Neuropathic-like knee pain and associated risk factors: a cross-sectional study in a UK community sample

Gwen Sascha Fernandes, Ana Marie Valdes, David Andrew Walsh, Weiya Zhang, Michael Doherty, Gwen Sascha Fernandes, Ana Marie Valdes, David Andrew Walsh, Weiya Zhang, Michael Doherty

Abstract

Background: Neuropathic-like knee pain (NKP) is often reported in individuals with knee pain (KP), but the contribution of specific central and peripheral risk factors to NKP has not been studied previously. The aims of the present study were to determine the prevalence of NKP in a community-derived sample with KP and to identify risk factors associated with NKP.

Methods: A cross-sectional study was undertaken (n = 9506) in the East Midlands community among responders (aged 40+ years) to a postal questionnaire. Questions included KP severity (numerical rating scale) and type (neuropathic versus nociceptive) using the modified painDETECT questionnaire, as well as age, body mass index (BMI), significant knee injury, widespread pain, pain catastrophising and fatigue. Multinomial regression analysis was used to determine ORs and 95% CIs. Risk factors were categorised into central and peripheral, and proportional risk contribution (PRC) and 95% CI were estimated using ROC.

Results: KP was reported in 28.2% of responders, of whom 13.65% had NKP (i.e., 3.9% of the total population). Women reported more NKP. After adjustment for age, gender, BMI and pain severity, definite NKP showed associations (aOR, 95% CI) with fibromyalgia (4.07, 2.49-6.66), widespread pain (1.93, 1.46-2.53), nodal osteoarthritis (1.80, 1.28-2.53), injury (1.50, 1.12-2.00), pain catastrophising (5.37, 2.93-9.84) and fatigue (5.37, 3.08-9.35) compared with non-NKP participants. Although only central risk factors contributed to NKP (PRC 8%, 95% CI 2.5-12.5 for central vs. PRC 3%, 95% CI -0.25 to 7.5 for peripheral), both central and peripheral risk factors contributed equally to non-NKP (PRC 10%, 95% CI 5-20 for both).

Conclusions: NKP appears to be driven largely by central risk factors and may require different prevention/treatment strategies.

Trial registration: ClinicalTrials.gov , NCT02098070 . Registered on 27 March 2014.

Keywords: Anxiety; Depression; Neuropathic pain; Osteoarthritis; Pain catastrophising; Risk factors.

Conflict of interest statement

Ethics approval and consent to participate

All aspects of this study were approved by the Nottingham Research Ethics Committee 1 (NREC reference 14/EM/0015), and all written informed consent forms were stored safely and securely in Academic Rheumatology, Nottingham City Hospital.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The prevalence of definite neuropathic-like knee pain in the knee pain population in Nottingham Knee Pain and Health in the Community study, by gender and in age categories
Fig. 2
Fig. 2
a Proportional risk contribution (PRC) of peripheral, central and comorbidity risk factors of definite neuropathic-like knee pain (NKP) vs. non-NKP. b PRC of peripheral, central and comorbidity risk factors of non-NKP vs. no knee pain (KP). Blue = full model. Red = PRC from peripheral factors. Green = PRC from central factors. Orange = PRC from comorbidities. Note: PRC was estimated from full ROC analysis. Full models included age, gender, body mass index and pain severity, nodal OA + significant knee injury (peripheral factors), anxiety + depression + Pain Catastrophising Scale, fibromyalgia and fatigue (central factors) and diabetes + hyperlipidaemia + widespread pain (comorbidities). Pain severity variable was removed from the second ROC analysis comparing non-NKP vs. no KP participants

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