Baseline self-report 'central mechanisms' trait predicts persistent knee pain in the Knee Pain in the Community (KPIC) cohort

Osteoarthritis Cartilage. 2020 Feb;28(2):173-181. doi: 10.1016/j.joca.2019.11.004. Epub 2019 Dec 10.


Objectives: We investigated whether baseline scores for a self-report trait linked to central mechanisms predict 1 year pain outcomes in the Knee Pain in the Community cohort.

Method: 1471 participants reported knee pain at baseline and responded to a 1-year follow-up questionnaire, of whom 204 underwent pressure pain detection thresholds (PPTs) and radiographic assessment at baseline. Logistic and linear regression models estimated the relative risks (RRs) and associations (β) between self-report traits, PPTs and pain outcomes. Discriminative performance for each predictor was compared using receiver-operator characteristics (ROC) curves.

Results: Baseline Central Mechanisms trait scores predicted pain persistence (Relative Risk, RR = 2.10, P = 0.001) and persistent pain severity (β = 0.47, P < 0.001), even after adjustment for age, sex, BMI, radiographic scores and symptom duration. Baseline joint-line PPTs also associated with pain persistence (RR range = 0.65 to 0.68, P < 0.02), but only in univariate models. Lower baseline medial joint-line PPT was associated with persistent pain severity (β = -0.29, P = 0.013) in a fully adjusted model. The Central Mechanisms trait model showed good discrimination of pain persistence cases from resolved pain cases (Area Under the Curve, AUC = 0.70). The discrimination power of other predictors (PPTs (AUC range = 0.51 to 0.59), radiographic OA (AUC = 0.62), age, sex and BMI (AUC range = 0.51 to 0.64), improved significantly (P < 0.05) when the central mechanisms trait was included in each logistic regression model (AUC range = 0.69 to 0.74).

Conclusion: A simple summary self-report Central Mechanisms trait score may indicate a contribution of central mechanisms to poor knee pain prognosis.

Keywords: Central pain mechanisms; Knee pain; Outcome measures; Phenotypes; Quantitative sensory testing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anxiety / psychology
  • Arthralgia / physiopathology*
  • Arthralgia / psychology
  • Catastrophization / psychology
  • Central Nervous System Sensitization*
  • Cognition
  • Depression / psychology
  • Fatigue / physiopathology
  • Female
  • Follow-Up Studies
  • Humans
  • Linear Models
  • Logistic Models
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / physiopathology*
  • Osteoarthritis, Knee / psychology
  • Pain Threshold
  • Pressure
  • Self Report*
  • Sleep Wake Disorders / physiopathology