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Patients With Knee Osteoarthritis Who Score Highly on the PainDETECT Questionnaire Present With Multimodality Hyperalgesia, Increased Pain, and Impaired Physical Function

Moss, Penny PhD*; Benson, Heather A.E. PhD; Will, Rob FRACP; Wright, Anthony PhD*

doi: 10.1097/AJP.0000000000000504
Original Articles

Objectives: PainDETECT is a self-report questionnaire that can be used to identify features of neuropathic pain. A proportion of patients with knee osteoarthritis (OA) score highly on the PainDETECT questionnaire. This study aimed to determine whether those with a higher “positive neuropathic” score on the PainDETECT questionnaire also had greater pain, hypersensitivity, and reduced function compared with individuals with knee OA with lower PainDETECT scores.

Materials and Methods: In total, 130 participants with knee OA completed the PainDETECT, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Pain Quality Assessment Scale questionnaires. Quantitative sensory testing was carried out at 3 sites (both knees and elbow) using standard methods. Cold and heat pain thresholds were tested using a Peltier thermode and pressure pain thresholds using a digital algometer. Physical function was assessed using 3 timed locomotor function tests.

Results: In total, 22.3% of participants scored in the “positive neuropathic” category with a further 35.4% in the unclear category. Participants in the “positive neuropathic” category reported higher levels of pain and more impaired function based on the WOMAC questionnaire (P<0.0001). They also exhibited increased levels of hyperalgesia at the knee and upper limb sites for all stimulation modalities except heat pain thresholds at the OA knee. They were also slower to complete 2 of the locomotion tasks.

Discussion: This study identified a specific subgroup of people with knee OA who exhibited PainDETECT scores in the “positive neuropathic” category. These individuals experienced increased levels of pain, widespread, multimodality hyperalgesia, and greater functional impairment than the remaining cohort. Identification of OA patients with this pain phenotype may permit more targeted and effective pain management.

*School of Physiotherapy and Exercise Science

School of Pharmacy, Curtin Health Innovation Research Institute, Curtin University

School of Medicine and Pharmacology, University of Western Australia, Perth, WA

Supported by an Investigator Initiated Studies Grant from Merck Inc., Kenilworth, NJ. The authors declare no conflict of interest.

Reprints: Anthony Wright, PhD, School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia (e-mail:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Received November 29, 2016

Received in revised form March 16, 2017

Accepted March 27, 2017

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