title: Development of a bedside pain assessment kit for the classification of patients with osteoarthritis.
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.
authors.affiliation: Analgesic Solutions, 232 Pond Street, Natick, MA, 01760, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Osgood
authors.forename: Jeremiah J
authors.initials: JJ
authors.lastname: Trudeau
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Eaton
authors.forename: Mark P
authors.initials: MP
authors.lastname: Jensen
authors.forename: Arnold
authors.initials: A
authors.lastname: Gammaitoni
authors.forename: Lee S
authors.initials: LS
authors.lastname: Simon
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D010147:Pain Measurement / Q000379:methods*; D058748:Pain Perception; D017288:Pain Threshold; D010865:Pilot Projects; D000067716:Point-of-Care Testing; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index