Recent studies suggest the lifetime risk for symptomatic knee OA (KOA) is 45%1. An aging population and increasing rates of obesity contribute to dramatic increases in the prevalence of this condition. Historically, the """"""""disease"""""""" of OA is viewed primarily as damage to the cartilage and bone. As such, the magnitude of damage or inflammation of these structures should predict symptoms. Population-based studies suggest otherwise;30- 50% of individuals with moderate to severe radiographic changes of OA are asymptomatic, and approximately 10% with moderate to severe knee pain have normal radiographs2,3. Psychological factors do account for some 4,5 of this variance in pain and other symptoms, but only to a small degree . This failure of peripheral damage, inflammation, or even psychological factors to explain the presence, absence, or severity of chronic pain should not be surprising. To date, no chronic pain state involves a strong relationship between peripheral factors and the level of pain reported. We hypothesize that, although peripheral nociceptive input and to a lesser extent psychological factors are important in leading to pain and symptom expression in KOA, some patients possess varying degrees of non-psychological central nervous system (CNS) factors which play an equally or even more prominent role in the expression of pain and co-morbid symptoms 6-8. Broadly within chronic pain states, subsets of patients have been identified that have prominent CNS mechanisms (as opposed or in addition to, peripheral damage) playing important roles in pain perception. Such factors include diffuse hyperalgesia or allodynia, and/or a lack of endogenous descending analgesic activity 6,8, 9 . The exploration of these CNS factors has been somewhat limited to date in OA, but evidence is emerging that supports the hypothesis that subsets of OA patients do indeed have these mechanisms operative 10-12. Our hypothesis is further strengthened by studies that have identified co-morbid somatic symptoms known to be associated with central pain conditions (e.g., fatigue, sleep problems) to be commonly present in OA 13, 14. Finally, recent RCTs have demonstrated that compounds that alter pain neurotransmitters centrally such as 15,16 serotonin and norepinephrine (e.g., duloxetine, tricyclics) are efficacious in OA . We will identify the role that CNS factors are playing in KOA by first showing that subsets of patients have symptom patterns and experimental sensory testing abnormalities consistent with having a """"""""central"""""""" component to their pain. We will then demonstrate the utility of these measures by showing that individuals with KOA with central pain will respond poorly to knee arthroplasty. Such a study possesses 17 high public health impact given the high """"""""failure"""""""" rate of knee arthroplasty . If the status quo in practice for KOA is maintained, demand for knee arthroplasty will increase by an expected 700% in the next 20 years 18. Thus, in addition to this study providing a potential paradigm shift in our thinking regarding the """"""""disease"""""""" of OA, this study also develops practical clinical tools for identifying the presence of centrally-enhanced pain in OA.

Public Health Relevance

This study aims to examine why individuals with osteroarthritis of the knee respond poorly to knee arthroplasty. With demand for this procedure increasing, and an aging population, it is important to examine why there is such a high failure rate in this population.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR060392-04
Application #
8688907
Study Section
Special Emphasis Panel (ZRG1-RPHB-A (02))
Program Officer
Lester, Gayle E
Project Start
2011-08-01
Project End
2016-05-31
Budget Start
2014-06-01
Budget End
2015-05-31
Support Year
4
Fiscal Year
2014
Total Cost
$586,871
Indirect Cost
$209,462
Name
University of Michigan Ann Arbor
Department
Anesthesiology
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Neville, Stephen J; Clauw, Andrew D; Moser, Stephanie E et al. (2018) Association Between the 2011 Fibromyalgia Survey Criteria and Multisite Pain Sensitivity in Knee Osteoarthritis. Clin J Pain 34:909-917
Hassett, Afton L; Marshall, Elizabeth; Bailey, Angela M et al. (2018) Changes in Anxiety and Depression Are Mediated by Changes in Pain Severity in Patients Undergoing Lower-Extremity Total Joint Arthroplasty. Reg Anesth Pain Med 43:14-18
Lee, Jay S; Hu, Hsou M; Brummett, Chad M et al. (2017) Postoperative Opioid Prescribing and the Pain Scores on Hospital Consumer Assessment of Healthcare Providers and Systems Survey. JAMA 317:2013-2015
Waljee, Jennifer F; Cron, David C; Steiger, Rena M et al. (2017) Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery. Ann Surg 265:715-721
Waljee, Jennifer F; Li, Linda; Brummett, Chad M et al. (2017) Iatrogenic Opioid Dependence in the United States: Are Surgeons the Gatekeepers? Ann Surg 265:728-730
Harte, Steven E; Ichesco, Eric; Hampson, Johnson P et al. (2016) Pharmacologic attenuation of cross-modal sensory augmentation within the chronic pain insula. Pain 157:1933-45
Goesling, Jenna; Moser, Stephanie E; Zaidi, Bilal et al. (2016) Trends and predictors of opioid use after total knee and total hip arthroplasty. Pain 157:1259-65
Cheng, Jennifer; Kahn, Richard L; YaDeau, Jacques T et al. (2016) The Fibromyalgia Survey Score Correlates With Preoperative Pain Phenotypes But Does Not Predict Pain Outcomes After Shoulder Arthroscopy. Clin J Pain 32:689-94
Brummett, Chad M; Bakshi, Rishi R; Goesling, Jenna et al. (2016) Preliminary validation of the Michigan Body Map. Pain 157:1205-12
Brummett, Chad M; Urquhart, Andrew G; Hassett, Afton L et al. (2015) Characteristics of fibromyalgia independently predict poorer long-term analgesic outcomes following total knee and hip arthroplasty. Arthritis Rheumatol 67:1386-94

Showing the most recent 10 out of 15 publications