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Development of a bedside pain assessment kit for the classification of patients with osteoarthritis

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Abstract

There are no standardized bedside assessments for subtyping patients with osteoarthritis (OA) based on pain mechanisms. Thus, we developed a bedside sensory testing kit (BSTK) to classify OA patients based on sensory profiles potentially indicative of pain mechanism. After usability and informal reliability testing (n = 22), the kit was tested in a formal reliability study (n = 20). Patients completed questionnaires and sensory testing: pressure algometry to detect hyperalgesia; repeat algometry after heterotopic noxious conditioning stimulation to measure diffuse noxious inhibitory control (DNIC); light touch using Von Frey filaments; and cold allodynia using a brass rod. The procedure was brief and well tolerated. Algometry and filament testing were highly reliable [intra-class correlation coefficients (ICCs) 0.71–0.91]; DNIC was acceptably reliable (ICCs 0.53–0.91); brass rod reliability was inconclusive. Patients were classified empirically into four groups: “All abnormal findings” (primary and secondary hyperalgesia and dysfunctional DNIC); “all normal findings”; and two intermediate groups. The “all abnormal findings” group had more neuropathic pain symptoms, and lower WOMAC total, stiffness, and activity scores than the “all normal findings” group. Simple BSTK procedures, consolidated in a kit, reliably classified OA patients into subgroups based on sensory profile, suggesting that OA patients differ in underlying pain mechanisms. Further research is needed to confirm these subgroups and determine their validity in predicting response to treatment.

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Abbreviations

APAP:

Acetaminophen

BSTK:

Bedside sensory testing kit

DNIC:

Diffuse noxious inhibitory control

HA:

Hyperalgesia/allodynia

HNCS:

Heterotopic noxious conditioning stimulus

ICC:

Intra-class correlation coefficient

LTT:

Light touch threshold

NRS:

Numerical Rating Scale

NSAIDs:

Nonsteroidal anti-inflammatory drugs

OA:

Osteoarthritis

PPT:

Pressure pain threshold

PQAS:

Pain Quality Assessment Scale

QDS:

Questionnaire Development Systems

QST:

Quantitative sensory testing

WOMAC:

Western Ontario McMaster Osteoarthritis Questionnaire

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Acknowledgments

This study was funded by a Grant from Merck Research Laboratories. The authors thank Florence Paillard for her assistance in drafting and revising the manuscript.

Conflict of interest

Support for this study was provided by Merck. Eric Osgood has no competing interests to disclose. Thomas Eaton has no competing interests to disclose. Jeremiah Trudeau has no competing interests to disclose. Mark P. Jensen has served as a consultant to Endo Pharmaceuticals, Inc., and has received consulting fees from RTI Health Solutions, Covidien, Bristol-Myers Squibb, Schwartz Biosciences, Analgesic Research, Depomed, Eli Lilly, Pfizer, Merck, Medtronic, and Smith & Nephew within the past 36 months. Arnold Gammaitoni at the time the study was conducted was an employee at Merck. Lee Simon is a principal at SDG consulting, with many clients throughout the medical device and pharmaceutical industries. Nathaniel Katz is the CEO of Analgesic Solutions, a clinical research and consulting firm with many clients throughout the medical device and pharmaceutical industries.

Author information

Authors and Affiliations

  1. Analgesic Solutions, 232 Pond Street, Natick, MA, 01760, USA

    Eric Osgood, Jeremiah J. Trudeau, Thomas A. Eaton & Nathaniel Katz

  2. University of Connecticut, Storrs, CT, USA

    Thomas A. Eaton

  3. University of Washington, Seattle, WA, USA

    Mark P. Jensen

  4. Nuvo Research, West Chester, PA, USA

    Arnold Gammaitoni

  5. SDG LLC, West Newton, MA, USA

    Lee S. Simon

  6. Tufts University School of Medicine, Boston, MA, USA

    Nathaniel Katz

Authors
  1. Eric Osgood
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  2. Jeremiah J. Trudeau
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  3. Thomas A. Eaton
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  4. Mark P. Jensen
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  5. Arnold Gammaitoni
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  6. Lee S. Simon
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  7. Nathaniel Katz
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Corresponding author

Correspondence to Nathaniel Katz.

Additional information

E.O., J.T., and T.E. are no longer working at Analgesic Solutions.

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Osgood, E., Trudeau, J.J., Eaton, T.A. et al. Development of a bedside pain assessment kit for the classification of patients with osteoarthritis. Rheumatol Int 35, 1005–1013 (2015). https://doi.org/10.1007/s00296-014-3191-z

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  • DOI: https://doi.org/10.1007/s00296-014-3191-z

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