Zentrale Sensibilisierung, Schmerzlokalisation und -ausdehnung bei Arthrose des Hüftgelenks

Abstract

Osteoarthritis (OA), especially with regard to current demographic trends a common health problem, frequently presents as a complex heterogeneous collection of musculoskeletal dysfunctions. Evidence suggests that the individual pain experience in people with osteoarthritis (OA) is caused by both peripheral factors and central sensitization, defined as an alteration in pain perception and processing within the central nervous system. The contribution of central sensitization to pain in people with OA of the knee or the hip has been demonstrated before, but not investigated with regard to widespread pain in joint distal regions in people with mild but painful hip OA. We therefore examined signs for central sensitization in patients with symptomatic hip OA, focussing on widespread pain. In this cross-sectional study, a cohort of thirty patients with osteoarthritis of the hip completed a collection of self-administered pain questionnaires and quantitative sensory testing (QST) of pressure and thermal pain thresholds in both joint-associated and peripheral regions of the body. The results were compared to a pain-free, age- and gender-matched group of 18 healthy subjects. In the patient group we found significantly lower pressure pain thresholds (PPT) over periarticular, as well as over peripheral sites. No potential influence could be shown for variables like sex, age or BMI on group comparison results, although significantly lower PPTs could be measured for women over all sites. Lower PPT’s for both sexes correlated with increased self-reported measures of pain and the pain extent in digital pain drawings. People with hip OA demonstrate widespread altered pain perception and processing, which occur even in mildly symptomatic OA. The presence of central sensitization should be considered in decisions with regard to treatment strategies.