Peripheral and Central Mechanisms in Knee Osteoarthritis

Musculoskeletal (MSK) pain conditions are the leading cause of disability worldwide, and this year’s American Pain Society track will explore the latest evidence addressing measurement, mechanisms, and management of MSK pain conditions. Among the most prevalent MSK pain conditions is knee osteoarthritis (OA), which is the leading cause of pain and disability among older adults. A brief overview of peripheral mechanisms and treatments, along with the epidemiology and clinical characteristics of knee OA, will be discussed in this course. Knee OA has historically been viewed as a regional pain condition driven by peripheral input due to arthritis changes in the knee joint. Accordingly, treatments have primarily focused on targeting peripheral changes. However, burgeoning evidence suggests that central pain processing is substantively altered among knee OA sufferers, raising the possibility that peripherally focused treatments may be ineffective for some proportion of these patients. Findings from studies using quantitative sensory testing and neuroimaging to examine central mechanisms related to knee OA will be presented. Because knee OA appears to disproportionately affect specific population groups, with African Americans at increased risk for OA related pain and disability, findings regarding ethnic group differences in OA pain and associated contributing factors will be discussed. The session will conclude with a summary of findings and recommendations to adopt a biopsychosocial approach to assessment and treatment of knee OA. (Recorded at PAINWeek 2018)