Нейропатический компонент боли у больных остеоартритом

Abstract

Background: chronic joint pain in osteoarthritis (OA) is an important factor of maladaptation. According to modern concepts, there are two variants presented in this pathology: nociceptive and nociplastic. Much less is known about the contribution of the neuropathic component (NC) to the pain syndrome formation. Aim: to study the pain syndrome patterns in patients with OA, as well as to identify NC in such patients and its impact on the life quality. Patients and Methods: the prospective study included 31 patients (mean age — 62.9±6.7 years, 26 (83.9%) women) with stage I–III OA of the knee and/or hip joint. The course of the articular syndrome corresponded to the pain syndrome course and ranged from 2 months to 30 years, averaging 10.6±9.9 years. All patients underwent general clinical examination. To detect neuropathic pain component (NPC), a neurological examination was performed using the DN4 and painDETECT questionnaires. The level of life quality was determined by the EQ-5D questionnaire. Results: NPC was detected in almost half (48%) of the examined patients. At the same time, the severity of radiological changes in the joints did not depend on its presence. However, in the presence of NC, the following manifestations were significantly more common in the area of the most affected joint (p<0.05): burning, numbness, electric shock, hypoesthesia, tingling, a feeling of crawling and/or tingling. There was practically no such symptom as itching, while the frequency of hypoesthesia in the groups did not significantly differ. According to the EQ-5D questionnaire, lower indicators were observed in patients with the NPC, their mobility assessment and daily activity were significantly worse. Mixed anxiety–depressive disorder were also observed (p<0.05) in such patients. Conclusion: for adequate treatment of pain syndrome, it is necessary to determine the presence of NPC in patients with OA and use antidepressants and anticonvulsants in complex therapy. KEYWORDS: osteoarthritis, chronic pain syndrome, nociceptive pain, nociplastic pain, neuropathic pain component, life quality. FOR CITATION: Filimonova O.G. Neuropathic pain component in patients with osteoarthritis. Russian Medical Inquiry. 2022;6(3):113–119 (in Russ.). DOI: 10.32364/2587-6821-2022-6-3-113-119.