age, sex, duration and dose of opioid intake, and self-reported pain intensity, but not depression and pain duration, correlated significantly with QST results. Limitations: Limitations include small numbers of patients with heterogeneous opioid therapy and the nonrandomized observational nature of the study. Conclusions: The current study demonstrated that chronic opioid intake may only reduce the temperature sensitivity but not pain sensitivity measured by QST which is a useful tool in detecting characteristic changes in pain perception of patients with chronic low back pain after long-term opioid intake. Key words: Pain sensitivity, opioid treatment, chronic low back pain (cLBP), quantitative sensory testing (QST)

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