scholarly journals Uncovering associations between data-driven learned qMRI biomarkers and chronic pain

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alejandro G. Morales ◽  
Jinhee J. Lee ◽  
Francesco Caliva ◽  
Claudia Iriondo ◽  
Felix Liu ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Knee Pain ◽  
Relaxation Times ◽  
Magnetic Resonance Images ◽  
Cartilage Thickness ◽  
Imaging Biomarkers ◽  
Lateral Side ◽  
Ratio Test ◽  
Medial Side ◽  
Chronic Knee Pain

AbstractKnee pain is the most common and debilitating symptom of knee osteoarthritis (OA). While there is a perceived association between OA imaging biomarkers and pain, there are weak or conflicting findings for this relationship. This study uses Deep Learning (DL) models to elucidate associations between bone shape, cartilage thickness and T2 relaxation times extracted from Magnetic Resonance Images (MRI) and chronic knee pain. Class Activation Maps (Grad-CAM) applied on the trained chronic pain DL models are used to evaluate the locations of features associated with presence and absence of pain. For the cartilage thickness biomarker, the presence of features sensitive for pain presence were generally located in the medial side, while the features specific for pain absence were generally located in the anterior lateral side. This suggests that the association of cartilage thickness and pain varies, requiring a more personalized averaging strategy. We propose a novel DL-guided definition for cartilage thickness spatial averaging based on Grad-CAM weights. We showed a significant improvement modeling chronic knee pain with the inclusion of the novel biomarker definition: likelihood ratio test p-values of 7.01 × 10–33 and 1.93 × 10–14 for DL-guided cartilage thickness averaging for the femur and tibia, respectively, compared to the cartilage thickness compartment averaging.

scholarly journals Differential Contribution of the Medial and the Lateral Side of the Joint to Symptoms in Knee Osteoarthritis: A Radiographic and Laboratory Analysis in the Nagahama Study

Cartilage ◽  
2021 ◽  
pp. 194760352110258
Author(s):  
Kazuya Nigoro ◽  
Hiromu Ito ◽  
Tomotoshi Kawata ◽  
Shinichiro Ishie ◽  
Yugo Morita ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Clinical Outcomes ◽  
Knee Pain ◽  
High Sensitivity ◽  
Analysis Of Covariance ◽  
Radiographic Evaluation ◽  
Radiographic Feature ◽  
Lateral Side ◽  
Cross Sectional ◽  
Medial Side

Objective: This cross-sectional study aimed to explore the differences of the medial and lateral sides of the knee joint and precise radiographic abnormalities in contribution to the knee pain and clinical outcomes. Design: Participants 60 years or older who underwent radiographic evaluation were included. Knee radiography was assessed using grading systems of the Osteoarthritis Research Society International (OARSI) atlas. The Japanese Knee Osteoarthritis Measure (JKOM) was evaluated as clinical outcomes. Serum high-sensitivity C-reactive protein (hsCRP) was used to evaluate systemic inflammation. We divided the participants into normal, medial-, lateral-, and medial & lateral-OA types and compared their JKOM using an analysis of covariance. Furthermore, we analyzed the relationship between the knee pain and stiffness of JKOM and the grading of each radiographic feature using a multiple regression model. Results: Lateral- and medial & lateral-OA groups had a significantly worse symptoms in the total and the pain score, especially in movement subscales, in JKOM score. Lateral-OA groups had higher hsCRP than medial-OA group. Multivariate analysis showed that medial joint space narrowing (JSN), and lateral femoral and tibial osteophytes significantly affected knee pain (adjusted odds ratios: 1.73, 1.28, and 1.55, respectively). The radiographic changes are associated with pain more in JSN in the medial side and osteophytes in the lateral side. Conclusion: Lateral- and medial & lateral-OA groups showed worth symptom. In addition, medial JSN and lateral osteophytes have potent effects on the knee pain.

scholarly journals Towards a brain signature of chronic pain using cerebral blood flow spatial covariance analysis in people with chronic knee pain

2019 ◽  
Author(s):  
Sarina J. Iwabuchi ◽  
Yue Xing ◽  
William J. Cottam ◽  
Marianne M. Drabek ◽  
Arman Tadjibaev ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Knee Pain ◽  
Current Evidence ◽  
Spatial Covariance ◽  
Default Mode ◽  
Chronic Knee Pain ◽  
Pain Sensitization ◽  
Pain Patients

AbstractChronic musculoskeletal pain is a common problem globally. Current evidence suggests that maladaptive modulation of central pain pathways is associated with pain chronicity following e.g. chronic post-operative pain after knee replacement. Other factors such as low mood, anxiety and tendency to catastrophize seem to also be important contributors. We aimed to identify a chronic pain brain signature that discriminates chronic pain from pain-free conditions using cerebral blood flow (CBF) measures, and explore how this signature relates to the chronic pain experience. In 44 chronic knee pain patients and 29 pain-free controls, we acquired CBF data (using arterial spin labelling) and T1-weighted images. Participants completed a series of questionnaires related to affective processes, and pressure and cuff algometry to assess pain sensitization. Two factor scores were extracted from these scores representing negative affect and pain sensitization, respectively. A spatial covariance principal components analysis of CBF identified five components that significantly discriminated chronic pain patients from controls, with the unified network achieving 0.83 discriminatory accuracy (area under the curve). In chronic knee pain, significant patterns of relative hypo-perfusion were evident in anterior regions of the default mode and salience network hubs, while hyperperfusion was seen in posterior default mode regions, the thalamus, and sensory regions. One component was positively correlated to the pain sensitization score (r=.43, p=.006), suggesting that this CBF pattern reflects the neural activity changes encoding pain sensitization. Here, we report the first chronic knee pain-related brain signature, pointing to a brain signature underpinning the central aspects of pain sensitisation.

scholarly journals A Systematic Review of the Effectiveness of Rehabilitation Therapy to Treat People with Chronic Knee Pain Following A Total Knee Replacement.

2020 ◽  
Author(s):  
Nathan Adam Johns ◽  
Justine Naylor ◽  
Brinda Thirugnanam ◽  
Dean Mckenzie ◽  
Bernadette Brady ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Chronic Pain ◽  
Total Knee Replacement ◽  
Knee Pain ◽  
Knee Replacement ◽  
Chronic Knee Pain ◽  
Total Knee ◽  
Full Text Screening

Abstract Background:Chronic knee pain after a total knee replacement has been estimated to affect 10 to 30% of patients and is related to dissatisfaction with surgery, reduced function and reduced quality of life. Rehabilitation is often prescribed in the subacute period post-operatively, but it may offer benefit to the increasing numbers of patients with chronic pain after their knee replacement. The aim of this systematic review is to evaluate the effectiveness of rehabilitation to improve pain, function and quality of life in people with chronic knee pain persisting for more than 3 months following a total knee replacement.Methods: The systematic review was conducted following PRISMA guidelines with a search of the online databases Ovid Medline, Embase via Ovid, CINAHL Plus, PsycINFO, Ovid Emcare and Proquest from their earliest date to July 12, 2020. The search criteria included English language randomised controlled trials of rehabilitation strategies in any setting to treat people with chronic knee pain, defined as knee pain persisting for more than 3 months, following a total knee replacement. Rehabilitation programs included exercise therapy, patient education, cognitive and mind-body strategies and self-management and excluded medication trials, procedural techniques and complementary therapies. Results:There were 254 abstracts screened for eligibility with 13 remaining for full-text screening. Following full-text screening, there were no studies that met the eligibility criteria for evaluating rehabilitation therapy to treat chronic knee pain persisting for more than 3 months following a total knee replacement.Conclusion:Despite the high volume of knee replacement surgery and the high incidence of moderate to severe chronic pain ensuing, there is currently no evidence available that rehabilitation commencing three months after surgery can effectively treat chronic pain and disability following a total knee replacement.

scholarly journals Relationships Between Chronic Pain Stage, Cognition, Temporal Lobe Cortex, and Sociodemographic Variables

2021 ◽  
Vol 80 (4) ◽  
pp. 1539-1551
Author(s):  
Jared J. Tanner ◽  
Shivani Hanchate ◽  
Catherine C. Price ◽  
Cynthia Garvan ◽  
Song Lai ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Knee Pain ◽  
Temporal Lobe ◽  
Temporal Cortex ◽  
Community Dwelling ◽  
Biological Aging ◽  
Sociodemographic Variables ◽  
Chronic Knee Pain ◽  
Increased Risk ◽  
Complex Relationships

Background: Non-Hispanic black (NHB) individuals have increased risk of Alzheimer’s disease (AD) relative to non-Hispanic whites (NHW). Ethnicity/race can serve as a proxy sociodemographic variable for a complex representation of sociocultural and environmental factors. Chronic pain is a form of stress with high prevalence and sociodemographic disparities. Chronic pain is linked to lower cognition and accelerated biological aging. Objective: The purpose of this study is to seek understanding of potential cognitive and temporal lobe structural brain AD vulnerabilities based on chronic pain stage and ethnicity/race. Methods: Participants included 147 community dwelling NHB and NHW adults without dementia between 45–85 years old who had or were at risk of knee osteoarthritis. All participants received an MRI (3T Philips), the Montreal Cognitive Assessment (MoCA), and assessment of clinical knee pain stage. Results: There were ethnic/race group differences in MoCA scores but no relationships with chronic knee pain stage. Ethnicity/race moderated the relationship between AD-related temporal lobe thickness and chronic pain stage with quadratic patterns suggesting thinner cortex in high chronic pain stage NHB adults. Conclusion: There appear to be complex relationships between chronic knee pain stage, temporal lobe cortex, and sociodemographic variables. Specifically, NHB participants without dementia but with high chronic knee pain stage appeared to have thinner temporal cortex in areas associated with AD. Understanding the effects of sociocultural and socioeconomic factors on health outcomes is the first step to challenging the disparities in healthcare that now appear to link disease conditions to neurodegenerative processes.

scholarly journals Genicular Nerve Radiofrequency Ablation and Dual Subsartorial Block for Chronic Knee Pain Post Total Knee Replacement: A Case Report

2022 ◽  
Vol 2 (2) ◽  
pp. 253-257
Author(s):  
Aidyl Fitrisyah ◽  
Stevanus Eliansyah Handrawan ◽  
Nurlaili Maya Ramadhanty
Keyword(s):  
Chronic Pain ◽  
Radiofrequency Ablation ◽  
Total Knee Replacement ◽  
Knee Pain ◽  
Knee Replacement ◽  
Rating Scale ◽  
Womac Score ◽  
Assessment Tools ◽  
Chronic Knee Pain ◽  
Total Knee

Introduction. Chronic pain defines as pain persisting for three months or longer, chronic post-surgical pain can affect all dimensions of health-related quality of life, and is associated with functional limitations. treatment of chronic pain after total knee replacement is challenging, and evaluation of combined treatments and individually targeted treatments matched to patient characteristic. Genicular nerve block radiofrequency ablation is a safe and effective therapeutic procedure for pain associated with chronic pain due to knee osteoarthritis, and the evolution of newer regional analgesia techniques aids in reducing postoperative pain Dual Subsartorial Block (DSB) as a procedure specific, post total knee replacemet. historically there has been a reliance on using a pain-spesific assessment tools Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Case Presentation. A 55-year old woman admitted she had pain on bilateral knee, the knee pain had affected her daily living, she was diagnosed with chronic knee pain post TKR because of osteoarthritis genu bilateral, the patient was planning genicular nerve radiofrequency ablation and dual subsartorial block, from the examination we found that numeric rating scale was 6 (moderate pain) with WOMAC score 76, before the procedure the patients are examined through radiology for any deformity in the knee. The genicular nerve radiofrequency ablation under ultrasound guidance on bonylandmark, resulting anesthesia of the anterior compartment of the knee, and dual subsartorial block that cover almost all the innervations of pain generating component of the anterior and posterior knee joint involved in TKR surgery. After the procedure we reevaluated the pain score using NRS was 2 (mild pain), and with WOMAC Score 19. Conclusion. Treatment of chronic pain post total knee replacemet was challenging, targeted treatment may ameliorate the pain and prevent long term disability.  

scholarly journals Long-Term Retrospective Assessment of Clinical Efficacy of Radiofrequency Ablation of the Knee Using a Cooled Radiofrequency System

2019 ◽  
Vol 5 (22;5) ◽  
pp. 489-489
Author(s):  
Leonardo Kapural
Keyword(s):  
Chronic Pain ◽  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Knee Pain ◽  
Controlled Trial ◽  
Real Life ◽  
Clinical Effectiveness ◽  
Opioid Use ◽  
Chronic Knee Pain

Background: Cooled radiofrequency ablation (CRFA) in a randomized, prospective study demonstrated significantly greater improvements in pain, functional, and global outcome measures. Objectives: This large, real-life, retrospective study evaluated the long-term effectiveness of CRFA in the general chronic knee pain population. Study Design: Retrospective electronic chart review. Setting: Outpatient private practice. Methods: After institutional review board approval, we reviewed data of 275 consecutive patients who had undergone a geniculate nerve block at a single-site pain practice between July 1, 2014 and July 1, 2017. A total of 44 patients had a negative response to the geniculate block, and 11 patients had long-term pain relief from the block and declined CRFA. Eight patients underwent knee surgery after the block, and 7 never followed up for further treatment. Finally, 205 patients had undergone CRFA, and 183 (89%) of them returned to provide data. Results: The average age of the 183 patients was 61 (28-95) years, body mass index 34 (18.5- 57), and there were 105 women and 78 men. A total of 137 patients had unilateral knee pain, whereas 46 patients had bilateral knee pain. Eighty percent (146/183) reported at least one or more additional sources of chronic pain (back, shoulder, and others). The average opioid use at baseline was 50 mg morphine sulfate equivalents (median 30 mg). The average baseline pain scores were 8.5, which decreased to 2.2 after the geniculate local anesthetic block, and to 4.2 after CRFA. A total of 65% of the patients claimed > 50% pain relief, whereas 77% had 2 or more Visual Analog Scale points decrease, and 26 (14%) patients reported no pain at all after CRFA. The mean duration of > 50% pain relief after CRFA was 12.5 months (range 0-35 months). There was no significant decrease of opioid use. Patients who underwent a repeated procedure (n = 43) achieved a similar pain relief (P = 0.402). We could not find a statistical difference in geniculate CRFA outcomes between the group who had total knee arthroplasty (TKA; n = 21) and maintained chronic knee pain and patients who had no prior surgery (P = 0.542). Limitations: Retrospective nature of the study. Conclusions: This study demonstrates the clinical effectiveness of CRFA in the treatment of chronic knee pain from osteoarthritis, and even in those patients who maintained chronic knee pain after TKA. Our real-life data seems to agree with data previously published in a randomized controlled trial, despite the fact that this was quite a heterogenous patient population with various sources of chronic pain. Key words: Radiofrequency ablation, chronic knee pain, knee osteoarthritis

An emerging technology: Nuclear magnetic resonance microscopy

1988 ◽  
Vol 46 ◽  
pp. 1000-1001
Author(s):  
M.J. Hennessy ◽  
E. Kwok
Keyword(s):  
Nuclear Magnetic Resonance ◽  
Magnetic Resonance ◽  
Relaxation Times ◽  
Basic Research ◽  
Local Environment ◽  
Magnetic Resonance Images ◽  
Nmr Microscopy ◽  
Mri Scans ◽  
Temperature Relaxation ◽  
Nuclear Magnetic

Much progress in nuclear magnetic resonance microscope has been made in the last few years as a result of improved instrumentation and techniques being made available through basic research in magnetic resonance imaging (MRI) technologies for medicine. Nuclear magnetic resonance (NMR) was first observed in the hydrogen nucleus in water by Bloch, Purcell and Pound over 40 years ago. Today, in medicine, virtually all commercial MRI scans are made of water bound in tissue. This is also true for NMR microscopy, which has focussed mainly on biological applications. The reason water is the favored molecule for NMR is because water is,the most abundant molecule in biology. It is also the most NMR sensitive having the largest nuclear magnetic moment and having reasonable room temperature relaxation times (from 10 ms to 3 sec). The contrast seen in magnetic resonance images is due mostly to distribution of water relaxation times in sample which are extremely sensitive to the local environment.

Visualization of Cartilage from Knee Joint Magnetic Resonance Images and Quantitative Assessment to Study the Effect of Age, Gender and Body Mass Index (BMI) in Progressive Osteoarthritis (OA)

2019 ◽  
Vol 15 (6) ◽  
pp. 565-572
Author(s):  
Mallikarjunaswamy Shivagangadharaiah Matada ◽  
Mallikarjun Sayabanna Holi ◽  
Rajesh Raman ◽  
Sujana Theja Jayaramu Suvarna
Keyword(s):  
Body Mass Index ◽  
Magnetic Resonance ◽  
Knee Joint ◽  
Body Mass ◽  
3D Visualization ◽  
Cartilage Degradation ◽  
Magnetic Resonance Images ◽  
Cartilage Thickness ◽  
Knee Joints ◽  
Data Set

Background: Osteoarthritis (OA) is a degenerative disease of joint cartilage affecting the elderly people around the world. Visualization and quantification of cartilage is very much essential for the assessment of OA and rehabilitation of the affected people. Magnetic Resonance Imaging (MRI) is the most widely used imaging modality in the treatment of knee joint diseases. But there are many challenges in proper visualization and quantification of articular cartilage using MRI. Volume rendering and 3D visualization can provide an overview of anatomy and disease condition of knee joint. In this work, cartilage is segmented from knee joint MRI, visualized in 3D using Volume of Interest (VOI) approach. Methods: Visualization of cartilage helps in the assessment of cartilage degradation in diseased knee joints. Cartilage thickness and volume were quantified using image processing techniques in OA affected knee joints. Statistical analysis is carried out on processed data set consisting of 110 of knee joints which include male (56) and female (54) of normal (22) and different stages of OA (88). The differences in thickness and volume of cartilage were observed in cartilage in groups based on age, gender and BMI in normal and progressive OA knee joints. Results: The results show that size and volume of cartilage are found to be significantly low in OA as compared to normal knee joints. The cartilage thickness and volume is significantly low for people with age 50 years and above and Body Mass Index (BMI) equal and greater than 25. Cartilage volume correlates with the progression of the disease and can be used for the evaluation of the response to therapies. Conclusion: The developed methods can be used as helping tool in the assessment of cartilage degradation in OA affected knee joint patients and treatment planning.

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