scholarly journals Neuropathic pain in the IMI-APPROACH knee osteoarthritis cohort: prevalence and phenotyping

RMD Open ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e002025
Author(s):  
Eefje Martine van Helvoort ◽  
Paco M J Welsing ◽  
Mylène P Jansen ◽  
Willem Paul Gielis ◽  
Marieke Loef ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Physical Function ◽  
Functional Disability ◽  
Short Form ◽  
Joint Damage ◽  
The Body ◽  
Knee Oa ◽  
Paindetect Questionnaire ◽  
Registration Number ◽  
Private Research

ObjectivesOsteoarthritis (OA) patients with a neuropathic pain (NP) component may represent a specific phenotype. This study compares joint damage, pain and functional disability between knee OA patients with a likely NP component, and those without a likely NP component.MethodsBaseline data from the Innovative Medicines Initiative Applied Public-Private Research enabling OsteoArthritis Clinical Headway knee OA cohort study were used. Patients with a painDETECT score ≥19 (with likely NP component, n=24) were matched on a 1:2 ratio to patients with a painDETECT score ≤12 (without likely NP component), and similar knee and general pain (Knee Injury and Osteoarthritis Outcome Score pain and Short Form 36 pain). Pain, physical function and radiographic joint damage of multiple joints were determined and compared between OA patients with and without a likely NP component.ResultsOA patients with painDETECT scores ≥19 had statistically significant less radiographic joint damage (p≤0.04 for Knee Images Digital Analysis parameters and Kellgren and Lawrence grade), but an impaired physical function (p<0.003 for all tests) compared with patients with a painDETECT score ≤12. In addition, more severe pain was found in joints other than the index knee (p≤0.001 for hips and hands), while joint damage throughout the body was not different.ConclusionsOA patients with a likely NP component, as determined with the painDETECT questionnaire, may represent a specific OA phenotype, where local and overall joint damage is not the main cause of pain and disability. Patients with this NP component will likely not benefit from general pain medication and/or disease-modifying OA drug (DMOAD) therapy. Reserved inclusion of these patients in DMOAD trials is advised in the quest for successful OA treatments.Trial registration numberThe study is registered under clinicaltrials.gov nr: NCT03883568.

scholarly journals Sex disparities in the prevalence of physical function disabilities: a population-based study in a low-income community

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elsa M. Orellano-Colón ◽  
Erick L. Suárez-Pérez ◽  
Marta Rivero-Méndez ◽  
Claudia X. Boneu-Meléndez ◽  
Nelson Varas-Díaz ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Physical Function ◽  
Low Income ◽  
Chronic Conditions ◽  
Daily Living ◽  
Sampling Design ◽  
Functional Disability ◽  
Short Form ◽  
T Score ◽  
Functional Disabilities

Abstract Background Functional disability continues to be a significant public health problem that increases older adults’ vulnerability to experience a diminished quality of life, loss of independence, higher healthcare costs and health services utilization, and increased risks of mortality. Thus, we aimed to study the prevalence of functional disabilities by sex according to the types of daily living activities, controlling for specific sociodemographic variables among older Hispanics from low-income communities. Methods We used a cross-sectional epidemiological research design, considering a complex sampling design of households to interview adults ≥65 years living in low-income communities in Puerto Rico. Functional disability was measured by the PROMIS® Physical Function Short Form-20 T-score. The selected community was reported to have 5980 adult residents ≥65 years, according to the USA Census. The prevalence of functional disability was estimated using the logistic regression model, weighting by the effect of the sampling. Our estimated prevalence was compared between sexes using the prevalence ratio (PR), which was estimated with logistic regression models, controlling for age, income, number of chronic conditions, high and low impact of chronic conditions in functional disabilities, marital status, and sampling design. Results We recruited 211 older Hispanics from a randomly selected sample. Their mean age was 74.4 ± 7.1 years, with female predominance (57.3%). The overall estimated prevalence of physical function disability using T-score among females was 2.70 (95% CI: 1.4, 5.1) times the estimated prevalence of physical function disability among males. Women were more likely to report functional disabilities in instrumental activities of daily living, self-care activities, and functional mobility compared to males. However, sex differences were largely explained by the presence of musculoskeletal conditions of high impact in functional disability. Conclusions The females in our study bear the greater burden of physical function disability in their adult age. Health policies, as well as future studies, should be targeted at reducing the burden of physical function disabilities in different types of daily activities through gender-sensitive disability self-management programs.

scholarly journals Title: Sex disparities in the prevalence of disabilities: A population-based study in a low-income community

2021 ◽  
Author(s):  
Elsa M Orellano-Colón ◽  
Erick L. Suárez-Pérez ◽  
Marta Rivero-Méndez ◽  
Claudia X. Boneu-Meléndez ◽  
Nelson Varas-Díaz ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Physical Function ◽  
Low Income ◽  
Chronic Conditions ◽  
Daily Living ◽  
Sampling Design ◽  
Functional Disability ◽  
Short Form ◽  
T Score ◽  
Functional Disabilities

Abstract Background: Functional disability continues to be a significant public health problem that increases older adults’ vulnerability to experience a diminished quality of life, loss of independence, higher healthcare costs and health services utilization, and increased risks of mortality. Thus, we aimed to study the prevalence of disabilities by sex according to the types of daily living activities, controlling for specific sociodemographic variables among older Hispanics from low-income communities.Methods: We used a cross-sectional epidemiological research design, considering a complex sampling design of households to interview adults ≥65 years living in low-income communities in Puerto Rico. Functional disability was measured by the PROMIS ® Physical Function Short Form-20 T-score. The prevalences of disability were estimated using the logistic regression model, weighting by the effect of the sampling. Our estimated prevalences were compared between sexes using the prevalence ratio (PR), which was estimated with logistic regression models, controlling for age, income, number of chronic conditions, high and low impact of chronic conditions in functional disabilities, marital status, and sampling design.Results: We recruited 211 older Hispanics from randomly selected sample. Their mean age was 74.4 ± 7.1 years, with female predominance (57.3%). The estimated prevalence of physical function disability using T-score among females was 2.70 (95% CI: 1.4, 5.1) times the estimated prevalence of physical function disability among males. Women were more likely to report functional disabilities in instrumental activities of daily living, self-care activities, and functional mobility compared to males. These sex differences were largely explained by differences in disability-related chronic conditions.Conclusions: The females in our study bear the greater burden of physical function disability in their adult age. Health policies as well as future studies should be targeted at reducing the burden of physical function disabilities in different types of daily activities through gender sensitive disability self-management programs.

scholarly journals Neuropathic Pain Component Insights in Patients with Knee Osteoarthritis: An Observational Study

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0005
Author(s):  
Devindra Prapto ◽  
Clarissa Tertia ◽  
Ivander Purvance
Keyword(s):  
Neuropathic Pain ◽  
Knee Osteoarthritis ◽  
Womac Score ◽  
Cross Sectional Study ◽  
Osteoarthritis Of The Knee ◽  
Cross Sectional ◽  
Knee Oa ◽  
Chronic Disability ◽  
Paindetect Questionnaire ◽  
Severe Group

Osteoarthritis (OA) is one of the most leading cause of chronic disability in musculoskeletal area with pain as the main manifestation. Chronic pain often leads to an abnormal excitability in pain pathway, resulting a central sensitization which corresponding to neuropathic pain (NP). To date, the existence of neuropathic component in osteoarthritis of the knee remains controversial. Methods: The cross-sectional study involved 74 patients of knee osteoarthritis who were diagnosed by using ACR classification criteria for osteoarthritis of the knee. The presence of NP component was assessed by DN4 and painDETECT questionnaire. All participant also completed the WOMAC score to evaluate their status of knee OA, and was divided into two groups, which were mild and severe OA. The prevalence of NP component within knee OA patients was evaluated and then compared between the mild and severe groups. Results: 45,9% of the participants examined with DN4 score were likely to have the NP component, while the others were doubtful. On the other hand, painDETECT score revealed that 36,5% of the patients were likely to have NP component, 21,6% unclear, and 41,9% unlikely. Comparison between WOMAC score and DN4 showed that 67,6% of the severe population had NP component, significantly higher than the mild population, 24,3% (p<0,05). Alternatively, painDETECT score showed 13,5% likely to have NP component, 24,3% unclear, 62,2% doubtful in the mild population, while in the severe group 59,5% likely, 18,9% unclear, 21,6% unlikely (p<0,05). Conclusion: Knee osteoarthritis has a significantly high prevalence of neuropathic pain component. NP component prevalence appears higher in the severe OA population, whether it assessed by DN4 or painDETECT scoring.

scholarly journals AB0880 NEUROPATHIC PAIN IN PATIENTS WITH KNEE OSTEOARTHRITIS: PREVALENCE AND RELATED FACTORS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1745.1-1745
Author(s):  
A. Ben Tekaya ◽  
L. Rouached ◽  
A. Slimi ◽  
O. Saidane ◽  
S. Bouden ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Marital Status ◽  
Short Form ◽  
Meta Analysis ◽  
Pain Severity ◽  
Pain Mechanisms ◽  
Duration Of Symptoms ◽  
Economic Class ◽  
Knee Oa ◽  
The Mean

Background:Discordance between radiographic and pain severity in osteoarthritis (OA) has led researchers to investigate other pain mechanisms, including neuropathic pain (NP). Recent meta-analysis concluded that NP prevalence in people with knee or hip OA was 23% [1].Objectives:The primary objective of this study was to determine the prevalence of NP in patients with painful knee OA. Secondarily, we evaluated the relationship between NP and pain intensity, function and radiographic severity of knee OA.Methods:This cross-sectional study enrolled patients with knee OA (ACR criteria) from a rheumatology outpatient Hospital over a four-month period. Exclusion criteria were: knee surgery, chronic conditions of the nervous system, cognitive or psychiatric disorders. The patient’s characteristics and pain severity using the Visual Analogue Scale (VAS) were evaluated. The NP was assessed according to the Douleur Neuropathique 4 questionnaire (DN4) (arabic valid version). Functional impairment was estimated using the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-PS) (KOOS-PS scores to 0 representing no difficulty and 100 representing extreme difficulty). Radiographs were rated using the Kellgren Lawrence (KL) grade classification (I-IV). Statistical analysis was performed to find the factors closely related with NP.Results:Ninety three patients with knee OA were included in the study. The mean age was 65.03±18.5 years with a sex ratio of 0.08. Mean duration of symptoms was 3.5 years [3months-20 years]. Concerning the marital status: 53.8% were married, 34.4% were widow and 10.8% were divorced. The majority of patients were illiterate (65.6%) and only 2.2% went to university. Patients were from low socio-economic class in 37.6% of cases. At least one comorbidity was revealed for 90.3% of patients and their mean BMI was 31.6±6.3 [19.9-52.3]. Concerning the clinical features of the KOA, mean VAS pain was 6.6±1.6 and KOOS-PS was 45.6±18.5. Of the subjects, 22.6% have radiographic at grade II, 57% at grade III and 20.4% at grade IV based on KL grading.The mean (SD) score by the study participants on the DN4 was 4.9± 2.4. The prevalence of NP (DN4≥4) was 71%.A DN4 score≥4 was significantly associated with the VAS pain (p=0.00) and the KOOS-PS (p=0.00) and the presence of comorbidity (p=0.04). However, there was no significant relation between DN4 score and, age, sex, marital status, socio economic class, level of education, BMI and KL grade (p=0.7, p=0.08, p=0.7,p=0.3, p=0.7, p=0.7, p=0.6).Conclusion:Our results highlight the high frequency of NP in patients with knee OA according to the DN4. Knee OA patients with NP encounter clinically relevant functional limitation. Thus, it is important to be aware of this neuropathic component to ensure appropriate management in the treatment of knee OA pain.References:[1]French HP, Smart KM, Doyle F. Prevalence of neuropathic pain in knee or hip osteoarthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. 2017;47(1):1-8.Acknowledgments:noneDisclosure of Interests:None declared

Impact of Preoperative Opioid Use on 2-Year Patient-Reported Outcomes in Knee Surgery Patients

2020 ◽  
Author(s):  
Ali Aneizi ◽  
Patrick M. J. Sajak ◽  
Aymen Alqazzaz ◽  
Tristan Weir ◽  
Cameran I. Burt ◽  
...  
Keyword(s):  
Physical Function ◽  
Patient Reported Outcomes ◽  
Knee Surgery ◽  
The Body ◽  
Pain Interference ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Social Satisfaction ◽  
Patient Reported ◽  
Met Expectations

AbstractThe objectives of this study are to assess perioperative opioid use in patients undergoing knee surgery and to examine the relationship between preoperative opioid use and 2-year postoperative patient-reported outcomes (PROs). We hypothesized that preoperative opioid use and, more specifically, higher quantities of preoperative opioid use would be associated with worse PROs in knee surgery patients. We studied 192 patients undergoing knee surgery at a single urban institution. Patients completed multiple PRO measures preoperatively and 2-year postoperatively, including six patient-reported outcomes measurement information system (PROMIS) domains; the International Knee Documentation Committee (IKDC) questionnaire, numeric pain scale (NPS) scores for the operative knee and the rest of the body, Marx's knee activity rating scale, Tegner's activity scale, International Physical Activity Questionnaire, as well as measures of met expectations, overall improvement, and overall satisfaction. Total morphine equivalents (TMEs) were calculated from a regional prescription monitoring program. Eighty patients (41.7%) filled an opioid prescription preoperatively, and refill TMEs were significantly higher in this subpopulation. Opioid use was associated with unemployment, government insurance, smoking, depression, history of prior surgery, higher body mass index, greater comorbidities, and lower treatment expectations. Preoperative opioid use was associated with significantly worse 2-year scores on most PROs, including PROMIS physical function, pain interference, fatigue, social satisfaction, IKDC, NPS for the knee and rest of the body, and Marx's and Tegner's scales. There was a significant dose-dependent association between greater preoperative TMEs and worse scores for PROMIS physical function, pain interference, fatigue, social satisfaction, NPS body, and Marx's and Tegner's scales. Multivariable analysis confirmed that any preoperative opioid use, but not quantity of TMEs, was an independent predictor of worse 2-year scores for function, activity, and knee pain. Preoperative opioid use and TMEs were neither independent predictors of met expectations, satisfaction, patient-perceived improvement, nor improvement on any PROs. Our findings demonstrate that preoperative opioid use is associated with clinically relevant worse patient-reported knee function and pain after knee surgery.

scholarly journals POS0375 CHAPERONE-MEDIATED AUTOPHAGY IS A HALLMARK OF JOINT DISEASE IN OSTEOARTHRITIC PATIENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 418.1-418
Author(s):  
I. Lorenzo ◽  
U. Nogueira-Recalde ◽  
N. Oreiro ◽  
J. A. Pinto Tasende ◽  
M. Lotz ◽  
...  
Keyword(s):  
Lateral Meniscus ◽  
Joint Damage ◽  
Joint Disease ◽  
Expression Array ◽  
Knee Oa ◽  
Human Knee Joint ◽  
Gene And Protein Expression ◽  
Functional Consequences ◽  
Chaperone Mediated Autophagy ◽  
Grade Iii

Background:In Osteoarthritis (OA), defects in macroautophagy (autophagy) are evident and precede joint damage. Indeed, pharmacological activation of autophagy protects against joint damage.Objectives:Therefore, identifying hallmarks associated with specific autophagy subtypes could shed light to fundamental mechanisms of joint disease.Methods:A comparative analysis of 35 autophagy genes was performed from blood from the Prospective OA Cohort of A Coruña (PROCOAC). Non-OA subjects (Age:61,44±1,16 years; BMI:25,25±0,52; Females, n=18) and Knee OA subjects (Age:65,50±1,05 years; BMI:29,55±0,67; Females, n=18, OA grade III-IV) were profiled using an autophagy gene expression array by SYBR green qPCR. Confirmatory studies were performed in blood from Non-OA subjects (Age:60,13±1,12 years; BMI:24,85±0,59; Females; n=30) and Knee-OA subjects (Age:68,4±1,11 years; BMI:29,65±0,55; Females; n=30, OA grade III-IV) by Taqman qPCR. The candidate gene was evaluated in human knee joint tissues (cartilage, meniscus, ligaments, synovium) with different KL grades (Age: KL0=28,3±4,50; KL2=77±6,08; KL4=62,3±3,05, n=3) and in both spontaneous aging (2, 6, 12, 18, and 30 months old, n=3) and surgically-induced OA (10 weeks after surgery, n=4) in mice by IHC. The functional consequences were studied in T/C28a2 and primary human OA chondrocytes. Autophagy, FOXO, Chaperone-mediated autophagy (CMA), inflammation, and cellular senescence were analyzing by gene and protein expression. Moreover, oxidative stress and cell death were evaluated by FACS. The contribution of CMA to chondrocyte homeostasis was evaluated by studying the capacity of CMA to restore proteostasis upon autophagy deficiency by siATG5.Results:15 autophagy-related genes were significantly downregulated in blood from knee OA patients compared to non-OA patients. No significant upregulation was found for any studied gene, although a trend towards upregulation was found in genes involved in the mTOR pathway. Four key autophagy-related genes, including ATG16L2, ATG12, ATG4B and MAP1LC3B were found downregulated in knee OA patients. Interestingly, HSP90AA1 and HSPA8, CMA markers involved in stress response and protein folding, were downregulated. Confirmatory studies showed a significant downregulation of MAP1LC3B and HSP90AA1 in blood from knee OA patients. Remarkably, HSP90A was found reduced in femoral cartilage (medial and lateral), meniscus and ACL. Moreover, this reduction was higher in medial cartilage compared to lateral cartilage and meniscus, while in synovial membrane, HSP90A expression was found increased. This expression signature was dependent on OA grade severity. In addition, we observed a decrease of HSP90A with aging and OA in mice. The functional consequences of HSP90AA1 gene silencing are related to an increase in NFκB, MMP13, and p16 expression. Interestingly, LAMP2A, a key CMA mediator, HSPA8, MAP1LC3B and FoxO1 expression were upregulated in chondrocytes with HSP90AA1 deficiency, which might indicate an early response to maintain homeostasis. On the other hand, LAMP2A protein is decreased upon HSP90AA1 deficiency, while LC3II and p62 were increased, indicating a failure in the autophagy flux that leads to impaired lysosomal degradation.Moreover, p21, p16 and prbS6 were increased upon HSP90AA1 deficiency, besides increasing mitochondrial ROS production and apoptosis. ATG5 silencing blocks autophagy by reducing LC3II and increasing prbs6, p62, p16 and p21. Interestingly, LAMP2A and HSP90A were found increased, indicating a possible compensative activation of CMA in response to autophagy defects. These results support that HSP90A has an important role in chondrocyte homeostasis by participating in the cross-talk between CMA and autophagy.Conclusion:Taking together, we identified HSP90A, a CMA regulator, as critical in chondrocyte homeostasis. These disease mechanisms are relevant in OA and constitute hallmarks potentially useful to prevent OA progression.References:[1]Caramés B, et al. Arthritis Rheum. 2010, 2015;[2]Caramés B, et al. Ann Rheum Dis. 2012.Disclosure of Interests:None declared

scholarly journals FRI0382 EFFECTS OF GENICULAR NERVE BLOCK IN PATIENTS WITH KNEE OSTEOARTHRITIS WHO HAVE NEUROPATHIC OR NOCICEPTIVE PAIN

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 788.2-789
Author(s):  
B. Tas ◽  
P. Akpinar ◽  
I. Aktas ◽  
F. Unlu Ozkan ◽  
I. B. Kurucu
Keyword(s):  
Neuropathic Pain ◽  
Knee Osteoarthritis ◽  
Nerve Block ◽  
Intractable Pain ◽  
Ultrasound Guided ◽  
Lidocaine Group ◽  
Knee Oa ◽  
Significant Difference ◽  
Genicular Artery ◽  
Saline Solutions

Background:Genicular nerve block (GNB) is a safe and effective therapeutic procedure for intractable pain associated with chronic knee osteoarthritis (OA)(1). There is increasing support for the neuropathic component to the knee OA pain. Investigators proposed that targeting treatment to the underlying pain mechanism can improve pain management in knee OA (2). There is a debate on injectable solutions used in nerve blocks (3).Objectives:To investigate the analgesic and functional effects of USG-guided GNB in patients with chronic knee OA (with/without neuropathic pain) and to evaluate the efficacy of the anesthetic and non-anesthetic solutions used.Methods:Ninety patients with chronic knee OA between the ages of 50-80 were divided into two groups with and without neuropathic pain according to painDETECT questionnaire (4). The groups were randomized into three subgroups to either the lidocaine group (n=30) or dextrose group (n=29) or saline solutions (n=31). After the ultrasound-guided GNB, quadriceps isometric strengthening exercises and cryotherapy were recommended to the patients. Visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne-algofunctional Index were assessed at baseline and at 1 week, 1 and 3 months later after the procedure.Results:Statistically significant improvement was observed in all groups with or without neuropathic pain according to VAS values at the 1stweek, 1stmonth and 3rdmonth compared to baseline (p<0.05). Statistically significant improvement was observed in all groups with neuropathic pain according to painDETECT values at the 1stweek, 1stmonth and 3rdmonth compared to baseline (p<0.05). There was a statistically significant improvement in the groups without neuropathic pain which received dextrose and saline solutions, according to painDETECT values, but not in the group which received lidocain at the 1stweek, 1stmonth and 3rdmonth compared to baseline (p>0.05). There was a statistically significant improvement in all groups with or without neuropathic pain according to WOMAC and Lequesne total scores at the 1stweek, 1stmonth and 3rdmonth compared to baseline (p<0.05).Conclusion:We conclude that in patients with chronic knee OA (with/without neuropathic pain), the use of GNB with USG is an analgesic method which provides short to medium term analgesia and functional recovery and has no serious side effects. The lack of significant difference between the anesthetic and non-anesthetic solutions used in the GNB suggests that this may be a central effect rather than a symptom of peripheral nerve dysfunction. It suggests that injection may have an indirect effect through nociceptive processing and changes in neuroplastic mechanisms in the brain. In addition, we can say that regular exercise program contributes to improved physical function with the decrease in pain.References:[1]Kim DH et al. Ultrasound-guided genicular nerve block for knee osteoarthritis: a double-blind, randomized controlled trial of local anesthetic alone or in combination with corticosteroid. Pain Physician 2018;21:41-51.[2]Thakur M et.al. Osteoarthritis pain: nociceptive or neuropathic?. Nat Rev Rheumatol 2014:10(6):374.[3]Lam SKH et al. Transition from deep regional blocks toward deep nerve hydrodissection in the upper body and torso: method description and results from a retrospective chart review. BioMed Research International Volume 2017;7920438.[4]Hochman JR et al. Neuropathic pain symptoms in a community knee OA cohort. Osteoarthritis Cartilage. 2011 Jun;19(6):647-54.Fig. 1:Ultrasound- guided identification of GNB target sites. Doppler mode. White arrows indicate genicular arteries.A.Superior medial genicular artery.B.Inferior medial genicular artery.C.Superior lateral genicular artery.Disclosure of Interests:None declared

scholarly journals Effects of mechanical interventions in the management of knee osteoarthritis: protocol for an OA Trial Bank systematic review and individual participant data meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043026
Author(s):  
Erin M Macri ◽  
Michael Callaghan ◽  
Marienke van Middelkoop ◽  
Miriam Hattle ◽  
Sita M A Bierma-Zeinstra
Keyword(s):  
Systematic Review ◽  
Knee Osteoarthritis ◽  
Broad Class ◽  
Meta Analysis ◽  
Individual Participant Data ◽  
Knee Oa ◽  
International Regulations ◽  
Individual Participant ◽  
Registration Number ◽  
Mechanical Intervention

IntroductionKnee osteoarthritis (OA) is a prevalent and disabling musculoskeletal condition. Biomechanical factors may play a key role in the aetiology of knee OA, therefore, a broad class of interventions involves the application or wear of devices designed to mechanically support knees with OA. These include gait aids, bracing, taping, orthotics and footwear. The literature regarding efficacy of mechanical interventions has been conflicting or inconclusive, and this may be because certain subgroups with knee OA respond better to mechanical interventions. Our primary aim is to identify subgroups with knee OA who respond favourably to mechanical interventions.Methods and analysisWe will conduct a systematic review to identify randomised clinical trials of any mechanical intervention for the treatment of knee OA. We will invite lead authors of eligible studies to share individual participant data (IPD). We will perform an IPD meta-analysis for each type of mechanical intervention to evaluate efficacy, with our main outcome being pain. Where IPD are not available, this will be achieved using aggregate data. We will then evaluate five potential treatment effect modifiers using a two-stage approach. If data permit, we will also evaluate whether biomechanics mediate the effects of mechanical interventions on pain in knee OA.Ethics and disseminationNo new data will be collected in this study. We will adhere to institutional, national and international regulations regarding the secure and confidential sharing of IPD, addressing ethics as indicated. We will disseminate findings via international conferences, open-source publication in peer-reviewed journals and summaries posted on websites serving the public and clinicians.PROSPERO registration numberCRD42020155466.

scholarly journals Investigation of the Correlation between Postherpetic Itch and Neuropathic Pain over Time

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Rie Ishikawa ◽  
Masako Iseki ◽  
Rie Koga ◽  
Eiichi Inada
Keyword(s):  
Neuropathic Pain ◽  
Herpes Zoster ◽  
Pain Intensity ◽  
Visual Analog Scale ◽  
Analog Scale ◽  
Paindetect Questionnaire ◽  
Relationship Of ◽  
The Relationship ◽  
Over Time

Postherpetic itch (PHI), or herpes zoster itch, is an intractable and poorly understood disease. We targeted 94 herpes zoster patients to investigate their pain and itch intensities at three separate stages of the condition (acute, subacute, and chronic). We used painDETECT questionnaire (PDQ) scores to investigate the correlation between PHI and neuropathic pain. Seventy-six patients were able to complete follow-up surveys. The prevalence of PHI was 47/76 (62%), 28/76 (37%), and 34/76 (45%) at the acute, subacute, and chronic stages, respectively. PHI manifestation times and patterns varied. We investigated the relationship of PHI with neuropathic pain using the visual analog scale (VAS), which is a measure of pain intensity, and the PDQ, which is a questionnaire used to evaluate the elements of neuropathic pain. The VAS and PDQ scores did not differ significantly between PHI-positive and PHI-negative patients. A large neuropathic component was not found for herpes zoster itch, suggesting that neuropathic pain treatments may not able to adequately control the itch. Accordingly, we suggest that a more PHI-focused therapy is required to address this condition.

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