Patients With Knee Osteoarthritis Who Score Highly on the PainDETECT Questionnaire Present With Multimodality Hyperalgesia, Increased Pain, and Impaired Physical Function

Overview

Journal Clin J Pain

Specialties Neurology
Psychiatry

Date 2017 Apr 6

PMID 28379872

Citations 26

Authors

Penny Moss

Heather A E Benson

Rob Will

Anthony Wright

Affiliations

Soon will be listed here.

Abstract

Objectives: PainDETECT is a self-report questionnaire that can be used to identify features of neuropathic pain. A proportion of patients with knee osteoarthritis (OA) score highly on the PainDETECT questionnaire. This study aimed to determine whether those with a higher "positive neuropathic" score on the PainDETECT questionnaire also had greater pain, hypersensitivity, and reduced function compared with individuals with knee OA with lower PainDETECT scores.

Materials And Methods: In total, 130 participants with knee OA completed the PainDETECT, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Pain Quality Assessment Scale questionnaires. Quantitative sensory testing was carried out at 3 sites (both knees and elbow) using standard methods. Cold and heat pain thresholds were tested using a Peltier thermode and pressure pain thresholds using a digital algometer. Physical function was assessed using 3 timed locomotor function tests.

Results: In total, 22.3% of participants scored in the "positive neuropathic" category with a further 35.4% in the unclear category. Participants in the "positive neuropathic" category reported higher levels of pain and more impaired function based on the WOMAC questionnaire (P<0.0001). They also exhibited increased levels of hyperalgesia at the knee and upper limb sites for all stimulation modalities except heat pain thresholds at the OA knee. They were also slower to complete 2 of the locomotion tasks.

Discussion: This study identified a specific subgroup of people with knee OA who exhibited PainDETECT scores in the "positive neuropathic" category. These individuals experienced increased levels of pain, widespread, multimodality hyperalgesia, and greater functional impairment than the remaining cohort. Identification of OA patients with this pain phenotype may permit more targeted and effective pain management.

Citing Articles

A Mediation Appraisal of Neuropathic-like Symptoms, Pain Catastrophizing, and Central Sensitization-Related Signs in Adults with Knee Osteoarthritis-A Cross-Sectional Study.

Salaffi F, Carotti M, Farah S, Ciccullo C, Gigante A, Bandinelli F J Pers Med. 2025; 15(1).

PMID: 39852214 PMC: 11767182. DOI: 10.3390/jpm15010022.

Transcutaneous vagus nerve stimulation as a pain modulator in knee osteoarthritis: a randomized controlled clinical trial.

Elsehrawy G, Ibrahim M, A Moneim N, Hefny M, El Shaarawy N BMC Musculoskelet Disord. 2025; 26(1):68.

PMID: 39828740 PMC: 11744843. DOI: 10.1186/s12891-025-08288-6.

Neuropathic-like symptoms have an additional predictive value for chronic postsurgical pain in total hip and knee arthroplasty patients.

Blikman T, van den Akker-Scheek I, van Raaij T, Dijkstra B, Bulstra S, Stevens M BMC Musculoskelet Disord. 2024; 25(1):987.

PMID: 39623411 PMC: 11610117. DOI: 10.1186/s12891-024-08129-y.

People with osteoarthritis have a higher component of neuropathic pain as compared to those with rheumatoid arthritis: A cross-sectional study.

Mahajan A, Mruthyunjaya P, Padhee S, Ahmed S Rheumatol Int. 2024; 44(10):2179-2184.

PMID: 38995417 DOI: 10.1007/s00296-024-05657-7.

Clinical Assessment of Osteoarthritis Pain: Contemporary Scenario, Challenges, and Future Perspectives.

Sethi V, Anand C, Della Pasqua O Pain Ther. 2024; 13(3):391-408.

PMID: 38662319 PMC: 11111648. DOI: 10.1007/s40122-024-00592-8.

References

Tsang A, Von Korff M, Lee S, Alonso J, Karam E, Angermeyer M . Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain. 2008; 9(10):883-91. DOI: 10.1016/j.jpain.2008.05.005. View

Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D . Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2005; 10(4):287-333. DOI: 10.1016/j.ejpain.2005.06.009. View

Horner G, Dellon A . Innervation of the human knee joint and implications for surgery. Clin Orthop Relat Res. 1994; (301):221-6. View

Hmamouchi I, Allali F, Tahiri L, Khazzani H, Mansouri L, Ali Ou Alla S . Clinically important improvement in the WOMAC and predictor factors for response to non-specific non-steroidal anti-inflammatory drugs in osteoarthritic patients: a prospective study. BMC Res Notes. 2012; 5:58. PMC: 3283484. DOI: 10.1186/1756-0500-5-58. 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

Moreton B, Tew V, das Nair R, Wheeler M, Walsh D, Lincoln N . Pain phenotype in patients with knee osteoarthritis: classification and measurement properties of painDETECT and self-report Leeds assessment of neuropathic symptoms and signs scale in a cross-sectional study. Arthritis Care Res (Hoboken). 2014; 67(4):519-28. PMC: 4407932. DOI: 10.1002/acr.22431. View

Thakur M, Dickenson A, Baron R . Osteoarthritis pain: nociceptive or neuropathic?. Nat Rev Rheumatol. 2014; 10(6):374-80. DOI: 10.1038/nrrheum.2014.47. View

Valdes A, Suokas A, Doherty S, Jenkins W, Doherty M . History of knee surgery is associated with higher prevalence of neuropathic pain-like symptoms in patients with severe osteoarthritis of the knee. Semin Arthritis Rheum. 2013; 43(5):588-92. DOI: 10.1016/j.semarthrit.2013.10.001. View

Treede R, Jensen T, Campbell J, Cruccu G, Dostrovsky J, Griffin J . Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2007; 70(18):1630-5. DOI: 10.1212/01.wnl.0000282763.29778.59. View

10.

Moss P, Knight E, Wright A . Subjects with Knee Osteoarthritis Exhibit Widespread Hyperalgesia to Pressure and Cold. PLoS One. 2016; 11(1):e0147526. PMC: 4726459. DOI: 10.1371/journal.pone.0147526. View

11.

. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum. 2000; 43(9):1905-15. DOI: 10.1002/1529-0131(200009)43:9<1905::AID-ANR1>3.0.CO;2-P. View

12.

Garsden L, Bullock-Saxton J . Joint reposition sense in subjects with unilateral osteoarthritis of the knee. Clin Rehabil. 1999; 13(2):148-55. DOI: 10.1191/026921599674996411. View

13.

Jinks C, Jordan K, Croft P . Measuring the population impact of knee pain and disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain. 2002; 100(1-2):55-64. DOI: 10.1016/s0304-3959(02)00239-7. View

14.

Hochman J, Gagliese L, Davis A, Hawker G . Neuropathic pain symptoms in a community knee OA cohort. Osteoarthritis Cartilage. 2011; 19(6):647-54. DOI: 10.1016/j.joca.2011.03.007. View

15.

Fruhstorfer H, Lindblom U, Schmidt W . Method for quantitative estimation of thermal thresholds in patients. J Neurol Neurosurg Psychiatry. 1976; 39(11):1071-5. PMC: 1083305. DOI: 10.1136/jnnp.39.11.1071. View

16.

Victor T, Jensen M, Gammaitoni A, Gould E, White R, Galer B . The dimensions of pain quality: factor analysis of the Pain Quality Assessment Scale. Clin J Pain. 2008; 24(6):550-5. DOI: 10.1097/AJP.0b013e31816b1058. View

17.

McCarthy C, Oldham J . The reliability, validity and responsiveness of an aggregated locomotor function (ALF) score in patients with osteoarthritis of the knee. Rheumatology (Oxford). 2004; 43(4):514-7. DOI: 10.1093/rheumatology/keh081. View

18.

Kosek E, Ordeberg G . Abnormalities of somatosensory perception in patients with painful osteoarthritis normalize following successful treatment. Eur J Pain. 2000; 4(3):229-38. DOI: 10.1053/eujp.2000.0175. View

19.

Harden R, Wallach G, Gagnon C, Zereshki A, Mukai A, Saracoglu M . The osteoarthritis knee model: psychophysical characteristics and putative outcomes. J Pain. 2013; 14(3):281-9. DOI: 10.1016/j.jpain.2012.11.009. View

20.

Ohtori S, Orita S, Yamashita M, Ishikawa T, Ito T, Shigemura T . Existence of a neuropathic pain component in patients with osteoarthritis of the knee. Yonsei Med J. 2012; 53(4):801-5. PMC: 3381480. DOI: 10.3349/ymj.2012.53.4.801. View