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Association between pain sensitization and functional disability in patients with hand osteoarthritis
Young Hak Roh, MD, PhD; Kim Min Sub, MD
Ewha Womans University Medical Center, Seoul, Korea, Republic of (South)
Aims: The aim of this study was to evaluate the influence of pain sensitization on functional disability and the treatment outcomes of topical nonsteroidal anti-inflammatory drug along with daily hand exercise intervention in patients with hand osteoarthritis.
Patients and Methods: We enrolled a total of 136 patients who presented with arthritic hand pain fulfilling the American College of Rheumatology clinical criteria for hand osteoarthritis. We initially measured pain sensitization by assessing the patients' pressure pain thresholds (PPTs) in the mid-dorsal forearm as well as administering a pain sensitization questionnaire (PSQ). Patients were then administered conservative management consisting of topical ketoprofen gel with daily hand exercise intervention for 16 weeks. For the outcome assessments, we assessed the pain numeric rating scale and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire at six months of follow-up.
Results: The PSQ scores were moderately correlated with the baseline DASH scores and were slightly correlated with symptom duration, while PPTs were slightly correlated with the baseline DASH scores. At six months, the DASH scores were moderately correlated with lower PPTs and higher PSQ scores. After accounting for confounding variables such as age and the duration of symptoms, persistently increased patient-reported disability was associated with initial lower pain thresholds to pressure (beta = -1.17 [-1.82 to -0.52]), initial higher (increased) pain sensitivity scores (beta = 1.85 [1.01 to 2.69]), and female gender (beta = 1.04 [0.48 to 1.60]), and these three factors accounted for 36 % of the variance in DASH scores.
Conclusion: Pain sensitization in patients with hand osteoarthritis was found to be correlated with symptom severity, and it was also associated with persistently increasing disability following conservative treatment. Further research is needed to show whether early identification and treatment of pain sensitization can enhance clinical symptoms and function in patients with hand osteoarthritis.
Table 1. Correlation analysis between potential variables and DASH scores
| Variables | Baseline | Month 6 |
| | correlation coefficient (p) |
| Age | 0.19 (.211) | 0.10 (.293) |
| BMI | 0.09 (.832) | 0.06 (.722) |
| Symptom duration | 0.34 (.044) | 0.29 (.091) |
| Education | 0.21 (.342) | 0.10 (.201) |
| Kellgren-Lawrence grade | 0.31 (.051) | 0.33 (.044) |
| PPT | 0.36 (.032) | 0.42 (.022) |
| PSQ | 0.42 (.021) | 0.48 (.012) |
Table 2. Independent predictors of persistently increased disability following conservative treatment
| Outcomes | Predictors | Beta [95% CI] | p value | Partial R2 | Total R2
|
| DASH
| PPT
PSQ
Female gender | -1.17 [-1.82 to -0.52]
1.85 [1.01 to 2.69]
1.04 [0.48 to 1.60] | .021
.013
.029 | 11%
18%
7% | 36% |
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