Neurophysiological Mechanisms Involved in Knee Osteoarthritis

Université de Sherbrooke

Status: Completed

Conditions: Chronic Pain; Knee Osteoarthritis

Study type: Observational

Funder types: Other

Identifiers

NCT03556423

2015-454-IUGS

Details and patient eligibility

About

Introduction: Total knee arthroplasty (TKA) is an effective intervention to relieve people with osteoarthritis (OA). Nevertheless, 15 to 30% of patients continue to experience severe pain following surgery. Recent data suggest that central nervous system (CNS) changes may play a role in OA pain and possibly explain why some patients have poorer clinical outcomes following TKA. Objectives: Our main objectives are to explore the relationship between OA pain and (1) the integrity of corticospinal system, (2) the efficacy of descending pain inhibition circuits. Methods: Fifty-two patients waiting for TKA will be recruited. The integrity of the corticospinal projections will be measured using transcranial magnetic stimulation (recruitment curve of the affected quadriceps femoris muscle) and the descending pain inhibition circuits (bulbospinal projections) will be assessed by a counter-irritation paradigm (i.e., conditioned pain modulation with immersion of the arm in painfully cold water). Diffuse tension imaging (DTI) will also be used to quantify the strength of these corticospinal and bulbospinal projections. Clinical outcomes will be evaluated before and after arthroplasty with a series of validated questionnaires such as the WOMAC Scale, the McGill Pain Questionnaire and the Brief Pain Inventory. These different neurophysiological and clinical measures will be taken before surgery, 6 months after surgery and 1 year post-surgery. Anticipated results: The investigators expect a moderate association between pain and the strength of the corticospinal and bulbospinal projections. Moreover, it is expected that there will be a moderate association between the strength of the corticospinal/bulbospinal projections and the clinical evolution of patients.

Full description

See outcome measures

Enrollment: 28 patients

Sex: All

Ages: 50 to 79 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Being an adults aged 50-79 years old with a diagnosis of knee OA and waiting for a primary arthroplasty
• Refrain from consuming cigarettes and caffeine 2 hours and 6 hours before testing, respectively
• Refrain from taking short-acting analgesics (e.g., acetaminophen) 6 hours before testing

Exclusion criteria

• Having difficulty understanding french language
• Having a diagnosis of neurological disorder or diagnosis of chronic pain (other knee OA)
• Having metal implants in the skull
• Having pacemaker or neurostimulator
• Being pregnant
• Being epileptic