What makes osteoarthritis painful? The evidence for local and central pain processing
Open Access
- 27 September 2011
- journal article
- review article
- Published by Oxford University Press (OUP) in Rheumatology
- Vol. 50 (12), 2157-2165
- https://doi.org/10.1093/rheumatology/ker283
Abstract
OA is a chronic arthritic disease characterized by pain, local tissue damage and attempts at tissue repair. Historically, cartilage damage was believed to be the hallmark of OA. However, since cartilage is an avascular, aneural tissue, the mechanisms of pain are likely to be complex and influenced by non-cartilaginous structures in the joint including the synovium, bone and soft tissue. Imaging studies reveal the presence of synovitis and bone marrow lesions that may mediate pain. The presence of local joint inflammation and altered cartilage and bone turnover in OA implicates a potential role for a range of molecular mediators in OA pain. Mechanisms of pain perception may include the activation and release of local pro-inflammatory mediators such as prostaglandins and cytokines accompanied by the destruction of tissue, which is mediated by proteases. However, clinically, there is often disparity between the degree of pain perception and the extent of joint changes in subjects with OA. Such observations have prompted work to investigate the mechanisms of central pain perception in OA. Functional MRI has identified multiple areas of the brain that are involved in OA pain processing. These data demonstrate that pain perception in OA is complex in being influenced by local factors and activation of central pain-processing pathways. In this review, we will discuss current concepts underlying the pathophysiology of pain perception in OA and suggest possible directions for the future management of pain in this condition based on recent clinical studies.Keywords
This publication has 43 references indexed in Scilit:
- What of guidelines for osteoarthritis?International Journal of Rheumatic Diseases, 2011
- A review of the clinical evidence for exercise in osteoarthritis of the hip and kneeJournal of Science and Medicine in Sport, 2010
- Subchondral Cystlike Lesions Develop Longitudinally in Areas of Bone Marrow Edema–like Lesions in Patients with or at Risk for Knee Osteoarthritis: Detection with MR Imaging—The MOST StudyRadiology, 2010
- Angiogenesis and nerve growth factor at the osteochondral junction in rheumatoid arthritis and osteoarthritisRheumatology, 2010
- Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAITAnnals Of The Rheumatic Diseases, 2010
- Meniscal pathology on MRI increases the risk for both incident and enlarging subchondral bone marrow lesions of the knee: the MOST StudyAnnals Of The Rheumatic Diseases, 2010
- Subchondral bone marrow lesions are highly associated with, and predict subchondral bone attrition longitudinally: the MOST studyOsteoarthritis and Cartilage, 2010
- Analysing the role of endogenous matrix molecules in the development of osteoarthritisInternational Journal of Experimental Pathology, 2009
- A Preliminary fMRI Study of Analgesic Treatment in Chronic Back Pain and Knee OsteoarthritisMolecular Pain, 2008
- Arthritic pain is processed in brain areas concerned with emotions and fearArthritis & Rheumatism, 2007