Intra-Articular Analgesia and Steroid Reduce Pain Sensitivity in Knee OA Patients: An Interventional Cohort Study

Overview

Journal Pain Res Treat

Date 2014 Jun 5

PMID 24895533

Citations 5

Authors

Tanja Schjodt Jorgensen

Thomas Graven-Nielsen

Karen Ellegaard

Bente Danneskiold-Samsoe

Henning Bliddal

Marius Henriksen

Affiliations

Soon will be listed here.

Abstract

Objectives. To assess the effects of intra-articular therapy on pain sensitivity in the knee and surrounding tissues in knee OA patients. Methods. Twenty-five knee OA patients with symptomatic knee OA were included in this interventional cohort study. Pressure pain thresholds (PPT) were recorded before, immediately after, and two weeks after ultrasound guided intra-articular injection of lidocaine combined with glucocorticosteroid. Computer-controlled and manual pressure algometers were used to assess PPT on the knee, vastus lateralis, tibialis anterior, and the extensor carpi radialis longus muscles (control site). Results. Significantly increased PPTs were found following intra-articular injection, at both the knee (P < 0.0001) and the surrounding muscles (P < 0.042). The treatment effects were sustained for two weeks, and at some points the effect was even greater at two weeks (P < 0.026). Albeit not statistically significant, a similar trend was observed at the control site. Conclusions. Intra-articular anesthesia, combined with glucocorticosteroid, reduced pain sensitivity in both the knee and surrounding muscles for at least two weeks.

Citing Articles

Does gabapentin provide benefit for patients with knee OA? A benefit-harm and cost-effectiveness analysis.

Bensen G, Rogers A, Leifer V, Edwards R, Neogi T, Kostic A Osteoarthritis Cartilage. 2022; 31(2):279-290.

PMID: 36414225 PMC: 9892279. DOI: 10.1016/j.joca.2022.07.013.

Intra-articular platelet-rich plasma vs corticosteroids in the treatment of moderate knee osteoarthritis: a single-center prospective randomized controlled study with a 1-year follow up.

Elksnins-Finogejevs A, Vidal L, Peredistijs A J Orthop Surg Res. 2020; 15(1):257.

PMID: 32650801 PMC: 7353717. DOI: 10.1186/s13018-020-01753-z.

Physical and Chemical Compatibility of Extended-Release Triamcinolone Acetonide (TA-ER) with Common Local Anesthetics.

Jackson J, Cotton L, Turkington M, Leblanc D, Kelley S Adv Ther. 2019; 36(3):652-661.

PMID: 30706409 PMC: 6824335. DOI: 10.1007/s12325-019-0878-2.

Intra-Articular Corticosteroids in Addition to Exercise for Reducing Pain Sensitivity in Knee Osteoarthritis: Exploratory Outcome from a Randomized Controlled Trial.

Soriano-Maldonado A, Klokker L, Bartholdy C, Bandak E, Ellegaard K, Bliddal H PLoS One. 2016; 11(2):e0149168.

PMID: 26871954 PMC: 4752217. DOI: 10.1371/journal.pone.0149168.

The effects of joint aspiration and intra-articular corticosteroid injection on flexion reflex excitability, quadriceps strength and pain in individuals with knee synovitis: a prospective observational study.

Rice D, McNair P, Lewis G, Dalbeth N Arthritis Res Ther. 2015; 17:191.

PMID: 26215105 PMC: 4517546. DOI: 10.1186/s13075-015-0711-5.

References

Schaible H, Grubb B . Afferent and spinal mechanisms of joint pain. Pain. 1993; 55(1):5-54. DOI: 10.1016/0304-3959(93)90183-P. View

Chao J, Wu C, Sun B, Hose M, Quan A, Hughes T . Inflammatory characteristics on ultrasound predict poorer longterm response to intraarticular corticosteroid injections in knee osteoarthritis. J Rheumatol. 2010; 37(3):650-5. DOI: 10.3899/jrheum.090575. View

Wylde V, Palmer S, Learmonth I, Dieppe P . The association between pre-operative pain sensitisation and chronic pain after knee replacement: an exploratory study. Osteoarthritis Cartilage. 2013; 21(9):1253-6. DOI: 10.1016/j.joca.2013.05.008. View

Goldring M, Otero M . Inflammation in osteoarthritis. Curr Opin Rheumatol. 2011; 23(5):471-8. PMC: 3937875. DOI: 10.1097/BOR.0b013e328349c2b1. View

Arendt-Nielsen L, Nie H, Laursen M, Laursen B, Madeleine P, Simonsen O . Sensitization in patients with painful knee osteoarthritis. Pain. 2010; 149(3):573-581. DOI: 10.1016/j.pain.2010.04.003. View

Schaible H . Mechanisms of chronic pain in osteoarthritis. Curr Rheumatol Rep. 2012; 14(6):549-56. DOI: 10.1007/s11926-012-0279-x. View

Suri P, Morgenroth D, Kwoh C, Bean J, Kalichman L, Hunter D . Low back pain and other musculoskeletal pain comorbidities in individuals with symptomatic osteoarthritis of the knee: data from the osteoarthritis initiative. Arthritis Care Res (Hoboken). 2010; 62(12):1715-23. PMC: 2995827. DOI: 10.1002/acr.20324. View

Jones A, Doherty M . Intra-articular corticosteroids are effective in osteoarthritis but there are no clinical predictors of response. Ann Rheum Dis. 1996; 55(11):829-32. PMC: 1010319. DOI: 10.1136/ard.55.11.829. View

Berenbaum F . Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!). Osteoarthritis Cartilage. 2012; 21(1):16-21. DOI: 10.1016/j.joca.2012.11.012. View

10.

Levinger P, Caldow M, Feller J, Bartlett J, Bergman N, McKenna M . Association between skeletal muscle inflammatory markers and walking pattern in people with knee osteoarthritis. Arthritis Care Res (Hoboken). 2011; 63(12):1715-21. DOI: 10.1002/acr.20625. View

11.

Creamer P, Hunt M, Dieppe P . Pain mechanisms in osteoarthritis of the knee: effect of intraarticular anesthetic. J Rheumatol. 1996; 23(6):1031-6. View

12.

Schaible H, von Banchet G, Boettger M, Brauer R, Gajda M, Richter F . The role of proinflammatory cytokines in the generation and maintenance of joint pain. Ann N Y Acad Sci. 2010; 1193:60-9. DOI: 10.1111/j.1749-6632.2009.05301.x. View

13.

Schaible H, Richter F . Pathophysiology of pain. Langenbecks Arch Surg. 2004; 389(4):237-43. DOI: 10.1007/s00423-004-0468-9. View

14.

Zhang W, Nuki G, Moskowitz R, Abramson S, Altman R, Arden N . OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage. 2010; 18(4):476-99. DOI: 10.1016/j.joca.2010.01.013. View

15.

Graven-Nielsen T . Fundamentals of muscle pain, referred pain, and deep tissue hyperalgesia. Scand J Rheumatol Suppl. 2006; 122:1-43. DOI: 10.1080/03009740600865980. View

16.

Joergensen T, Henriksen M, Danneskiold-Samsoee B, Bliddal H, Graven-Nielsen T . Experimental knee pain evoke spreading hyperalgesia and facilitated temporal summation of pain. Pain Med. 2013; 14(6):874-83. DOI: 10.1111/pme.12093. View

17.

Graven-Nielsen T, Mense S, Arendt-Nielsen L . Painful and non-painful pressure sensations from human skeletal muscle. Exp Brain Res. 2004; 159(3):273-83. DOI: 10.1007/s00221-004-1937-7. View

18.

Graven-Nielsen T, Wodehouse T, Langford R, Arendt-Nielsen L, Kidd B . Normalization of widespread hyperesthesia and facilitated spatial summation of deep-tissue pain in knee osteoarthritis patients after knee replacement. Arthritis Rheum. 2012; 64(9):2907-16. DOI: 10.1002/art.34466. View

19.

Pyne D, Ioannou Y, Mootoo R, Bhanji A . Intra-articular steroids in knee osteoarthritis: a comparative study of triamcinolone hexacetonide and methylprednisolone acetate. Clin Rheumatol. 2004; 23(2):116-20. DOI: 10.1007/s10067-003-0841-z. View

20.

Suokas A, Walsh D, McWilliams D, Condon L, Moreton B, Wylde V . Quantitative sensory testing in painful osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2012; 20(10):1075-85. DOI: 10.1016/j.joca.2012.06.009. View