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Exercise-induced Hypoalgesia in People With Knee Osteoarthritis With Normal and Abnormal Conditioned Pain Modulation

Fingleton, Caitríona PhD, BSc; Smart, Keith M. PhD, MSc, BSc; Doody, Catherine M. PhD, MSc, Dip TP

The Clinical Journal of Pain: May 2017 - Volume 33 - Issue 5 - p 395–404
doi: 10.1097/AJP.0000000000000418
Original Articles

Objectives: Normal efficiency of exercise-induced hypoalgesia (EIH) has been demonstrated in people with knee osteoarthritis (OA), while recent evidence suggests that EIH may be associated with features of pain sensitization such as abnormal conditioned pain modulation (CPM). The aim of this study was to investigate whether people with knee OA with abnormal CPM have dysfunctional EIH compared with those with normal CPM and pain-free controls.

Methods: Forty peoples with knee OA were subdivided into groups with abnormal and normal CPM, as determined by a decrease/increase in pressure pain thresholds (PPTs) following the cold pressor test. Abnormal CPM (n=19), normal CPM (n=21), and control participants (n=20) underwent PPT testing before, during, and after aerobic and isometric exercise protocols. Between-group differences were analyzed using repeated-measures analysis of variance and within-group differences were analyzed using Wilcoxon signed-rank tests.

Results: Significant differences were demonstrated between groups for changes in PPTs postaerobic (F 2,55=4.860; P=0.011) and isometric (F 2,57=4.727; P=0.013) exercise, with significant decreases in PPTs demonstrated during and postexercise in the abnormal CPM group (P<0.05), and significant increases in PPTs shown during and postexercise in the normal CPM and control groups (P<0.05).

Conclusions: Results are suggestive of dysfunctional EIH in response to aerobic and isometric exercise in knee OA patients with abnormal CPM, and normal function of EIH in knee OA patients with an efficient CPM response. Identification of people with knee OA with inefficient endogenous pain modulation may allow for a more individualized and graded approach to exercises in these individuals.

*School of Public Health, Physiotherapy and Sports Science and Population Science, University College Dublin

St. Vincent’s University Hospital, Dublin, Ireland

Supported by an EMBARK postgraduate scholarship from the Irish Research Council, Dublin.

The authors declare no conflict of interest.

Reprints: Caitríona Fingleton, PhD, BSc, School of Public Health, Physiotherapy and Sports Science & Population Science, Health Sciences Centre, Belfield, Dublin 4 (e-mail:

Received September 15, 2015

Received in revised form August 24, 2016

Accepted July 4, 2016

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