Neuropathic pain research in knee osteoarthritis patients at the outpatients clinic of physical medicine

Abstract

Osteoartritis (OA) koljena je česta progresivna zglobna bolest razvijenog svijeta i jedan od glavnih uzroka kronične onesposobljenosti. Osteoartritisom su zahvaćene sve zglobne strukture, uključujući mišiće, tetive, ligamente sinoviju i kost. Bol je najznačajniji simptom OA i glavni razlog zbog kojeg se bolesnici javljaju svom liječniku obiteljske medicine. Do danas se smatralo da je bol u OA nociceptivna. Izostanak smanjenja boli primjenom nesteroidnih antireumatika (NSAR) primijećen je kod nekih bolesnika u kojih je bol smanjena primjenom morfija, što sugerira da je u OA koljena uz nociceptinu prisutna i neuropatska komponenta boli. Cilj ovog rada bio je utvrditi postojanje neuropatske boli u bolesnika s OA koljena primjenom upitnika painDETECT (upitnika za neuropatsku bol) i istražiti povezanost prisustva neuropatske boli s intenzitetom boli, spolom bolesnika te stadijem OA. Uključeno je 122 bolesnika koji su upućeni u ambulantu fizikalne medicine radi OA koljena. Intenzitet boli mjeren vizualno-analognom skalom boli (VAS), painDETECT, trajanje simptoma, radiološko stupnjevanje OA uporabom Kellgren-Lawrence (KL) ljestvice, lijekovi koje su bolesnici primali i fizikalna terapija kojom su liječeni, analizirani su uporabom Pearsonovog korelacijskog koeficijenta i hi-kvadrat testom. U ovom istraživanju 14,8% bolesnika s OA koljena vjerojatno ima prisutnu neuropatsku komponentu, a u 24,6% bolesnika možda je prisutna komponenta neuropatske boli. Rezultat painDETECT-a značajno korelira s VAS-om. Nije utvrđena statistički značajna povezanost dobi i spola bolesnika s prisustvom neuropatske boli. Svi bolesnici u kojih je utvrđena komponenta neuropatske boli uzimali su NSAR-e.Introduction: Knee osteoarthritis (OA) is a common and progresive joint disease of the develoved world and leading cause of chronic disability. OA is a disease of the whole joint, including muscles, tendons, ligaments, synovium and bone. Pain is the most prominent symptom of OA and the most common reason why OA patients consult their general practitioner. Pain from knee OA is generally classified as nociceptive (inflammatory). Some opservations, such as lack of pharmacological sensitivity to NSAIDs in patients with knee OA but not morphine, suggest that the pain of knee OA is both nociceptive (NC) and neuropatic (NP). Objective of this study was to examine NP in the knee OA patients using painDETECT (an NP questionnaire) and to evaluate the relationship between NP, pain intensity, influence of gender, age and stage of OA. This study included 122 outher patients with knee OA. Pain scores using Visual Analogue Scales (VAS), painDETECT, duration of simptoms, severity of OA using Kellgren-Lawrence (KL) system, medications and phisical therapy which patients used were evaluated and compared using a Pearson's correlation coefficient and chi-square test. This study identified at least 14,8% of our knee patients as likely to have NP and 24,6% as possibly having NP. The painDETECT score was significanty correlated with the VAS. There was no significant correlation between gender and age with existance of NP. NP tended to be seen in patients threated by standard NSAIDs