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Pain sensitivity profiles in patients with advanced knee osteoarthritis

Frey-Law, Laura A.; Bohr, Nicole L.; Sluka, Kathleen A.; Herr, Keela; Clark, Charles R.; Noiseux, Nicolas O.; Callaghan, John J.; Zimmerman, M. Bridget; Rakel, Barbara A.

doi: 10.1097/j.pain.0000000000000603
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The development of patient profiles to subgroup individuals on a variety of variables has gained attention as a potential means to better inform clinical decision making. Patterns of pain sensitivity response specific to quantitative sensory testing (QST) modality have been demonstrated in healthy subjects. It has not been determined whether these patterns persist in a knee osteoarthritis population. In a sample of 218 participants, 19 QST measures along with pain, psychological factors, self-reported function, and quality of life were assessed before total knee arthroplasty. Component analysis was used to identify commonalities across the 19 QST assessments to produce standardized pain sensitivity factors. Cluster analysis then grouped individuals who exhibited similar patterns of standardized pain sensitivity component scores. The QST resulted in 4 pain sensitivity components: heat, punctate, temporal summation, and pressure. Cluster analysis resulted in 5 pain sensitivity profiles: a “low pressure pain” group, an “average pain” group, and 3 “high pain” sensitivity groups who were sensitive to different modalities (punctate, heat, and temporal summation). Pain and function differed between pain sensitivity profiles, along with sex distribution; however, no differences in osteoarthritis grade, medication use, or psychological traits were found. Residualizing QST data by age and sex resulted in similar components and pain sensitivity profiles. Furthermore, these profiles are surprisingly similar to those reported in healthy populations, which suggests that individual differences in pain sensitivity are a robust finding even in an older population with significant disease.

Supplemental Digital Content is Available in the Text.Quantitative sensory testing in individuals with advanced knee osteoarthritis resulted in 4 pain sensitivity components and 5 pain sensitivity profiles associated with differences in pain and function.

aDepartment of Physical Therapy and Rehabilitation Science, College of Medicine, University of Iowa, Iowa City, IA, USA

bCollege of Nursing, University of Iowa, Iowa City, IA, USA

cDepartment of Orthopedics and Rehabilitation, College of Medicine, University of Iowa, Iowa City, IA, USA

dDepartment of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA

Corresponding author. Address: 318 CNB, College of Nursing, University of Iowa, 50 Newton Rd, Iowa City, IA 52242, USA. Tel.: 319-335-7036; fax: 319-335-7030. E-mail address: barbara-rakel@uiowa.edu (B.A. Rakel).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received October 26, 2015

Received in revised form April 07, 2016

Accepted April 14, 2016

© 2016 International Association for the Study of Pain
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