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Current concepts in joint pain in knee osteoarthritis

Aktuelles zum Gelenkschmerz bei Kniearthrose

Abstract

Joint pain attributable to osteoarthritis (OA) is complex and influenced by a myriad of factors beyond local joint pathology. Current practice continues to predominantly adopt a biomedical approach to OA despite emerging evidence of the importance of a more holistic approach. This paper will summarise evidence for the presence of multidimensional pain profiles in knee joint pain and the presence of subgroups characterized by systemic features such as psychological distress, high comorbidity load or sensitisation of the nervous system. These factors have the potential to influence patient outcomes making them relevant for clinicians and highlighting the necessity of a broader multifactorial approach to assessment and treatment. This review describes the current state of the evidence for treatments of people with knee OA-related pain, including those receiving strong recommendations from current clinical guidelines, namely exercise, weight loss, self-management advice and pharmacological approaches. Other pain-modulating treatment options are emerging such as sleep and psychological interventions, pain education and multisensory retraining. The evidence and rationale for these newer therapeutic approaches is discussed. Finally, this review will highlight some of the limitations of current international guidelines for the management of OA and make recommendations for future research.

Zusammenfassung

Arthrosebedingte Gelenkschmerzen sind ein komplexes Phänomen, das durch eine Vielzahl lokaler und systemischer Faktoren beeinflusst wird. Obwohl aktuelle wissenschaftliche Untersuchungen zunehmend auf die Bedeutung eines ganzheitlichen Therapieansatzes hinweisen, orientiert sich die klinische Praxis vorrangig am biomedizinischen Krankheitsmodell. Die vorliegende Arbeit gibt eine Übersicht über die aktuelle wissenschaftliche Evidenz zu multidimensionalen Schmerzprofilen bei Personen mit Kniearthrose, unter besonderer Berücksichtigung von systemischen Faktoren wie psychische Belastung, Komorbidität und Sensitivierung des Nervensystems. Die Erkenntnis, dass diese Faktoren Patientenoutcomes maßgeblich beeinflussen können, unterstreicht die Wichtigkeit eines multidimensionalen Diagnose- und Therapieansatzes. Ein weiteres Ziel dieser Übersicht ist die Darstellung des aktuellen Forschungsstands zur Therapie der schmerzhaften Kniearthrose. Dargestellt werden insbesondere Maßnahmen mit starkem Empfehlungsgrad in klinischen Leitlinien, nämlich körperliche Aktivität/Bewegungstherapie, Gewichtsreduktion, Selbstmanagement, Aufklärung und Information sowie pharmakologische Interventionen. Aufgezeigt werden auch innovative Therapieansätze mit potenziell schmerzmodulierender Wirkung. Hierzu zählen Interventionen zur Behandlung von Schlafstörungen, psychologische Interventionen, Schmerzedukation und multisensorisches Training. Die theoretische Begründung und wissenschaftliche Evidenz für diese neueren Ansätze wird diskutiert. Abschließend werden Limitationen aktueller internationaler Leitlinien zur Behandlung von Kniearthrose skizziert und Anregungen für zukünftige Forschungsarbeiten abgeleitet.

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Acknowledgements

We thank Prof. Marcus Schiltenwolf for his helpful comments on earlier drafts of the manuscript.

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Correspondence to M. Hübscher.

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K. Mills, M. Hübscher, H. O’Leary and N. Moloney declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Mills, K., Hübscher, M., O’Leary, H. et al. Current concepts in joint pain in knee osteoarthritis. Schmerz 33, 22–29 (2019). https://doi.org/10.1007/s00482-018-0275-9

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Keywords

  • Joint pain
  • Knee
  • Osteoarthritis
  • Pain assessment
  • Therapy

Schlüsselwörter

  • Gelenkschmerz
  • Knie
  • Arthrose
  • Schmerzassessment
  • Therapie