Enrique Lluch1,2,3, Jo Nijs2,3, Carol A Courtney4, Trudy Rebbeck5, Vikki Wylde6, Isabel Baert3,7, Timothy H Wideman8, Nick Howells9,10, Søren T Skou11,12. 1. a Department of Physical Therapy , University of Valencia , Valencia , Spain. 2. b Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy , Vrije Universiteit Brussel , Brussels , Belgium. 3. c Pain in Motion International Research Group , Brussel , Belgium. 4. d Department of Physical Therapy , University of Illinois at Chicago , Chicago , IL , USA. 5. e Faculty of Health Sciences, Discipline of Physiotherapy , John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, University of Sydney , Sydney , Australia. 6. f Musculoskeletal Research Unit , University of Bristol, Southmead Hospital , Bristol , UK. 7. g Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences , University of Antwerp , Wilrijk , Belgium. 8. h School of Physical and Occupational Therapy , McGill University , Montreal , Canada. 9. i Avon Orthopaedic Centre , Southmead Hospital, North Bristol NHS Trust , Bristol , UK. 10. j Musculoskeletal Research Unit , University of Bristol , Bristol , UK. 11. k Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy , University of Southern Denmark , Odense , Denmark. 12. l Department of Physiotherapy and Occupational Therapy , Naestved-Slagelse-Ringsted Hospitals , Slagelse , Denmark.
Abstract
BACKGROUND: Despite growing awareness of the contribution of central pain mechanisms to knee osteoarthritis pain in a subgroup of patients, routine evaluation of central sensitization is yet to be incorporated into clinical practice. AIM: The objective of this perspective is to design a set of clinical descriptors for the recognition of central sensitization in patients with knee osteoarthritis that can be implemented in clinical practice. METHODS: A narrative review of original research papers was conducted by nine clinicians and researchers from seven different countries to reach agreement on clinically relevant descriptors. RESULTS: It is proposed that identification of a dominance of central sensitization pain is based on descriptors derived from the subjective assessment and the physical examination. In the former, clinicians are recommended to inquire about intensity and duration of pain and its association with structural joint changes, pain distribution, behavior of knee pain, presence of neuropathic-like or centrally mediated symptoms and responsiveness to previous treatment. The latter includes assessment of response to clinical test, mechanical hyperalgesia and allodynia, thermal hyperalgesia, hypoesthesia and reduced vibration sense. CONCLUSIONS: This article describes a set of clinically relevant descriptors that might indicate the presence of central sensitization in patients with knee osteoarthritis in clinical practice. Although based on research data, the descriptors proposed in this review require experimental testing in future studies. Implications for Rehabilitation Laboratory evaluation of central sensitization for people with knee osteoarthritis is yet to be incorporated into clinical practice. A set of clinical indicators for the recognition of central sensitization in patients with knee osteoarthritis is proposed. Although based on research data, the clinical indicators proposed require further experimental testing of psychometric properties.
BACKGROUND: Despite growing awareness of the contribution of central pain mechanisms to knee osteoarthritis pain in a subgroup of patients, routine evaluation of central sensitization is yet to be incorporated into clinical practice. AIM: The objective of this perspective is to design a set of clinical descriptors for the recognition of central sensitization in patients with knee osteoarthritis that can be implemented in clinical practice. METHODS: A narrative review of original research papers was conducted by nine clinicians and researchers from seven different countries to reach agreement on clinically relevant descriptors. RESULTS: It is proposed that identification of a dominance of central sensitization pain is based on descriptors derived from the subjective assessment and the physical examination. In the former, clinicians are recommended to inquire about intensity and duration of pain and its association with structural joint changes, pain distribution, behavior of knee pain, presence of neuropathic-like or centrally mediated symptoms and responsiveness to previous treatment. The latter includes assessment of response to clinical test, mechanical hyperalgesia and allodynia, thermal hyperalgesia, hypoesthesia and reduced vibration sense. CONCLUSIONS: This article describes a set of clinically relevant descriptors that might indicate the presence of central sensitization in patients with knee osteoarthritis in clinical practice. Although based on research data, the descriptors proposed in this review require experimental testing in future studies. Implications for Rehabilitation Laboratory evaluation of central sensitization for people with knee osteoarthritis is yet to be incorporated into clinical practice. A set of clinical indicators for the recognition of central sensitization in patients with knee osteoarthritis is proposed. Although based on research data, the clinical indicators proposed require further experimental testing of psychometric properties.
Entities:
Keywords:
Knee osteoarthritis; central sensitization syndromes; clinical descriptors; identification
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