Mechanistic pain profiling as a tool to predict the efficacy of 3-weeks non-steroidal anti-inflammatory drugs (NSAIDs) plus paracetamol in patients with painful knee osteoarthritis

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Abstract

Joint inflammation is present in a subpopulation of knee osteoarthritic (KOA) patients. Pro-inflammatory cytokines are known to sensitize the peripheral and central pain pathways. This can be mechanistically assessed by pressure pain thresholds and temporal summation of pain (TSP). Non-steroidal anti-inflammatory drugs (NSAIDs) combined with paracetamol are recommended as OA treatment. The current study hypothesized that evidence of central sensitization would predict poor responses to peripherally directed therapies in KOA and therefore aimed to investigate the value of mechanistic pain profiling for predicting pain outcome of treatment with NSAIDs plus paracetamol.One-hundred-and-thirty-two patients received Ibuprofen 1200 mg/daily, paracetamol 3g/daily, and pantoprazole 20 mg/daily for 3-weeks. Prior to administration, cuff pain detection, tolerance threshold and TSP were assessed. Worst pain within the last 24-hours and pain during activity (visual analog scales) were assessed before and after treatment.Facilitated TSP was found at baseline in the non-responders to the 3-weeks treatment as compared with responders for both the 30% and 50% pain alleviation criteria (P<0.02). Linear regression models identified facilitated TSP (P<0.01) and low clinical pain scores (P<0.001) as independent factors for prediction of poor pain alleviation by the treatment.In conclusion, this study found that mechanistic pain profiling can predict pain alleviation of NSAIDs and paracetamol. Facilitated TSP and low clinical pain scores prior to treatment are independent predictors of poor pain alleviation following NSAIDs and paracetamol. This study adds to the growing evidence that a subgroup of KOA patients with manifested central sensitization may require special management attention.

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Detaljer

Joint inflammation is present in a subpopulation of knee osteoarthritic (KOA) patients. Pro-inflammatory cytokines are known to sensitize the peripheral and central pain pathways. This can be mechanistically assessed by pressure pain thresholds and temporal summation of pain (TSP). Non-steroidal anti-inflammatory drugs (NSAIDs) combined with paracetamol are recommended as OA treatment. The current study hypothesized that evidence of central sensitization would predict poor responses to peripherally directed therapies in KOA and therefore aimed to investigate the value of mechanistic pain profiling for predicting pain outcome of treatment with NSAIDs plus paracetamol.One-hundred-and-thirty-two patients received Ibuprofen 1200 mg/daily, paracetamol 3g/daily, and pantoprazole 20 mg/daily for 3-weeks. Prior to administration, cuff pain detection, tolerance threshold and TSP were assessed. Worst pain within the last 24-hours and pain during activity (visual analog scales) were assessed before and after treatment.Facilitated TSP was found at baseline in the non-responders to the 3-weeks treatment as compared with responders for both the 30% and 50% pain alleviation criteria (P<0.02). Linear regression models identified facilitated TSP (P<0.01) and low clinical pain scores (P<0.001) as independent factors for prediction of poor pain alleviation by the treatment.In conclusion, this study found that mechanistic pain profiling can predict pain alleviation of NSAIDs and paracetamol. Facilitated TSP and low clinical pain scores prior to treatment are independent predictors of poor pain alleviation following NSAIDs and paracetamol. This study adds to the growing evidence that a subgroup of KOA patients with manifested central sensitization may require special management attention.

OriginalsprogEngelsk
TidsskriftPain
ISSN0304-3959
DOI
StatusAccepteret/In press - 26 okt. 2018
PublikationsartForskning
Peer reviewJa
ID: 290722710