title: A Mechanism-Based Approach to the Management of Osteoarthritis Pain.
abstract: Pain from osteoarthritis (OA) affects millions of people worldwide, yet treatments are limited to acetaminophen, NSAIDs, physical therapy, and ultimately, surgery when there is significant disability. In recent years, our understanding of pain pathways in OA has developed considerably. Though joint damage and inflammation play a significant role in pain generation, it is now understood that both central and peripheral nervous system mechanisms exacerbate symptoms. Evolving management strategies for OA address central factors (e.g., sleep difficulties, catastrophizing, and depression) with treatments such as cognitive behavioral therapy and exercise. In addition, emerging data suggest that antibodies against peripheral signaling neuropeptides, such as nerve growth factor-1 (NGF-1), may significantly alleviate pain. However, concerns regarding potential adverse effects, such as rapidly progressive OA, still remain. A nuanced understanding is essential if we are to make headway in developing more effective treatments for OA.
authors.affiliation: Department of Rheumatology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA. Ezra.cohen@childrens.harvard.edu.
authors.forename: Ezra
authors.initials: E
authors.lastname: Cohen
authors.affiliation: Department of Rheumatology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA. Ylee9@partners.org.
authors.forename: Yvonne C
authors.initials: YC
authors.lastname: Lee
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D019643:Arthroplasty, Replacement; D002211:Capsaicin / Q000627:therapeutic use; D058443:Catastrophization / Q000628:therapy*; D059333:Central Nervous System Sensitization; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000628:therapy; D005081:Exercise Therapy / Q000379:methods; D005944:Glucosamine / Q000627:therapeutic use; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use; D020932:Nerve Growth Factor / Q000037:antagonists & inhibitors; D010003:Osteoarthritis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D010146:Pain / Q000503:physiopathology / Q000523:psychology; D059408:Pain Management / Q000379:methods*; D026741:Physical Therapy Modalities; D053657:Platelet-Rich Plasma; D018689:Sensory System Agents / Q000627:therapeutic use; D012893:Sleep Wake Disorders / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D055675:Viscosupplements / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D018689:Sensory System Agents; D055675:Viscosupplements; D006820:Hyaluronic Acid; D020932:Nerve Growth Factor; D005944:Glucosamine; D002211:Capsaicin
keywords: Central sensitization; Musculoskeletal pain; NGF; Osteoarthritis; Pain mechanisms