Purpose: Chronic pain is the most typical clinical presentation of osteoarthritis (OA). To improve diagnostics of a pain syndrome at knee and hip osteoarthritis and to advance approaches to drug therapy for better outcomes, surveys were conducted to identify neuropathic components in the chronic pain structure. Traditionally, the pain in osteoarthritis is nociceptive in nature but frequent lack of effect of the use of traditional means of analgesic underscores an underestimation of pain mechanisms. Method(s): To study neuropathic pain (NP) in the OA patients. Surveys and assessment of NP through questionnaires DN4 (Douleur Neuropathique en 4 Questions) and LANSS (Leeds Assessment of Neuropathic Symptoms and Signs) in 112 patients with knee and hip osteoarthritis were carried out. The average age of patients was 62.5+/-5.8 years, average disease duration 8.3+/-3.7 years. (Table presented) Results: Questionnaire DN4 survey established NP in 34.8% of patients with osteoarthritis, the average being 5.8 +/- 0.7points. Among these patients, 51.38% answered positively to 5 questions, 30.77%, to 6 questions and 17.94% to 7. Patients with OA registered positive sensory symptoms with higher rates, primarily burning sensation and shock; they recorded negative sensory symptoms and allodynia less frequently. 29.5% of patients indicated burning sensation in the painful area, 21.4% -painful sensation of cold, 16.9% - tingling and crawling, 26.7% - numbness; 9.8% of patients identified increase in pain when touched with a brush. LANSS measuring scale was used to differentiate nociceptive and neuropathic pain syndromes. In the questioning by LANSS 42 (37.5%), patients gained more than 12 points, indicating that they have neuropathic pain. NP is more often diagnosed in women, with 2 and 3 stages of osteoarthritis, while reactive synovitis is present as well. Cumulative data suggest that central sensitization may contribute to pain in osteoarthritis (OA) with symptoms typically associated with NP. Conclusion(s): More than a third of patients with osteoarthritis may have elements of NP, which is the cause of insufficient response to standard therapy, aimed at elimination of nociceptive pain. Questioning allows us to identify neuropathic pain in patients with OA and thus improves treatment results.
Golovach, I., Golovach, D., Avramenko, O., Semeniv, I., Chipko, T., Vlasenko, A., … Matijko, V. (2012). Diagnosis of neuropathic pain in patients with osteoarthritis using questionnaires. Osteoarthritis and Cartilage, 20, S251–S252. https://doi.org/10.1016/j.joca.2012.02.419