title: Variability in conditioned pain modulation predicts response to NSAID treatment in patients with knee osteoarthritis.
abstract: Patients with painful knee osteoarthritis (OA) demonstrate hyperalgesia and altered pain-modulatory responses. While some prior work has demonstrated cross-sectional associations between laboratory and clinical pain measures, it is unknown whether individual variability in quantitative sensory testing (QST) responses at baseline can prospectively predict analgesic treatment responses.
  
  
  
  Patients with knee OA (n = 35) were compared on QST responses to a demographically-matched pain-free control group (n = 39), after which patients completed a month-long treatment study of diclofenac sodium topical gel (1 %), applied up to 4 times daily.
  
  
  
  OA patients demonstrated reduced pain thresholds at multiple anatomic sites, as well as reduced conditioned pain modulation (CPM) and enhanced temporal summation of pain. The most pain-sensitive patients tended to report the most intense and neuropathic OA pain. Following diclofenac treatment, the knee OA cohort showed a roughly 30 % improvement in pain, regardless of the presence or absence of neuropathic symptoms. Baseline CPM scores, an index of endogenous pain-inhibitory capacity, were prospectively associated with treatment-related changes in clinical pain. Specifically, participants with higher CPM at baseline (i.e., better functioning endogenous pain-inhibitory systems) showed more reduction in pain at the end of treatment (p < .05).
  
  
  
  These results support prior findings of amplified pain sensitivity and reduced pain-inhibition in OA patients. Moreover, the moderate to strong associations between laboratory-based measures of pain sensitivity and indices of clinical pain highlight the clinical relevance of QST in this sample. Finally, the prospective association between CPM and diclofenac response suggests that QST-based phenotyping may have utility in explaining inter-patient variability in long-term analgesic treatment outcomes.
  
  
  
  ClinicalTrials.Gov Identifier: NCT01383954 . Registered June 22, 2011.
authors.affiliation: Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, 850 Boylston St, Suite 302, Chestnut Hill, MA, 02467, USA. RREdwards@partners.org.|Pain Management Center, Brigham & Women's Hospital, 850 Boylston St, Chestnut Hill, MA, 02467, USA. RREdwards@partners.org.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Edwards
authors.affiliation: Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, 850 Boylston St, Suite 302, Chestnut Hill, MA, 02467, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Dolman
authors.affiliation: Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, 850 Boylston St, Suite 302, Chestnut Hill, MA, 02467, USA.
authors.forename: Marc O
authors.initials: MO
authors.lastname: Martel
authors.affiliation: Department of Psychiatry, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Suite 100, Baltimore, MD, 21224, USA.
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Finan
authors.affiliation: Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, 850 Boylston St, Suite 302, Chestnut Hill, MA, 02467, USA.
authors.forename: Asimina
authors.initials: A
authors.lastname: Lazaridou
authors.affiliation: Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, 850 Boylston St, Suite 302, Chestnut Hill, MA, 02467, USA.
authors.forename: Marise
authors.initials: M
authors.lastname: Cornelius
authors.affiliation: Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, 850 Boylston St, Suite 302, Chestnut Hill, MA, 02467, USA.|Departments of Anesthesiology and Psychiatry, University of Pittsburgh School of Medicine, 400 Centre Ave, #400, Pittsburgh, PA, 15206, USA.
authors.forename: Ajay D
authors.initials: AD
authors.lastname: Wasan
mesh_terms: D000287:Administration, Topical; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D016022:Case-Control Studies; D004008:Diclofenac / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005782:Gels; D006801:Humans; D006930:Hyperalgesia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000188:drug therapy*; D010146:Pain / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005782:Gels; D004008:Diclofenac
keywords: Conditioned pain modulation; Diclofenac; NSAID; Neuropathic; Osteoarthritis; Pain; Quantitative sensory testing