title: Pain mechanisms in osteoarthritis: understanding the role of central pain and current approaches to its treatment.
abstract: In this literature review, the mechanisms underlying pain associated with osteoarthritis (OA) are discussed, along with evidence for the efficacy of medications thought to act centrally to relieve OA pain. We survey the cascade of events from inflammation to activation of nociceptive and neuropathic pathways, to the development and maintenance of central and peripheral sensitization. Preclinical and clinical evidence for the sensitization hypothesis is discussed, along with recently identified genetic variations that may increase sensitivity to pain in patients with OA. Evidence is presented for the efficacy of centrally acting analgesics for OA pain (opioids, antiepileptics, tricyclic antidepressants, and serotonin/norepinephrine receptor inhibitors).
authors.affiliation: Seattle Rheumatology Associates, Seattle, WA 98104, USA. pmease@nwlink.com
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Mease
authors.forename: Sylvia
authors.initials: S
authors.lastname: Hanna
authors.forename: Elijah P
authors.initials: EP
authors.lastname: Frakes
authors.forename: Roy D
authors.initials: RD
authors.lastname: Altman
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D059333:Central Nervous System Sensitization / Q000502:physiology; D002986:Clinical Trials as Topic; D006801:Humans; D007249:Inflammation / Q000473:pathology / Q000503:physiopathology; D010003:Osteoarthritis / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid