Neuropathic pain symptoms on the modified painDETECT correlate with signs of central sensitization in knee osteoarthritis

Osteoarthritis Cartilage. 2013 Sep;21(9):1236-42. doi: 10.1016/j.joca.2013.06.023.


Objective: Clinical tools are needed to identify and target a neuropathic-like phenotype, which may be associated with central sensitization (CS), in osteoarthritis (OA). The modified painDETECT questionnaire (mPD-Q) has face and content validity for identifying neuropathic-like symptoms in knee OA. To further validate the mPD-Q, this study assessed the unknown relationship between mPD-Q scores and signs of CS on quantitative sensory testing (QST) in knee OA.

Design: 36 Individuals were recruited with chronic, symptomatic, knee OA without other pain/neurological conditions. Reference QST data were obtained from 18 controls/32 eligible knees, enabling identification of sensory abnormalities/CS among case knees. A standardized questionnaire assessed psychological factors (depressive symptoms and pain catastrophizing), and for individual knees, mPD-Q and pain intensity scores. A standardized/comprehensive QST protocol was conducted for each knee. QST signs of CS were defined as: mechanical hyperalgesia and/or enhanced temporal summation and/or allodynia. The relationship between the presence of CS (yes/no) and a pre-selected mPD-Q score (≤12 or >12), by knees, was assessed using generalized estimating equations.

Results: Among 57 eligible case knees, 45.6% had ≥1 sign of CS. Controlling for age, knees with higher mPD-Q scores (>12.0) had higher odds of having QST signs of CS (adjusted odds ratio (OR) = 5.6; 95% confidence interval (CI), 1.3-22.9). This relationship was unaffected by controlling for depression and pain intensity, but was attenuated by pain catastrophizing.

Conclusions: Among painful OA knees, higher mPD-Q scores were associated with greater odds of having signs of CS. Thus, the mPD-Q may aid the identification of CS in people with chronic knee OA.

Keywords: Central sensitization; Modified painDETECT; Osteoarthritis; Pain; Quantitative sensory testing.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Catastrophization / diagnosis
  • Catastrophization / etiology
  • Catastrophization / psychology
  • Chronic Pain / diagnosis
  • Chronic Pain / etiology
  • Chronic Pain / psychology
  • Depressive Disorder / diagnosis
  • Female
  • Humans
  • Hyperalgesia / diagnosis
  • Hyperalgesia / etiology
  • Hyperalgesia / psychology
  • Male
  • Middle Aged
  • Neuralgia / diagnosis*
  • Neuralgia / etiology*
  • Neuralgia / psychology
  • Osteoarthritis, Knee / complications*
  • Osteoarthritis, Knee / psychology
  • Pain Measurement / standards*
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Surveys and Questionnaires / standards*