![]() ![]() Bajaj at al reported that both the area and intensity of secondary hyperalgesia were increased in subjects with knee OA, following hypertonic saline injection into the tibialis anterior muscle. This hypothesis is also supported by studies that have reported changes in other centrally mediated pain phenomena in subjects with OA. Thus it has been proposed that even in an apparently localised musculoskeletal condition such as OA there may be significant central augmentation of nociceptive input. It has been hypothesised that this widespread mechanical hyperalgesia may be a sign of altered nociceptive system function and reflects centrally augmented nociceptive system processing. A number of studies have also reported reduced PPT in the upper limb of subjects with knee OA compared with matched controls. Imamura et al reported reduced pressure pain threshold (PPT) and consequent pressure hyperalgesia at a number of lower extremity sites in subjects with knee OA, correlating with higher disability scores. Several studies have reported that mechanical hyperalgesia extends beyond the vicinity of the OA joint indicating relatively widespread changes in nociceptive system function. Most commonly, studies have evaluated pressure pain thresholds and reported widespread mechanical hyperalgesia in subjects with OA of the knee. Over recent years QST methods have been used to evaluate various aspects of hyperalgesia in this population. It is also often anecdotally associated with exacerbations during cold weather conditions. Osteoarthritis is one of the most prevalent musculoskeletal disorders affecting Western society and is associated with joint pain, tenderness and decreased function. The importance of cold hyperalgesia as a prognostic indicator in osteoarthritis (OA) has not been extensively explored. It has been suggested that there is an association between pain severity and chronicity, and the presence of cold hyperalgesia in the immediate period post whiplash injury and based on the findings of a systematic review, the presence of cold hyperalgesia has been identified as an important prognostic factor for long term pain and disability in WAD and tennis elbow. Studies utilizing quantitative sensory testing (QST) data suggest that widespread pressure and cold hyperalgesia are also present in a number of musculoskeletal pain disorders such as tennis elbow, back pain, fibromyalgia and whiplash associated disorder (WAD). This study found widespread elevated pain thresholds in subjects with painful knee osteoarthritis, suggesting that altered nociceptive system processing may play a role in ongoing arthritic pain for some patients. No significant differences were found between groups for heat pain threshold, although correlations showed that subjects with greater sensitivity to pressure pain were also likely to be more sensitive to both cold pain and heat pain. A similar pattern of results extended to the pain-free ipsilateral ankle and elbow indicating widespread pressure and cold hyperalgesia. Significant between-groups differences for pressure pain and cold pain thresholds were found with osteoarthritic subjects demonstrating significantly increased sensitivity to both pressure (p =. Pain thresholds to pressure, cold and heat were tested at the knee, ipsilateral heel and ipsilateral elbow, in randomized order, using standardised methodology. Volunteers with any additional chronic pain conditions were excluded. Twenty-three subjects with knee osteoarthritis and 23 healthy controls, matched for age, gender and body mass index, were recruited for the study. This study evaluated the presence of local and widespread mechanical and thermal hyperalgesia in individuals with knee osteoarthritis, compared to healthy control subjects. Hyperalgesia to mechanical and thermal stimuli are characteristics of a range of disorders such as tennis elbow, whiplash and fibromyalgia. ![]()
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