Pain Phenotypes in Knee Osteoarthritis
| Status: | Recruiting |
|---|---|
| Conditions: | Arthritis, Chronic Pain, Osteoarthritis (OA) |
| Therapuetic Areas: | Musculoskeletal, Rheumatology |
| Healthy: | No |
| Age Range: | 50 - 85 |
| Updated: | 4/21/2016 |
| Start Date: | April 2013 |
| End Date: | March 2016 |
| Contact: | Andrew Kittelson, DPT |
| Email: | andrew.kittelson@ucdenver.edu |
| Phone: | 303-724-9590 |
Determination of Pain Phenotypes in Older Adults With Knee Osteoarthritis
Recently, the medical community has learned damage to the knee joint may be one of many
possible reasons for pain in knee osteoarthritis. Psychological factors and other aspects of
brain function seem to play an important role in the pain experience. Although research
studies have examined these factors on an individual basis, no study has examined all of
these factors in the same population. Furthermore, some measures of brain function- having
to do with perception of the painful body part- have yet to be examined in knee
osteoarthritis. The investigators plan to study many of these variables in a group of people
with knee osteoarthritis, as well in some healthy controls (without knee pain), in order to
establish the relative importance of these measures in contributing to pain, as well as
validate new measures of perception in people with knee osteoarthritis. We also plan to use
a statistical tool- known as latent profile analysis- to look at subgroups of knee
osteoarthritis pain. The hypothesis is that different people experience pain in knee
osteoarthritis for different reasons. This study will be the first study to use all of these
different variables- which can be reproduced in a clinical setting- to look for different
subgroups of knee osteoarthritis pain. Ultimately, the goal is to help clinicians better
prioritize and target interventions to individual patients. The investigators believe this
will lead to better outcomes and fewer treatment complications currently associates with
pharmaceutical and surgical interventions that are widely used to treat knee osteoarthritis.
possible reasons for pain in knee osteoarthritis. Psychological factors and other aspects of
brain function seem to play an important role in the pain experience. Although research
studies have examined these factors on an individual basis, no study has examined all of
these factors in the same population. Furthermore, some measures of brain function- having
to do with perception of the painful body part- have yet to be examined in knee
osteoarthritis. The investigators plan to study many of these variables in a group of people
with knee osteoarthritis, as well in some healthy controls (without knee pain), in order to
establish the relative importance of these measures in contributing to pain, as well as
validate new measures of perception in people with knee osteoarthritis. We also plan to use
a statistical tool- known as latent profile analysis- to look at subgroups of knee
osteoarthritis pain. The hypothesis is that different people experience pain in knee
osteoarthritis for different reasons. This study will be the first study to use all of these
different variables- which can be reproduced in a clinical setting- to look for different
subgroups of knee osteoarthritis pain. Ultimately, the goal is to help clinicians better
prioritize and target interventions to individual patients. The investigators believe this
will lead to better outcomes and fewer treatment complications currently associates with
pharmaceutical and surgical interventions that are widely used to treat knee osteoarthritis.
In a 2011 statement to the Food and Drug Administration, the Osteoarthritis Research Society
International (OARSI) identified the "phenotyping" of OA pain as a research priority to
"better target pain therapies to individual patients." Successful identification of pain
phenotypes will allow new interventions to be tested in homogeneous populations of patients
presenting with similar pain pathophysiology, ultimately enhancing treatment effects in
defined populations for whom interventions are determined safe and effective. Clinical
populations of knee OA are clearly heterogeneous, spanning wide age ranges and encompassing
patients with a wide variety of functional abilities. The pain experience in knee OA may be
similarly individualized and complex; some patients may present with pain that appears
attributable to classic signs of joint damage, while others may present with pain due to
psychological distress or central mechanisms. Changes in somatosensory processing and pain
threshold are also known to occur with aging.However, the scientific community has yet to
examine these variables concurrently in the same study population. Therefore, the relative
importance of each of these measures in determining pain severity across the lifespan is
unknown. It is also unknown whether these variables (or interactions between variables) are
representative of different pain phenotypes in knee OA. This is an important yet unresolved
question; a patient with high levels of psychological distress and low levels of joint
damage may warrant a different intervention strategy than the traditional knee-directed
approach. On the other hand, someone with increased psychological distress in addition to
severe joint damage may benefit from traditional interventions that are further augmented
with other impairment-specific interventions. This sort of targeted approach is the topic of
current research in other chronic pain populations, where a similar conceptual model,
composed of peripheral, psychological and central components to the pain experience (among
others), is recognized.
International (OARSI) identified the "phenotyping" of OA pain as a research priority to
"better target pain therapies to individual patients." Successful identification of pain
phenotypes will allow new interventions to be tested in homogeneous populations of patients
presenting with similar pain pathophysiology, ultimately enhancing treatment effects in
defined populations for whom interventions are determined safe and effective. Clinical
populations of knee OA are clearly heterogeneous, spanning wide age ranges and encompassing
patients with a wide variety of functional abilities. The pain experience in knee OA may be
similarly individualized and complex; some patients may present with pain that appears
attributable to classic signs of joint damage, while others may present with pain due to
psychological distress or central mechanisms. Changes in somatosensory processing and pain
threshold are also known to occur with aging.However, the scientific community has yet to
examine these variables concurrently in the same study population. Therefore, the relative
importance of each of these measures in determining pain severity across the lifespan is
unknown. It is also unknown whether these variables (or interactions between variables) are
representative of different pain phenotypes in knee OA. This is an important yet unresolved
question; a patient with high levels of psychological distress and low levels of joint
damage may warrant a different intervention strategy than the traditional knee-directed
approach. On the other hand, someone with increased psychological distress in addition to
severe joint damage may benefit from traditional interventions that are further augmented
with other impairment-specific interventions. This sort of targeted approach is the topic of
current research in other chronic pain populations, where a similar conceptual model,
composed of peripheral, psychological and central components to the pain experience (among
others), is recognized.
Inclusion Criteria:
- Age 50-85
- Diagnosed with Knee Osteoarthritis by a physician or by ACR clinical criteria
Exclusion Criteria:
- sensory dysfunction due to injury (i.e. known nerve damage)
- neurological diagnosis affecting sensory or motor function (e.g. stroke, Parkinson's
Disease, multiple sclerosisetc.)
Healthy Volunteers eligibility criteria:
- Age 50-85
- Do not possess knee osteoarthritis diagnosis
- do not have knee pain
- do not have a history major knee trauma or lower extremity trauma or surgery
- do not have any other pain condition
We found this trial at
1
site
Aurora, Colorado 80045
Principal Investigator: Jennifer E Stevens-Lapsley, PT, PhD
Phone: 303-724-9170
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