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The
effectiveness of NSAIDs plus paracetamol in patients with painful knee
osteoarthritis can be successfully predicted with a tool called mechanistic
pain profiling.
Mechanistic
pain profiling helps to identify the nonresponders to standard pharmacological
treatment, as explained in a study by Kristian Petersen et al. issued in
'PAIN'.
The knee
osteoarthritis (OA) patients often complain of joint inflammation. The
proinflammatory cytokines are responsible for sensitizing the peripheral and
central pain pathways. This can be mechanistically assessed via the pressure
pain thresholds and temporal summation of pain (TSP).
Nonsteroidal anti-inflammatory drugs (NSAIDs) combined with paracetamol is a
recommended treatment for OA. This study hypothesised that evidence of central
sensitisation would predict the inadequate responses to peripherally directed
therapies in knee OA and hence, aimed to investigate the value of mechanistic
pain profiling for predicting pain outcome of NSAIDs plus paracetamol
treatment.
A total of 132 patients received ibuprofen 1200 mg/daily, paracetamol 3 g/daily, and pantoprazole 20 mg/daily for 3 weeks. Tolerance threshold, cuff pain detection, and TSP were evaluated before administration. Worst pain within the last 24 hours and during activity (visual analogue scales) were examined before the and after treatment.
It was found that facilitated TSP was there at baseline in the nonresponders to
the 3-weeks treatment as opposed to responders helped to recognise the
identified facilitated TSP and low clinical pain scores as independent factors
for the prediction of poor pain alleviation by the treatment.
The study researchers culminated, mechanistic pain profiling can predict the
pain alleviation of NSAIDs and paracetamol. The facilitated TSP and low
clinical pain scores before treatment are independent predictors of poor pain
alleviation following NSAIDs and paracetamol. They further noted, "This
study adds to the growing evidence that a subgroup of knee OA patients with
manifested central sensitisation may need special management attention."
PAIN
Mechanistic pain profiling as a tool to predict the efficacy of 3-week nonsteroidal anti-inflammatory drugs plus paracetamol in patients with painful knee osteoarthritis
Kristian Petersen et al.
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