The Effect of Medical Exercise Therapy on Pressure Sensitivity in Patients with Knee Osteoarthritis: A Cohort Pilot Study

Håvard Østerås, Fredrik Paulsberg, Håvard Østerås, Fredrik Paulsberg

Abstract

Introduction: While continued research into pain and exercise may address the underlying mechanisms, the mechanisms through which exercise may act are still poorly understood. The purpose of this study was to examine the effects of medical exercise therapy on pressure sensitivity in knee osteoarthritis patients, and to assess whether the decreased pain perception after medical exercise therapy can be explained by changes in pressure sensitivity.

Methods: We adopted acohort design in which 16 patients with long term pain were tested before and after 3 months of medical exercise therapy intervention. Pain was detected by visual analogue scale (VAS) and a digital pressure algometer, which also assessed pressure sensitivity. Function (Knee Osteoarthritis Outcome Score, KOOS), anxiety and depression (HAD) and kinesiophobia (Tampa Scale of Kinesiophobia, TSK) were also measured.

Results: The VAS showed a statistically significant reduction of perceived pain, from 5.19 (SD 2.04) to 4.12 (SD 2.09) from pre- to post-test (p < 0.05). There was no significant change in pressure algometry on either the painful side or the non-painful side.

Conclusion: As there were no significant correlations between the reduced pain perception and pressure sensitivity in knee osteoarthritis patients, we suggest that local knee pain does not necessarily alter generalized sensitivity. These findings should be further investigated in a randomized trial in the future.

Trial registration: Clinicaltrials.gov, identifier NCT02905747.

Keywords: Knee osteoarthritis; Pressure algometer; Sensitivity.

References

    1. Arendt-Nielsen L. Joint pain: more to it than just structural damage? Pain. 2017;158(Suppl 1):S66–S73. doi: 10.1097/j.pain.0000000000000812.
    1. Fusco M, Skaper SD, Coaccioli S, Varrassi G, Paladini A. Degenerative joint diseases and neuroinflammation. Pain Pract. 2017;17(4):522–532. doi: 10.1111/papr.12551.
    1. Drury DG, Greenwood K, Stuempfle K, Koltyn K. Changes in pain perception in women during and following an exhaustive incremental cycling exercise. J Sports Sci Med. 2005;4(3):215–222.
    1. Koltyn KF, Brellenthin AG, Cook DB, Sehgal N, Hillard C. Mechanisms of exercise-induced hypoalgesia. J Pain. 2014;15(12):1294–1304. doi: 10.1016/j.jpain.2014.09.006.
    1. Naugle KM, Naugle KE, Fillingim RB, Samuels B, Riley BS, Riley JL. Intensity thresholds for aerobic exercise-induced hypoalgesia. Med Sci Sports Exerc. 2014;46(4):817–825. doi: 10.1249/MSS.0000000000000143.
    1. Hoeger Bement MK, Dicapo J, Rasiarmos R, Hunter SK. Dose response of isometric contractions on pain perception in healthy adults. Med Sci Sports Exerc. 2008;40(11):1880–1889. doi: 10.1249/MSS.0b013e31817eeecc.
    1. Kosek E, Ekholm J. Modulation of pressure pain thresholds during and following isometric contraction. Pain. 1995;61(3):481–486. doi: 10.1016/0304-3959(94)00217-3.
    1. Kosek E, Lundberg L. Segmental and plurisegmental modulation of pressure pain thresholds during static muscle contractions in healthy individuals. Eur J Pain. 2003;7(3):251–258. doi: 10.1016/S1090-3801(02)00124-6.
    1. Bartley EJ, King CD, Sibille KT, et al. Enhanced osteoarthritis: potential sex differences in central sensitization pain sensitivity among individuals with symptomatic knee. Arthritis Care Res (Hoboken). 2016;68(4):472–480. doi: 10.1002/acr.22712.
    1. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494–502. doi: 10.1136/ard.16.4.494.
    1. Scott J, Huskisson EC. Graphic representation of pain. Pain. 1976;2:175–184. doi: 10.1016/0304-3959(76)90113-5.
    1. Snaith RP. The hospital anxiety and depression scale. Health Qual Life Outcomes. 2003;1:29. doi: 10.1186/1477-7525-1-29.
    1. Lundeberg T, Lund I, Dahlin L, Borg E, Gustafsson C, Sandin L, et al. Reliability and responsiveness of three different pain assessments. J Rehabil Med. 2011;33:279–283. doi: 10.1080/165019701753236473.
    1. Roos PH, Laurèn M, Adalberth T, Roos EM, Jonsson K, Lohmander LS. Knee osteoarthritis after meniscectomy. Arthritis Rheum. 1998;41:687–693. doi: 10.1002/1529-0131(199804)41:4<687::AID-ART16>;2-2.
    1. Kinser AM, Sands WA, Stone MH. Reliability and validity of a pressure algometer. J Strength Cond Res. 2009;23(1):312–314. doi: 10.1519/JSC.0b013e31818f051c.
    1. Torstensen TA, Grooten W, Østerås H, Heijne A, Harms-Ringdahl K, Äng BO. How does exercise dose affect patients with long-term osteoarthritis of the knee? A study protocol of a randomized controlled trial in Sweden and Norway: the SWENOR Study. BMJ Open. 2018;8:e018471. doi: 10.1136/bmjopen-2017-018471.
    1. Lorås H, Østerås B, Torstensen TA, Østerås H. Medical exercise therapy for treating musculoskeletal pain: a narrative review of results from randomized controlled trials with a theoretical perspective. Physiother Res Int. 2015;20(3):182–190. doi: 10.1002/pri.1632.
    1. Teders SJ, Blanchard EB, Andrasik F, Jurish SE, Neff DF, Arena JG. Relaxation training for tension headache: comparative efficacy and cost-effectiveness of a minimal therapist contact versus a therapist-delivered procedure. Behav Ther. 1984;15:59–70. doi: 10.1016/S0005-7894(84)80041-6.
    1. Kashima K, Rahman OI, Sakoda S, Shiba R. Increased pain sensitivity of the upper extremities of TMD patients with myalgia to experimentally-evoked noxious stimulation: possibility of worsened endogenous opioid systems. Cranio. 1999;17:241–246. doi: 10.1080/08869634.1999.11746100.
    1. Leffler AS, Hansson P, Kosek E. Somatosensory perception in a remote pain-free area and function of diffuse noxious inhibitory controls (DNIC) in patients suffering from long-term trapezius myalgia. Eur J Pain. 2002;6:149–159. doi: 10.1053/eujp.2001.0312.
    1. Kumazawa T. Primitivism and plasticity of pain—implication of polymodal receptors. Neurosci Res. 1998;32:9–31. doi: 10.1016/S0168-0102(98)00060-1.
    1. Iannetti GD, Mouraux A. From the neuromatrix to the pain matrix (and back) Exp Brain Res. 2010;205(1):1–12. doi: 10.1007/s00221-010-2340-1.
    1. Gold MS, Gebhart GF. Nociceptor sensitization in pain pathogenesis. Nat Med. 2010;16(11):1248–1257. doi: 10.1038/nm.2235.
    1. Fingleton C, et al. Pain sensitization in people with knee osteoarthritis: a systematic review and meta-analysis. Osteoarthr Cartil. 2015;23(7):1043–1056. doi: 10.1016/j.joca.2015.02.163.
    1. Thorstensson CA, et al. Natural course of knee osteoarthritis in middle-aged subjects with knee pain: 12-year follow-up using clinical and radiographic criteria. Ann Rheum Dis. 2009;68(12):1890–1893. doi: 10.1136/ard.2008.095158.
    1. Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: why and when. Best Pract Res Clin Rheumatol. 2015;29(1):120–130. doi: 10.1016/j.berh.2015.04.022.
    1. Naugle KM, Fillingim RB, Riley JL. A meta-analytic review of the hypoalgesic effects of exercise. J Pain. 2012;13(12):1139–1150. doi: 10.1016/j.jpain.2012.09.006.
    1. Bergmann N, Ballegaard S, Holmager P, et al. Pressure pain sensitivity: a new method of stress measurement in patients with ischemic heart disease. Scand J Clin Lab Investig. 2013;73(5):773–779. doi: 10.3109/00365513.2013.785588.
    1. Cunha GO, Pinto-Fiamengui L, Sampaio F, Conti P. Is aerobic exercise useful to manage chronic pain? Rev Dor São Paulo. 2016;17(1):61–64.
    1. Reddy KS, Naidu MU, Rani PU, Rao TR. Human experimental pain models: a review of standardized methods in drug development. J Res Med Sci. 2012;17(6):587–595.
    1. Chapman CR, Donaldson GW, Nakamura Y, Jacobson RC, Bradshaw DH, Gavrin J. A psychophysiological causal model of pain report validity. J Pain. 2002;3:143–155. doi: 10.1054/jpai.2002.123771.
    1. Vaegter HB, Handberg G, Graven-Nielsen T. Isometric exercises reduce temporal summation of pressure pain in humans. Eur J Pain. 2015;19:973–983. doi: 10.1002/ejp.623.
    1. Cooper MA, Kluding PM, Wright DE. Emerging relationships between exercise, sensory nerves, and neuropathic pain. Front Neurosci. 2016;10:372. doi: 10.3389/fnins.2016.00372.
    1. Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med. 2015;49:1554–1557. doi: 10.1136/bjsports-2015-095424.
    1. McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, Hawker GA, Henrotin Y, Hunter DJ, Kawaguchi H, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22:363–388. doi: 10.1016/j.joca.2014.01.003.

Source: PubMed

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