Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Current Osteoporosis Reports
Erschienen in: Current Osteoporosis Reports 6/2015

01.12.2015 | Bone and Joint Pain (PW Mantyh and TJ Schnitzer, Section Editors)

A Mechanism-Based Approach to the Management of Osteoarthritis Pain

verfasst von: Ezra Cohen, Yvonne C. Lee

Erschienen in: Current Osteoporosis Reports | Ausgabe 6/2015

Einloggen, um Zugang zu erhalten

Abstract

Pain from osteoarthritis (OA) affects millions of people worldwide, yet treatments are limited to acetaminophen, NSAIDs, physical therapy, and ultimately, surgery when there is significant disability. In recent years, our understanding of pain pathways in OA has developed considerably. Though joint damage and inflammation play a significant role in pain generation, it is now understood that both central and peripheral nervous system mechanisms exacerbate symptoms. Evolving management strategies for OA address central factors (e.g., sleep difficulties, catastrophizing, and depression) with treatments such as cognitive behavioral therapy and exercise. In addition, emerging data suggest that antibodies against peripheral signaling neuropeptides, such as nerve growth factor-1 (NGF-1), may significantly alleviate pain. However, concerns regarding potential adverse effects, such as rapidly progressive OA, still remain. A nuanced understanding is essential if we are to make headway in developing more effective treatments for OA.
Literatur
1.
Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum. 2008;58:15–25.CrossRefPubMed
2.
Leigh JP, Seavey W, Leistikow B. Estimating the costs of job related arthritis. J Rheumatol. 2001;28:1647–54.PubMed
3.
White AG, Birnbaum HG, Janagap C, Buteau S, Schein J. Direct and indirect costs of pain therapy for osteoarthritis in an insured population in the United States. J Occup Environ Med. 2008;50:998–1005.CrossRefPubMed
4.
Gabriel SE, Crowson CS, Campion ME, O’Fallon WM. Indirect and nonmedical costs among people with rheumatoid arthritis and osteoarthritis compared with nonarthritic controls. J Rheumatol. 1997;24:43–8.PubMed
5.
Elliott AM, Smith BH, Penny KI, Smith WC, Chambers WA. The epidemiology of chronic pain in the community. Lancet. 1999;354:1248–52.CrossRefPubMed
6.
Neogi T, Felson D, Niu J, Nevitt M, Lewis CE, Aliabadi P, et al. Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies. BMJ. 2009;339:b2844.PubMedCentralCrossRefPubMed
7.
Torres L, Dunlop DD, Peterfy C, Guermazi A, Prasad P, Hayes KW, et al. The relationship between specific tissue lesions and pain severity in persons with knee osteoarthritis. Osteoarthr Cartil. 2006;14:1033–40.CrossRefPubMed
8.
Stoppiello LA, Mapp PI, Wilson D, Hill R, Scammell BE, Walsh DA. Structural associations of symptomatic knee osteoarthritis. Arthritis Rheumatol (Hoboken, NJ). 2014;66:3018–27.CrossRef
9.
McKelvey L, Shorten GD, O’Keeffe GW. Nerve growth factor-mediated regulation of pain signalling and proposed new intervention strategies in clinical pain management. J Neurochem. 2013;124:276–89.CrossRefPubMed
10.
Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA. 1999;282:2131–5.CrossRefPubMed
11.
Isola M, Ferrari V, Miolo A, Stabile F, Bernardini D, Carnier P, et al. Nerve growth factor concentrations in the synovial fluid from healthy dogs and dogs with secondary osteoarthritis. Vet Comp Orthop Traumatol. 2011;24:279–84.CrossRefPubMed
12.
Pecchi E, Priam S, Gosset M, Pigenet A, Sudre L, Laiguillon M-C, et al. Induction of nerve growth factor expression and release by mechanical and inflammatory stimuli in chondrocytes: possible involvement in osteoarthritis pain. Arthritis Res Ther. 2014;16:R16.PubMedCentralCrossRefPubMed
13.
Walsh DA, Mcwilliams DF, Turley MJ, Dixon MR, Fransès RE, Mapp PI, et al. Angiogenesis and nerve growth factor at the osteochondral junction in rheumatoid arthritis and osteoarthritis. Rheumatology. 2010;49:1852–61.PubMedCentralCrossRefPubMed
14.
Svensson P, Cairns BE, Wang K, Arendt-Nielsen L. Injection of nerve growth factor into human masseter muscle evokes long-lasting mechanical allodynia and hyperalgesia. Pain. 2003;104:241–7.CrossRefPubMed
15.
König C, Zharsky M, Möller C, Schaible HG, Ebersberger A. Involvement of peripheral and spinal tumor necrosis factor α in spinal cord hyperexcitability during knee joint inflammation in rats. Arthritis Rheum. 2014;66:599–609.CrossRef
16.
Stannus OP, Jones G, Blizzard L, Cicuttini FM, Ding C. Associations between serum levels of inflammatory markers and change in knee pain over 5 years in older adults: a prospective cohort study. Ann Rheum Dis. 2013;72:535–40.CrossRefPubMed
17.
Takeshita M, Nakamura J, Ohtori S, Inoue G, Orita S, Miyagi M, et al. Sensory innervation and inflammatory cytokines in hypertrophic synovia associated with pain transmission in osteoarthritis of the hip: a case-control study. Rheumatology (Oxford). 2012;51:1790–5.CrossRef
18.
Lee YC, Lu B, Bathon JM, Haythornthwaite JA, Smith MT, Page GG, et al. Pain sensitivity and pain reactivity in osteoarthritis. Arthritis Care Res. 2011;63:320–7.
19.
Graven-Nielsen T, Wodehouse T, Langford RM, Arendt-Nielsen L, Kidd BL. Normalization of widespread hyperesthesia and facilitated spatial summation of deep-tissue pain in knee osteoarthritis patients after knee replacement. Arthritis Rheum. 2012;64:2907–16.CrossRefPubMed
20.
21.
Arendt-Nielsen L, Nie H, Laursen MB, Laursen BS, Madeleine P, Simonsen OH, et al. Sensitization in patients with painful knee osteoarthritis. Pain. 2010;149:573–81.CrossRefPubMed
22.••
Petersen KK, Arendt-Nielsen L, Simonsen O, Wilder-Smith O, Laursen MB. Presurgical assessment of temporal summation of pain predicts the development of chronic postoperative pain 12 months after total knee replacement. Pain. 2015;156:55–61. Petersen et al. studied patients undergoing total knee replacement and found a significant association between pre-operative measures of central sensitization and post-operative pain intensity. This knowledge may ultimately be useful to predict which patients with OA are suitable candidates for total knee replacement surgery.
23.
24.
Kosek E, Ordeberg G. Lack of pressure pain modulation by heterotopic noxious conditioning stimulation in patients with painful osteoarthritis before, but not following, surgical pain relief. Pain. 2000;88:69–78.CrossRefPubMed
25.
Kulkarni B, Bentley DE, Elliott R, Julyan PJ, Boger E, Watson A, et al. Arthritic pain is processed in brain areas concerned with emotions and fear. Arthritis Rheum. 2007;56:1345–54.CrossRefPubMed
26.
Monfort J, Pujol J, Lopez-Ruiz M, Llorente-Onaindia J, Martinez-Vilavella G, Macia D, et al. Functional magnetic resonance imaging evaluation of pain central sensitization phenomena in subjects with knee osteoarthritis. Osteoarthr Cartil. 2015; 23:A60.
27.
Smith MT, Quartana PJ, Okonkwo RM, Nasir A. Mechanisms by which sleep disturbance contributes to osteoarthritis pain: a conceptual model. Curr Pain Headache Rep. 2009;13:447–54.CrossRefPubMed
28.
Vitiello MV, McCurry SM, Shortreed SM, Baker LD, Rybarczyk BD, Keefe FJ, et al. Short-term improvement in insomnia symptoms predicts long-term improvements in sleep, pain, and fatigue in older adults with comorbid osteoarthritis and insomnia. Pain. 2014;155:1547–54.PubMedCentralCrossRefPubMed
29.
Petrov M, Goodin B, Cruz-Almeida Y. Disrupted sleep is associated with altered pain processing by sex and ethnicity in knee osteoarthritis. J Pain. 2015;16:478–90.CrossRefPubMed
30.
Smith MT, Edwards RR, McCann UD, Haythornthwaite JA. The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep. 2007;30:494–505.PubMed
31.
Haack M, Sanchez E, Mullington JM. Elevated inflammatory markers in response to prolonged sleep restriction are associated with increased pain experience in healthy volunteers. Sleep. 2007;30:1145–52.PubMedCentralPubMed
32.•
Egsgaard L, Eskehave T, Bay-Jensen AC, Hoeck HC, Arendt-Nielsen L. Identifying specific profiles in patients with different degrees of painful knee osteoarthritis based on serological biochemical and mechanistic pain biomarkers: a diagnostic approach based on cluster analysis. Pain. 2015;156:96–107. This paper provides an example of how biochemical, physical and psychological factors can be integrated to characterize OA patients into distinct pain profiles that reflect underlying pain mechanisms.
33.
Campbell C, Buenaver L, Finan P, Bounds SC, Redding M, McCauley L, et al. Sleep, pain catastrophizing and central sensitization in knee osteoarthritis patients with and without insomnia. Arthritis Care Res (Hoboken). 2015;67(10):1387–96.
34.
Cruz‐Almeida Y, King C. Psychological profiles and pain characteristics of older adults with knee osteoarthritis. Arthritis Care Res (Hoboken). 2013;65:1786–94.CrossRef
35.
Finan P, Quartana P, Smith M. Positive and negative affect dimensions in chronic knee osteoarthritis: effects on clinical and laboratory pain. Psychosom Med. 2013;75:463–70.CrossRefPubMed
36.
Hochberg MC et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012;64(4):465–74.CrossRef
37.
Bradley JD, Brandt KD, Katz BP, Kalasinski LA, Ryan SI. Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee. New Engl J Med. 1991;325:87–91.
38.
Towheed TE, Maxwell L, Judd MG, Catton M, Hochberg MC, Wells G. Acetaminophen for osteoarthritis. Cochrane Database Syst Rev. 2006;1:CD004257.
39.
Anderson BJ. Paracetamol (acetaminophen): mechanisms of action. Paediatr Anaesth. 2008;18:915–21.CrossRefPubMed
40.
Bertolini A, Ferrari A, Ottani A, Guerzoni S, Tacchi R, Leone S. Paracetamol: new vistas of an old drug. CNS Drug Rev. 2006;12:250–75.CrossRefPubMed
41.
Bjordal JM, Ljunggren AE, Klovning A, Slørdal L. Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: meta-analysis of randomised placebo controlled trials. BMJ. 2004;329:1317.PubMedCentralCrossRefPubMed
42.
Chou R, McDonagh M, Nakamoto E, Griffin J. Analgesics for osteoarthritis: an update of the 2006 comparative effectiveness review. Comp Eff Rev. 2011;38:1–113.
43.
Baigent C, Bhala N, Emberson J, Merhi A, Abramson S, Arber N, et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013;382:769–79.CrossRefPubMed
44.
45.
Kienzler J-L, Gold M, Nollevaux F. Systemic bioavailability of topical diclofenac sodium gel 1% versus oral diclofenac sodium in healthy volunteers. J Clin Pharmacol. 2010;50:50–61.CrossRefPubMed
46.
Radermacher J, Jentsch D, Scholl MA, Lustinetz T, Frölich JC. Diclofenac concentrations in synovial fluid and plasma after cutaneous application in inflammatory and degenerative joint disease. Br J Clin Pharmacol. 1991;31:537–41.PubMedCentralCrossRefPubMed
47.
Singh P, Roberts MS. Skin permeability and local tissue concentrations of nonsteroidal anti-inflammatory drugs after topical application. J Pharmacol Exp Ther. 1994;268:144–51.PubMed
48.
Zacher J, Burger KF, Farber L. Topical diclofenac Emulgel versus oral ibuprofen in the treatment of active osteoarthritis of the finger joints (Heberden’s and/ or Bouchard’s nodes): double-blind, controlled, randomized study. Aktuelle Rheumatologie. 2001; 26:7–14.
49.
Simon LS, Grierson LM, Naseer Z, et al. Efficacy and safety of topical diclofenac containing dimethyl sulfoxide (DMSO) compared with those of topical placebo, DMSO vehicle and oral diclofenac for knee osteoarthritis. Pain 2009; 143:238–45.
50.
Tugwell PS, Wells GA, Shainhouse JZ. Equivalence study of a topical diclofenac solution (Pennsaid) compared with oral diclofenac in symptomatic treatment of osteoarthritis of the knee: a randomized controlled trial. J Rheumatol. 2004;31:2002–12.
51.
Sandelin J, Harilainen A, Crone H, et al. Local NSAID gel (eltenac) in the treatment of osteoarthritis of the knee: a double blind study comparing eltenac with oral diclofenac and placebo gel. Scand J Rheumatol. 1997;26:287–92.
52.
Dickson DJ. A double-blind evaluation of topical piroxicam gel with oral ibuprofen in osteoarthritis of the knee. Curr Ther Res Clin Exp. 1991;49:199–207.
53.
Rains C, Bryson HM. Topical capsaicin. A review of its pharmacological properties and therapeutic potential in post-herpetic neuralgia, diabetic neuropathy and osteoarthritis. Drugs Aging. 1995;7:317–28.CrossRefPubMed
54.
Anand P, Bley K. Topical capsaicin for pain management: therapeutic potential and mechanisms of action of the new high-concentration capsaicin 8 patch. Br J Anaesth. 2011;107:490–502.PubMedCentralCrossRefPubMed
55.
56.
McCarthy GM, McCarty DJ. Effect of topical capsaicin in the therapy of painful osteoarthritis of the hands. J Rheumatol. 1992;19:604–7.PubMed
57.
Altman RD, Aven A, Holmburg CE, Pfeifer LM, Sack M, Young GT. Capsaicin cream 0.025% as monotherapy for osteoarthritis: a double-blind study. Semin Arthritis Rheum. 1994;23:25–33.CrossRef
58.
Schnitzer TJ, Marks JA. A systematic review of the efficacy and general safety of antibodies to NGF in the treatment of OA of the hip or knee. Osteoarthr Cartil. 2015;23 Suppl 1:S8–S17.CrossRefPubMed
59.••
Schnitzer TJ, Ekman EF, Spierings ELH, Greenberg HS, Smith MD, Brown MT, et al. Efficacy and safety of tanezumab monotherapy or combined with non-steroidal anti-inflammatory drugs in the treatment of knee or hip osteoarthritis pain. Ann Rheum Dis. 2015;74:1202–11. Schnitzer et al. conducted a trial comparing tanezumab (an anti-NGF-1 antibody) monotherapy, with NSAID monotherapy and a combination of both tanezumab and NSAIDs. Both tanezumab monotherapy and tanezumab plus NSAID combination therapy produced statistically significant improvements in WOMAC scores, compared to NSAIDs alone. However, combination therapy was associated with the highest frequency of serious adverse events, including osteonecrosis and progressive OA.
60.
Chappell AS, Desaiah D, Liu-Seifert H, Zhang S, Skljarevski V, Belenkov Y, et al. A double-blind, randomized, placebo-controlled study of the efficacy and safety of duloxetine for the treatment of chronic pain due to osteoarthritis of the knee. Pain Pract. 2011;11:33–41.CrossRefPubMed
61.
Abou-Raya S, Abou-Raya A, Helmii M. Duloxetine for the management of pain in older adults with knee osteoarthritis: randomised placebo-controlled trial. Age Ageing. 2012;41:646–52.CrossRefPubMed
62.
Chappell AS, Ossanna MJ, Liu-Seifert H, Iyengar S, Skljarevski V, Li LC, et al. Duloxetine, a centrally acting analgesic, in the treatment of patients with osteoarthritis knee pain: a 13-week, randomized, placebo-controlled trial. Pain. 2009;146:253–60.CrossRefPubMed
63.
Brunton S, Wang F, Edwards SB, Crucitti AS, Ossanna MJ, Walker DJ, et al. Profile of adverse events with duloxetine treatment: a pooled analysis of placebo-controlled studies. Drug Saf. 2010;33:393–407.CrossRefPubMed
64.
Nijs J, Kosek E, Van Oosterwijck J, Meeus M. Dysfunctional endogenous analgesia during exercise in patients with chronic pain: to exercise or not to exercise? Pain Physician. 2012;15(3 Suppl):ES205–13.PubMed
65.
Uthman OA, van der Windt DA, Jordan JL, Dziedzic KS, Healey EL, Peat GM, et al. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. BMJ. 2013;347:f5555.
66.
67.•
Smith MT, Finan PH, Buenaver LF, Robinson M, Haque U, Quain A, et al. Cognitive-behavioral therapy for insomnia in knee osteoarthritis: a randomized, double-blind, active placebo-controlled clinical trial. Arthritis Rheumatol (Hoboken, NJ). 2015;67:1221–33. This group conducted a randomized, double-blind, placebo-controlled trial of cognitive behavioral therapy for insomnia in knee OA. They found that this intervention decreased clinical pain but did not have any effect on conditioned pain modulation as measured by quantitative sensory testing.CrossRef
68.
Hochberg M, Martel-Pelletier J, Monfort J, Moller I, Castillo JR, Arden N, et al. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis: a multicentre, randomised, double-blind, non-inferiority trial versus celecoxib. Ann Rheum Dis. 2015. doi:10.​1136/​annrheumdis-2014-206792.
69.
Yang S, Eaton C. Effects of glucosamine and chondroitin supplementation on knee osteoarthritis: an analysis with marginal structural models. Arthritis Rheum. 2015;67:714–23.CrossRef
70.
Rutjes AWS, Jüni P, da Costa BR, Trelle S, Nüesch E, Reichenbach S. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med. 2012;157:180–91.CrossRefPubMed
71.
Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K, Müllner M. Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis. CMAJ. 2005;172:1039–43.PubMedCentralCrossRefPubMed
72.
Drengk A, Zapf A, Stürmer EK, Stürmer KM, Frosch KH. Influence of platelet-rich plasma on chondrogenic differentiation and proliferation of chondrocytes and mesenchymal stem cells. Cells Tissues Organs. 2009;189:317–26.CrossRefPubMed
73.
Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med. 2013;41:356–64.CrossRefPubMed
74.
Pendleton A, Arden N, Dougados M, Doherty M, Bannwarth B, Bijlsma JW, et al. EULAR recommendations for the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2000;59:936–44.PubMedCentralCrossRefPubMed
75.
Zhang W, Doherty M, Leeb BF, Alekseeva L, Arden NK, Bijlsma JW et al. EULAR evidence based recommendations for the management of hand osteaorthritis: report of a task force of the EULAR standing committee for international clinical studies including therapeutics (ESCISIT). Ann Rheum Dis. 2007;66:377–88.
76.
Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther K-P, et al. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2005;64:669–81.PubMedCentralCrossRefPubMed
Metadaten
Titel
A Mechanism-Based Approach to the Management of Osteoarthritis Pain
verfasst von
Ezra Cohen
Yvonne C. Lee
Publikationsdatum
01.12.2015
Verlag
Springer US
Erschienen in
Current Osteoporosis Reports / Ausgabe 6/2015
Print ISSN: 1544-1873
Elektronische ISSN: 1544-2241
DOI
https://doi.org/10.1007/s11914-015-0291-y

Weitere Artikel der Ausgabe 6/2015

Current Osteoporosis Reports 6/2015 Zur Ausgabe

Skeletal Development (E Schipani and E Zelzer, Section Editors)

Articular Cartilage: Structural and Developmental Intricacies and Questions

Skeletal Biology and Regulation (MR Forwood and A Robling, Section Editors)

Pathophysiology of Vascular Calcification

Epidemiology and Pathophysiology (J Cauley and B Dawson-Hughes, Section Editors)

Bone Density Screening and Re-screening in Postmenopausal Women and Older Men

Skeletal Biology and Regulation (MR Forwood and A Robling, Section Editors)

Vibration Therapy to Prevent Bone Loss and Falls: Mechanisms and Efficacy

Skeletal Biology and Regulation (MR Forwood and A Robling, Section Editors)

Prebiotic and Probiotic Regulation of Bone Health: Role of the Intestine and its Microbiome

Therapeutics and Medical Management (E Shane and R Adler, Section Editors)

How Long to Treat with Denosumab

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

23.04.2024 | Leitsymptom Rückenschmerzen | Nachrichten

Ärztliche Empathie hilft gegen Rückenschmerzen

18.04.2024 | Wirbelsäulenmetastase | Nachrichten

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

16.04.2024 | Spondylitis ankylosans | Nachrichten

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

15.04.2024 | Knie-TEP | Nachrichten

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger
weitere anzeigen

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise