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Osteoarthritis pain: nociceptive or neuropathic?

Abstract

In this article, we present the case for the existence of a subgroup of patients with osteoarthritis (OA) who experience pain with neuropathic features. Recognizing these patients as a distinct subgroup will allow clinicians to improve the management of their symptoms. We discuss the diagnostic criteria for pain to be classed as neuropathic, then systematically examine the applicability of these criteria to the symptoms, signs and pathology of OA. What are the implications for the preclinical development and clinical use of analgesics for OA? How should existing treatment options be reassessed? Differences in the aetiology of OA and the pharmacological sensitivity of patients with OA pain with neuropathic features, compared with other patients with OA, might explain the frequent negative findings of clinical trials of treatments for symptomatic OA. If the global prevalence of OA pain with neuropathic features is accurately represented by reports from small experimental groups of patients, then a substantial unmet need to tailor diagnosis and therapy for these individuals exists.

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Figure 1: Diagnostic algorithm for neuropathic pain.
Figure 2: Referred pain.
Figure 3: Development of neuropathic pain in an OA knee.

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Acknowledgements

A.H.D. is funded by the Wellcome Trust, London Pain Consortium and Arthritis Research UK. M.T. is funded by the Wellcome Trust. R.B. is funded by the German Federal Ministry of Education and Research (BMBF, NoPain) and GrĂĽnenthal GmbH.

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M.T. wrote the article. M.T., R.B. and A.H.D. researched data for the article, substantially contributed to discussion of the content, and reviewed and edited the manuscript before submission.

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Correspondence to Matthew Thakur.

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Competing interests

R.B. declares that he is a member of the speakers' bureau or has received honoraria from Astellas, Bayer-Schering, Boehringer Ingelheim, Desitin, Eisai, Esteve, Genzyme, Grünenthal, Lilly, Medtronic, MSD, Mundipharma, Pfizer, Sanofi Pasteur, and Teva Pharma, and that he has received grant or research support from Genzyme, the German Federal Ministry of Education and Research (BMBF): German Research Network on Neuropathic Pain and NoPain system biology, Grünenthal, the German Research Foundation (DFG) and Pfizer, and he is a member of the IMI “Europain” collaboration, which has industry members, including Astra Zeneca, Boehringer Ingelheim, Grünenthal, Eli Lilly, Esteve, Pfizer, Sanofi Aventis, and UCB-Pharma, and he declares that he has acted as a consultant for Abbvie, Allergan, Astellas, AstraZeneca, Biogenidec, Boehringer Ingelheim, Bristol-Myers Squibb, Eisai, Genzyme, Grünenthal, Eli Lilly, Medtronic, Merck, Mundipharma, Novartis, Pfizer, Sanofi Pasteur, and UCB BioSciences. A.H.D. declares that he is a member of the speakers' bureau or has received honoraria from Astellas, Grünenthal, Lilly and Pfizer, and that he has received grant or research support from Grünenthal and he is a member of the IMI “Europain” collaboration, which has industry members, including Astra Zeneca, Boehringer Ingelheim, Eli Lilly, Esteve, Grünenthal, Pfizer, Sanofi Aventis and UCB-Pharma, and he declares that he has acted as a consultant for Astellas, Grünenthal and Pfizer. M.T. declares no competing interests.

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Thakur, M., Dickenson, A. & Baron, R. Osteoarthritis pain: nociceptive or neuropathic?. Nat Rev Rheumatol 10, 374–380 (2014). https://doi.org/10.1038/nrrheum.2014.47

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