Assessment of Frequency of Neuropathic Pain in Knee Osteoarthritis and its Relation to Functional State, Quality of Life and Depression

Objective: Neuropathic mechanisms are considered to play a role in development of pain in knee osteoarthritis (OA) as well as nocicieptive mechanisms. The present study aimed to determine neuropathic pain in patients with knee OA and investigate its relation to functional state,,quality of life and depression. Material and Methods: The present cross-sectional study enrolled 150 patients with primary knee OA. Demographic data of the patients were recorded. Anteroposterior knee radiographs were assessed using the Kellgren Lawrence staging system. Pain severity was evaluated with Visual Analogue Scale (VAS), the Douleur Neuropathique en 4 Questions (DN4) questionnaire was used to detect the neuropathic pain component, the Lequesne index was used to assess the functional status, the Beck Depression Inventory (BDI) was used to assess depressive symptoms and the Short Form-36 (SF-36) questionnaire was applied to assess the quality of life. Results: Of 150 patients,133 (88.7%) were female and 17 (11.3%) were male patients. The mean age was 61.5±9.7 years. The DN4 scale revealed that 40% of the patients had neuropathic pain. In the group with neuropathic pain, VAS resting, VAS movement and Lequesne scores were significantly higher than those of without neuropathic pain (p=0.004, p=0.005, p=0.0001, respectively). There were no significant differences in SF-36 and BDI scores between the two groups (p>0.05). There was no correlations between DN4, SF-36 and BDI scores; however, these scores showed a significant positive correlation with the Lequesne index (r=0.562, p=0.0001). Conclusion: Chronic pain in patients with OA has degenerative and neuropathic components. As neuropathic pain is a factor that increases pain and disability and disrupts functional status in osteoarthritis, it should be questioned and neuropathic pain treatment should take place as part of the treatment of osteoarthritis.

Diz Osteoartritinde Nöropatik Ağrı Sıklığı ve Fonksiyonel Durum, Yaşam Kalitesi ve Depresyon ile İlişkisinin Değerlendirilmesi

Amaç: Diz osteoartritinde (OA) ağrı oluşumu üzerine, nosiseptif mekanizmaların yanı sıra nöropatik mekanizmaların da rol oynayabileceği düşünülmektedir. Bu çalışmada diz osteoartriti olan hastalarda nöropatik ağrı komponenti olup olmadığının belirlenmesi ve nöropatik ağrı komponenti varsa fonksiyonel durum, yaşam kalitesi ve depresyon ile ilişkisinin araştırılması amaçlandı. Gereç ve Yöntemler: Bu kesitsel çalışmaya primer diz OA tanısı olan 150 hasta dahil edildi. Hastaların demografik verileri kaydedildi. Hastaların ön-arka diz grafileri Kellgren-Lawrence evreleme sistemi ile değerlendirildi. Ağrı şiddeti için Görsel Analog Skala (VAS), nöropatik ağrı komponentinin tespiti için DN4 anketi, fonksiyonel durumu değerlendirmek için Lequesne indeksi, depresif semptomlar açısından Beck Depresyon Ölçeği (BDÖ) ve yaşam kalitesi için Kısa form-36 (SF-36) anketi uygulandı. Bulgular: Hastaların 133’ü (%88,7) kadın, 17’si (%11,3) erkek idi. Yaş ortalaması 61,5±9,7 yıl idi. DN4 skalasına göre hastaların %40’ında nöropatik ağrı mevcuttu. Nöropatik ağrı olan grupta, nöropatik ağrı olmayan gruba göre VAS istirahat, VAS hareket ve Lequesne skorları istatistiksel olarak anlamlı derecede yüksek bulunmuştur (p=0,004, p=0,005 ve p=0,0001). İki grupta, SF-36 ile BDÖ skorları arasında anlamlı bir fark gözlenmedi (p>0,05). DN4 skoru ile SF36 ve Beck depresyon skoru arasında korelasyon olmadığı; Lequesne indeksi ile anlamlı pozitif korelasyon (r=0,562, p=0,0001) olduğu saptandı. Sonuç: Bu araştırmanın bulguları, kronik diz osteoartritli hastalarda ağrının nosiseptif komponenti yanı sıra nöropatik komponenti de olduğunu göstermektedir. Nöropatik ağrı, ağrı ve dizabiliteyi arttıran bir faktör olduğundan, osteoartritte fonksiyonel durumu bozan nöropatik ağrı sorgulanmalı ve nöropatik ağrı tedavisi osteoartrit tedavisinin bir parçası olarak uygulanmalıdır.

Kaynakça

Thakur M, Dickenson AH, Baron R. Osteoarthritis pain: nociceptive or neuropathic? Nat Rev Rheumatol. 2014;10:374-80. [Crossref] [PubMed]

Wu Q, Henry JL. Changes in Abeta non-nociceptive primary sensory neurons in a rat model of osteoarthritis pain. Mol Pain. 2010;6:37. [Crossref] [PubMed]

Hochman JR, Gagliese L, Davis AM, et al. Neuropathic pain symptoms in a community knee OA cohort. Osteoarthritis Cartilage. 2011;19:647-54. [Crossref] [PubMed]

Chong MS, Hester J. Diabetic painful neuropathy: current and future treatment options. Drugs. 2007;67:569-85. [Crossref] [PubMed]

Kawano MM, Araújo IL, Castro MC, et al. Assessment of quality of life in patients with knee osteoarthritis. Acta Ortop Bras. 2015;23:307- 10. [Crossref] [PubMed] [PMC]

Aşkın A, Özkan A, Tosun A, et al. Quality of life and functional capacity are adversely affected in osteoarthritis patients with neuropathic pain. Kaohsiung J Med Sci. 2017;33:152-8. [Crossref] [PubMed]

Hochman JR, French MR, Bermingham SL, et al. The nerve of osteoarthritis pain. Arthritis Care Res (Hoboken). 2010;62:1019-23. [Crossref] [PubMed]

Gölge UH, Şen HM, Kuyucu E, et al. Investigation of knee pain in osteoarthritic and neuropathic pain awareness. Acta Orthop Belg. 2015;81:639-46. [PubMed]

Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and therapeutic criteria committee of the American Rheumatism Association. Arthritis Rheum. 1986;29:1039-49. [Crossref] [PubMed]

Kellgren JH, Lawrance JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494-502. [Crossref] [PubMed]

Dixon JS, Bird HA. Reproducibility along a 10 cm vertical visual analogue scale. Ann Rheum Dis. 1981;40:87-99. [Crossref] [PubMed]

Lequesne MG, Samson S. Indices of severity in osteoarthritis of weight. J Rheumatol. 1991;18:16-8. [PubMed]

Koçyigit H. Turkish validity and reliability of short-form 36. Drug Treat. 1999;12:102-6.

Hisli N. A study on the validity of Beck Depression Inventory. J Psychol. 1988;6:118-22.

Unal-Cevik I, Sarioglu-Ay S, Evcik D. Comparison of the DN4 and LANSS questionnaires in the assessment of neuropathic pain: validity and reliability of the Turkish version of DN4. J Pain. 2010;11:1129-35. [Crossref] [PubMed]

Ohtori S, Orita S, Yamashita M, et al. Existence of a neuropathic pain component in patients with osteoarthritis of the knee. Yonsei Med J. 2012;53:801-5. [Crossref] [PubMed]

Mesci N, Mesci E, Külcü DG. Association of neuropathic pain wit ultrasonographic measurements of femoral cartilage thickness and clinical parameters in patients with knee osteoarthritis. J Phys Ther Sci. 2016;28:2190-5. [Crossref] [PubMed] [PMC]

Bouhassira D, Attal N, Alchaar H, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114:29-36. [Crossref] [PubMed]

Oteo-Álvaro Á, Ruiz-Ibán MA, Miguens X, et al. High prevalence of neuropathic pain features in patients with knee osteoarthritis: a cross-sectional study. Pain Pract. 2015;15: 618-26. [Crossref] [PubMed]

Rienstra W, Blikman T, Mensink FB, et al. The modified painDETECT questionnaire for patients with hip or knee osteoarthritis: translation into Dutch, cross-cultural adaptation and reliability assessment. PLoS One. 2015;10:e0146117. [Crossref] [PubMed]

Pereira D, Severo M, Barros H, et al. The effect of depressive symptoms on the association between radiographic osteoarthritis and knee pain: a crosssectional study. BMC Musculoskelet Disord. 2013;14:214. [Crossref] [PubMed] [PMC]

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