Understanding pain in osteoarthritis

  • Gwilym S
  • Pollard T
  • Carr A
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The majority of patients with osteoarthritis present to orthopaedic surgeons seeking relief of pain and associated restoration of function. Although our understanding of the physiology of pain has improved greatly over the last 25 years there remain a number of unexplained pain-related observations in patients with osteoarthritis. The understanding of pain in osteoarthritis, its modulation and treatment is central to orthopaedic clinical practice and in this annotation we explore some of the current concepts applicable. We also introduce the concept of the 'phantom joint' as a cause for persistent pain after joint replacement. The majority of patients who present to ortho-paedic surgeons do so with pain and loss of func-tion. Musculoskeletal pain is the primary cause of chronic pain worldwide. 1 Commonly, it is the perception of pain which troubles the patient and is the principle reason for seeking redress. 2 Despite scientific advances in both its under-standing and treatment, the burden of muscu-loskeletal pain is estimated to have increased between two-and fivefold over the last 40 years. 3 During this period, research in pain has led to an improved understanding of nociceptive transmission 4 and how a stimulus is modified as it passes from peripheral detection, to awareness and to behaviour. It is now apparent that the pro-cess is rather more complex than the initial the-ory proposed by Descartes in the 17th century, in which pain sensation was thought to pass, unadulterated, from stimulus to brain (Fig. 1). 5

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  • S. E. Gwilym

  • T. C. B. Pollard

  • A. J. Carr

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