Pain mechanisms in osteoarthritis: Understanding the role of central pain and current approaches to its treatment

  • P.J. M
  • S. H
  • E.P. F
 et al. 
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In this literature review, the mechanisms underlying pain associated with osteoarthritis (OA) are discussed, along with evidence for the efficacy of medications thought to act centrally to relieve OA pain. We survey the cascade of events from inflammation to activation of nociceptive and neuropathic pathways, to the development and maintenance of central and peripheral sensitization. Preclinical and clinical evidence for the sensitization hypothesis is discussed, along with recently identified genetic variations that may increase sensitivity to pain in patients with OA. Evidence is presented for the efficacy of centrally acting analgesics for OA pain (opioids, antiepileptics, tricyclic antidepressants, and serotonin/norepinephrine receptor inhibitors). The Journal of Rheumatology Copyright © 2011. All rights reserved.

Author-supplied keywords

  • *neuropathic pain/dt [Drug Therapy]
  • *osteoarthritis/dt [Drug Therapy]
  • 4 aminobutyric acid
  • 4 aminobutyric acid/ec [Endogenous Compound]
  • Analgesics
  • COMT gene
  • Central Nervous System Sensitization
  • Central sensitization
  • Clinical Trials as Topic
  • Humans
  • Inflammation
  • Neuropathic pain
  • Opioid
  • Osteoarthritis
  • Pain
  • alpha adrenergic receptor blocking agent
  • alpha adrenergic receptor blocking agent/dt [Drug
  • analgesic activity
  • anticonvulsive agent
  • anticonvulsive agent/dt [Drug Therapy]
  • anticonvulsive agent/pd [Pharmacology]
  • aspartic acid
  • aspartic acid/ec [Endogenous Compound]
  • bone marrow disease
  • bradykinin
  • bradykinin/ec [Endogenous Compound]
  • calcitonin gene related peptide
  • calcitonin gene related peptide/ec [Endogenous Com
  • comt gene
  • correlational study
  • cyclooxygenase 2
  • cyclooxygenase 2/ec [Endogenous Compound]
  • disease association
  • disease severity
  • drug targeting
  • enchondral ossification
  • gene
  • genetic polymorphism
  • genetic variability
  • glutamic acid
  • glutamic acid/ec [Endogenous Compound]
  • histamine
  • histamine/ec [Endogenous Compound]
  • human
  • hyperalgesia
  • inflammation
  • lactic acid
  • lactic acid/ec [Endogenous Compound]
  • macrophage activation
  • myelinated nerve
  • narcotic analgesic agent
  • narcotic analgesic agent/cb [Drug Combination]
  • narcotic analgesic agent/cm [Drug Comparison]
  • narcotic analgesic agent/dt [Drug Therapy]
  • narcotic analgesic agent/pd [Pharmacology]
  • nerve growth factor
  • nerve growth factor/ec [Endogenous Compound]
  • neuropathic pain
  • neuropathology
  • neurotransmission
  • nociception
  • nociceptive stimulation
  • nonmyelinated nerve
  • nonsteroid antiinflammatory agent
  • nonsteroid antiinflammatory agent/dt [Drug Therapy
  • noradrenalin
  • noradrenalin/ec [Endogenous Compound]
  • nuclear magnetic resonance imaging
  • opiate
  • opiate/cb [Drug Combination]
  • opiate/cm [Drug Comparison]
  • opiate/dt [Drug Therapy]
  • opiate/pd [Pharmacology]
  • osteoarthritis
  • osteophyte
  • pain assessment
  • pain threshold
  • paracetamol
  • paracetamol/cb [Drug Combination]
  • paracetamol/cm [Drug Comparison]
  • paracetamol/dt [Drug Therapy]
  • placebo
  • priority journal
  • prostaglandin E2
  • prostaglandin E2/ec [Endogenous Compound]
  • prostaglandin release
  • quality of life
  • review
  • sensory nerve
  • serotonin
  • serotonin antagonist
  • serotonin antagonist/dt [Drug Therapy]
  • serotonin antagonist/pd [Pharmacology]
  • serotonin noradrenalin reuptake inhibitor
  • serotonin noradrenalin reuptake inhibitor/ct [Clin
  • serotonin noradrenalin reuptake inhibitor/dt [Drug
  • serotonin noradrenalin reuptake inhibitor/pd [Phar
  • serotonin/ec [Endogenous Compound]
  • substance P
  • substance P/ec [Endogenous Compound]
  • sympathetic innervation
  • tricyclic antidepressant agent
  • tricyclic antidepressant agent/dt [Drug Therapy]
  • tricyclic antidepressant agent/pd [Pharmacology]
  • upregulation
  • vasculotropin
  • vasculotropin/ec [Endogenous Compound]

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  • Mease P.J.

  • Hanna S.

  • Frakes E.P.

  • P J Mease

  • S Hanna

  • E P Frakes

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