Knee osteoarthritis (KOA) presents a complex pain landscape, with symptoms evolving beyond nociceptive pain into neuropathic and nociplastic types. The International Association for the Study of Pain (IASP) recognizes nociceptive (tissue damage), neuropathic (nerve injury), and nociplastic (sensitized nervous system) pain as distinct mechanisms. In KOA, pain often progresses from nociceptive due to joint trauma or overload to neuropathic from nerve injury or neuroinflammation, potentially leading to nociplastic pain when the nervous system becomes hypersensitive.
Understanding and evaluating central sensitization, which is present in about 30% of KOA patients, is critical for optimizing treatment. Tools like Quantitative Sensory Testing and the Central Sensitization Inventory (CSI) can help identify these pain mechanisms, especially in candidates for total knee replacement (TKR). A CSI score above 40 suggests central sensitization, linked to slower post-surgical recovery and higher pain levels. Effective management requires a thorough patient history, physical exams, and the identification of biomarkers to adapt treatment strategies. Ultimately, personalized treatment approaches aligned with each patient’s pain type can enhance outcomes and improve care for KOA patients.
Reference: Alcántara Montero A. Importance of understanding pain phenotypes in knee osteoarthritis for selecting appropriate pain-management strategies. Eur J Pain. 2024 Sep;28(8):1247-1248. doi: 10.1002/ejp.2312. Epub 2024 Jul 2. PMID: 38953582.
