Alisa J. Johnson, Staja Q. Booker, Katie A. Butera, Ruth L. Chimenti, Ericka N. Merriwether, Patrick J. Knox, Arthur Woznowski-Vu, Corey B. Simon
{"title":"运动诱发的疼痛与膝关节骨性关节炎患者静息时的疼痛或身体功能无关 \"的评论。","authors":"Alisa J. Johnson, Staja Q. Booker, Katie A. Butera, Ruth L. Chimenti, Ericka N. Merriwether, Patrick J. Knox, Arthur Woznowski-Vu, Corey B. Simon","doi":"10.1002/ejp.2263","DOIUrl":null,"url":null,"abstract":"<p>Movement-evoked pain (MEP), or pain that occurs with or is provoked by movement, is prevalent in individuals with knee osteoarthritis (KOA) and is associated with mobility impairment, clinical pain and poor health outcomes (Butera et al., <span>2024</span>). Recent studies and literature reviews show that MEP is distinguishable from pain-at-rest (PAR) and is driven by shared and distinct mechanisms, underscoring the importance of studying and assessing these constructs (Butera et al., <span>2024</span>).</p><p>The article by Lozano-Meca et al. (<span>2024</span>), recently published in the <i>European Journal of Pain</i>, entitled ‘Movement-evoked pain is not associated with pain at rest or physical function in knee osteoarthritis’, examined correlations between PAR, MEP and physical performance in adults with KOA. We commend the authors for their work to distinguish MEP from PAR, and also take this opportunity to provide our methodological perspective on MEP and KOA to clarify some misinterpretations of our own cited work. First, the assertion that associations between MEP and PAR have not been studied in KOA is inaccurate; multiple recent studies have examined this relationship in KOA and other musculoskeletal conditions (Fullwood et al., <span>2021</span>). Second, based on their cross-sectional analysis in a relatively small sample (<i>N</i> = 59) with minimally-to-moderately severe radiographic KOA (KL grade ≤ II), the authors concluded that MEP was not associated with PAR or physical performance (Lozano-Meca et al., <span>2024</span>). This may be interpreted as counterintuitive and inconsistent with prior work. We propose several plausible reasons for these findings, some of which were highlighted by the authors.</p><p>In their study, MEP was operationalized as pain occurring in response to four walking tasks (Lozano-Meca et al., <span>2024</span>). While our paper is cited to support their definition of MEP (Fullwood et al., <span>2021</span>), we must clarify that MEP is not limited to pain during walking. Particular to KOA, individuals commonly report pain during squatting, ascending/descending stairs, and standing from a sitting position; indicating MEP is best characterized by assessing pain over a variety of tasks that are meaningful to the individual. Also, in the current study the average report of MEP was relatively low, implying that walking on a flat surface may not provoke pain (Lozano-Meca et al., <span>2024</span>). Having less pain with movement or movement-evoked hypoalgesia (Butera et al., <span>2024</span>) is an important consideration which was not discussed. Findings may also be due to measuring MEP after each walking task rather than calculating an aggregate pain score across all tasks, which is superior (Knox et al., <span>2023</span>). Interestingly, PAR (average self-reported pain over the past 7 days) was high, which implies differential pain phenotypes may be represented. As highlighted by the authors, recall measures of pain are limited in their ability to assess PAR, yet this approach was used in the current study. Alternatively, we suggest measuring PAR as current pain intensity while seated immediately prior to each performance task as a baseline, allowing for direct comparisons between PAR and MEP.</p><p>Prior studies investigating MEP in KOA have relied on larger, more heterogeneous samples with better representation of varying radiographic severity. We bring up this point because the sample employed by Lozano-Meca et al. (<span>2024</span>) was predominantly minimal-moderate radiographic severity. Also, a substantial proportion of patients in their study used assistive devices (Lozano-Meca et al., <span>2024</span>). While typically allowed in physical performance testing and MEP assessments, assistive devices potentially influence MEP and functional performance and thus need to be controlled for in the analysis to ensure confidence in the measures and findings. In our prior work examining MEP in KOA, we also controlled for other potentially confounding factors including age, sex, race, KL score, body mass index and socioeconomic status, which are important biopsychosocial components of pain.</p><p>While the title of the article states there are no relationships between MEP and PAR, we found it interesting that there were statistically significant, albeit small, correlations between performance on the 10 m walk test and MEP, as well as PAR and the MEP recorded for the timed-up-and-go test and the 10 m walk test (Lozano-Meca et al., <span>2024</span>). As noted, the negative correlation between the 10 m walk test time and MEP was surprising, as it suggests that greater MEP was associated with faster walking times. Upon further consideration, it is possible that those individuals not using assistive devices or those with faster speeds may have experienced greater pain due to increased effort/exertion. Future studies of MEP-related factors, such as motivation and perceived effort, may provide additional information to better understand the nuances of MEP and function.</p><p>Ultimately, the study by Lozano-Meca et al. contributes to the emerging science of MEP and highlights the need for consensus regarding definitions and standardization of provocation tasks intended to capture the impact of pain on natural human movements (Butera et al., <span>2024</span>). We support the authors' conclusion that PAR and MEP are indeed distinct constructs and that both should be considered for optimizing pain management. However, study findings should be interpreted with caution and additional research is needed to replicate these findings and better understand MEP and its impact on KOA.</p><p>The authors have no financial disclosures to report.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"28 6","pages":"863-864"},"PeriodicalIF":3.5000,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.2263","citationCount":"0","resultStr":"{\"title\":\"Commentary to ‘Movement-evoked pain is not associated with pain at rest or physical function in knee osteoarthritis’\",\"authors\":\"Alisa J. Johnson, Staja Q. Booker, Katie A. Butera, Ruth L. Chimenti, Ericka N. Merriwether, Patrick J. Knox, Arthur Woznowski-Vu, Corey B. Simon\",\"doi\":\"10.1002/ejp.2263\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Movement-evoked pain (MEP), or pain that occurs with or is provoked by movement, is prevalent in individuals with knee osteoarthritis (KOA) and is associated with mobility impairment, clinical pain and poor health outcomes (Butera et al., <span>2024</span>). Recent studies and literature reviews show that MEP is distinguishable from pain-at-rest (PAR) and is driven by shared and distinct mechanisms, underscoring the importance of studying and assessing these constructs (Butera et al., <span>2024</span>).</p><p>The article by Lozano-Meca et al. (<span>2024</span>), recently published in the <i>European Journal of Pain</i>, entitled ‘Movement-evoked pain is not associated with pain at rest or physical function in knee osteoarthritis’, examined correlations between PAR, MEP and physical performance in adults with KOA. We commend the authors for their work to distinguish MEP from PAR, and also take this opportunity to provide our methodological perspective on MEP and KOA to clarify some misinterpretations of our own cited work. First, the assertion that associations between MEP and PAR have not been studied in KOA is inaccurate; multiple recent studies have examined this relationship in KOA and other musculoskeletal conditions (Fullwood et al., <span>2021</span>). Second, based on their cross-sectional analysis in a relatively small sample (<i>N</i> = 59) with minimally-to-moderately severe radiographic KOA (KL grade ≤ II), the authors concluded that MEP was not associated with PAR or physical performance (Lozano-Meca et al., <span>2024</span>). This may be interpreted as counterintuitive and inconsistent with prior work. We propose several plausible reasons for these findings, some of which were highlighted by the authors.</p><p>In their study, MEP was operationalized as pain occurring in response to four walking tasks (Lozano-Meca et al., <span>2024</span>). While our paper is cited to support their definition of MEP (Fullwood et al., <span>2021</span>), we must clarify that MEP is not limited to pain during walking. Particular to KOA, individuals commonly report pain during squatting, ascending/descending stairs, and standing from a sitting position; indicating MEP is best characterized by assessing pain over a variety of tasks that are meaningful to the individual. Also, in the current study the average report of MEP was relatively low, implying that walking on a flat surface may not provoke pain (Lozano-Meca et al., <span>2024</span>). Having less pain with movement or movement-evoked hypoalgesia (Butera et al., <span>2024</span>) is an important consideration which was not discussed. Findings may also be due to measuring MEP after each walking task rather than calculating an aggregate pain score across all tasks, which is superior (Knox et al., <span>2023</span>). Interestingly, PAR (average self-reported pain over the past 7 days) was high, which implies differential pain phenotypes may be represented. As highlighted by the authors, recall measures of pain are limited in their ability to assess PAR, yet this approach was used in the current study. Alternatively, we suggest measuring PAR as current pain intensity while seated immediately prior to each performance task as a baseline, allowing for direct comparisons between PAR and MEP.</p><p>Prior studies investigating MEP in KOA have relied on larger, more heterogeneous samples with better representation of varying radiographic severity. We bring up this point because the sample employed by Lozano-Meca et al. (<span>2024</span>) was predominantly minimal-moderate radiographic severity. Also, a substantial proportion of patients in their study used assistive devices (Lozano-Meca et al., <span>2024</span>). While typically allowed in physical performance testing and MEP assessments, assistive devices potentially influence MEP and functional performance and thus need to be controlled for in the analysis to ensure confidence in the measures and findings. In our prior work examining MEP in KOA, we also controlled for other potentially confounding factors including age, sex, race, KL score, body mass index and socioeconomic status, which are important biopsychosocial components of pain.</p><p>While the title of the article states there are no relationships between MEP and PAR, we found it interesting that there were statistically significant, albeit small, correlations between performance on the 10 m walk test and MEP, as well as PAR and the MEP recorded for the timed-up-and-go test and the 10 m walk test (Lozano-Meca et al., <span>2024</span>). As noted, the negative correlation between the 10 m walk test time and MEP was surprising, as it suggests that greater MEP was associated with faster walking times. Upon further consideration, it is possible that those individuals not using assistive devices or those with faster speeds may have experienced greater pain due to increased effort/exertion. Future studies of MEP-related factors, such as motivation and perceived effort, may provide additional information to better understand the nuances of MEP and function.</p><p>Ultimately, the study by Lozano-Meca et al. contributes to the emerging science of MEP and highlights the need for consensus regarding definitions and standardization of provocation tasks intended to capture the impact of pain on natural human movements (Butera et al., <span>2024</span>). We support the authors' conclusion that PAR and MEP are indeed distinct constructs and that both should be considered for optimizing pain management. 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引用次数: 0
摘要
运动诱发痛(MEP),即在运动时发生或由运动诱发的疼痛,在膝关节骨性关节炎(KOA)患者中很普遍,并与活动障碍、临床疼痛和不良健康后果相关(Butera 等人,2024 年)。最近的研究和文献综述表明,运动诱发痛(MEP)与静息痛(PAR)是有区别的,由共同的和不同的机制驱动,这突出了研究和评估这些结构的重要性(Butera 等人,2024 年)。Lozano-Meca 等人最近在《欧洲疼痛杂志》(European Journal of Pain)上发表了一篇题为《运动诱发痛与膝关节骨性关节炎患者的静息痛或身体功能无关》(Movement-evoked pain is not associated with pain at rest or physical function in knee osteoarthritis)的文章(2024 年),研究了膝关节骨性关节炎成人患者的静息痛、运动诱发痛和身体表现之间的相关性。我们对作者区分 MEP 和 PAR 的工作表示赞赏,并借此机会提供我们对 MEP 和 KOA 的方法论观点,以澄清我们自己所引用工作中的一些误解。首先,关于 MEP 和 PAR 之间的关系尚未在 KOA 中进行过研究的说法是不准确的;最近的多项研究已经检查了 KOA 和其他肌肉骨骼疾病中的这种关系(Fullwood 等人,2021 年)。其次,根据他们对具有轻度至中度严重放射学 KOA(KL 等级≤ II)的相对较小样本(N = 59)进行的横断面分析,作者得出结论,MEP 与 PAR 或体能表现无关(Lozano-Meca 等人,2024 年)。这可能会被解释为违反直觉,与之前的研究不一致。在他们的研究中,MEP 被操作化为对四项步行任务做出反应时发生的疼痛(Lozano-Meca 等人,2024 年)。虽然我们的论文被引用来支持他们对 MEP 的定义(Fullwood 等人,2021 年),但我们必须澄清,MEP 并不局限于行走时的疼痛。特别是在 KOA 中,患者通常会报告在下蹲、上/下楼梯和从坐姿站立时感到疼痛;这表明 MEP 的最佳特征是对患者有意义的各种任务进行疼痛评估。此外,在目前的研究中,MEP 的平均报告值相对较低,这意味着在平地上行走可能不会引起疼痛(Lozano-Meca 等人,2024 年)。运动或运动诱发的低痛感(Butera et al.研究结果也可能是由于在每次行走任务后测量 MEP,而不是计算所有任务的综合疼痛评分,后者更胜一筹(Knox 等人,2023 年)。有趣的是,PAR(过去 7 天内自我报告的平均疼痛程度)很高,这意味着可能存在不同的疼痛表型。正如作者所强调的,疼痛的回忆测量方法在评估 PAR 方面能力有限,但本研究采用了这种方法。另外,我们建议将 PAR 作为每次执行任务前坐着时的当前疼痛强度作为基线进行测量,以便直接比较 PAR 和 MEP。我们之所以提出这一点,是因为 Lozano-Meca 等人(2024 年)采用的样本主要是轻中度放射学严重程度。此外,在他们的研究中,有相当一部分患者使用了辅助设备(Lozano-Meca 等人,2024 年)。虽然体能测试和 MEP 评估通常允许使用辅助设备,但辅助设备可能会影响 MEP 和功能表现,因此需要在分析中加以控制,以确保测量结果和结论的可信度。在我们之前研究 KOA 的 MEP 时,我们还控制了其他可能的混杂因素,包括年龄、性别、种族、KL 评分、体重指数和社会经济状况,这些都是疼痛的重要生物心理社会因素。虽然文章标题指出 MEP 与 PAR 之间没有关系,但我们发现一个有趣的现象,即 10 米步行测试的成绩与 MEP 之间存在统计学意义上的显著相关性,尽管这种相关性很小,而且 PAR 与定时起立行走测试和 10 米步行测试记录的 MEP 之间也存在相关性(Lozano-Meca et al、2024).如前所述,10 米步行测试时间与 MEP 之间的负相关关系令人惊讶,因为这表明 MEP 越大,步行时间越快。进一步考虑,那些没有使用辅助设备的人或速度较快的人可能由于增加了努力/运动量而经历了更大的疼痛。未来对 MEP 相关因素(如动机和感知到的努力)的研究可能会提供更多信息,以更好地了解 MEP 和功能的细微差别。 该研究为新兴的 MEP 科学做出了贡献,并强调需要就旨在捕捉疼痛对人类自然运动影响的挑衅任务的定义和标准化达成共识(Butera 等人,2024 年)。我们支持作者的结论,即 PAR 和 MEP 确实是不同的概念,在优化疼痛管理时应同时考虑 PAR 和 MEP。不过,在解释研究结果时应谨慎,还需要进行更多的研究来复制这些结果,并更好地理解 MEP 及其对 KOA 的影响。
Commentary to ‘Movement-evoked pain is not associated with pain at rest or physical function in knee osteoarthritis’
Movement-evoked pain (MEP), or pain that occurs with or is provoked by movement, is prevalent in individuals with knee osteoarthritis (KOA) and is associated with mobility impairment, clinical pain and poor health outcomes (Butera et al., 2024). Recent studies and literature reviews show that MEP is distinguishable from pain-at-rest (PAR) and is driven by shared and distinct mechanisms, underscoring the importance of studying and assessing these constructs (Butera et al., 2024).
The article by Lozano-Meca et al. (2024), recently published in the European Journal of Pain, entitled ‘Movement-evoked pain is not associated with pain at rest or physical function in knee osteoarthritis’, examined correlations between PAR, MEP and physical performance in adults with KOA. We commend the authors for their work to distinguish MEP from PAR, and also take this opportunity to provide our methodological perspective on MEP and KOA to clarify some misinterpretations of our own cited work. First, the assertion that associations between MEP and PAR have not been studied in KOA is inaccurate; multiple recent studies have examined this relationship in KOA and other musculoskeletal conditions (Fullwood et al., 2021). Second, based on their cross-sectional analysis in a relatively small sample (N = 59) with minimally-to-moderately severe radiographic KOA (KL grade ≤ II), the authors concluded that MEP was not associated with PAR or physical performance (Lozano-Meca et al., 2024). This may be interpreted as counterintuitive and inconsistent with prior work. We propose several plausible reasons for these findings, some of which were highlighted by the authors.
In their study, MEP was operationalized as pain occurring in response to four walking tasks (Lozano-Meca et al., 2024). While our paper is cited to support their definition of MEP (Fullwood et al., 2021), we must clarify that MEP is not limited to pain during walking. Particular to KOA, individuals commonly report pain during squatting, ascending/descending stairs, and standing from a sitting position; indicating MEP is best characterized by assessing pain over a variety of tasks that are meaningful to the individual. Also, in the current study the average report of MEP was relatively low, implying that walking on a flat surface may not provoke pain (Lozano-Meca et al., 2024). Having less pain with movement or movement-evoked hypoalgesia (Butera et al., 2024) is an important consideration which was not discussed. Findings may also be due to measuring MEP after each walking task rather than calculating an aggregate pain score across all tasks, which is superior (Knox et al., 2023). Interestingly, PAR (average self-reported pain over the past 7 days) was high, which implies differential pain phenotypes may be represented. As highlighted by the authors, recall measures of pain are limited in their ability to assess PAR, yet this approach was used in the current study. Alternatively, we suggest measuring PAR as current pain intensity while seated immediately prior to each performance task as a baseline, allowing for direct comparisons between PAR and MEP.
Prior studies investigating MEP in KOA have relied on larger, more heterogeneous samples with better representation of varying radiographic severity. We bring up this point because the sample employed by Lozano-Meca et al. (2024) was predominantly minimal-moderate radiographic severity. Also, a substantial proportion of patients in their study used assistive devices (Lozano-Meca et al., 2024). While typically allowed in physical performance testing and MEP assessments, assistive devices potentially influence MEP and functional performance and thus need to be controlled for in the analysis to ensure confidence in the measures and findings. In our prior work examining MEP in KOA, we also controlled for other potentially confounding factors including age, sex, race, KL score, body mass index and socioeconomic status, which are important biopsychosocial components of pain.
While the title of the article states there are no relationships between MEP and PAR, we found it interesting that there were statistically significant, albeit small, correlations between performance on the 10 m walk test and MEP, as well as PAR and the MEP recorded for the timed-up-and-go test and the 10 m walk test (Lozano-Meca et al., 2024). As noted, the negative correlation between the 10 m walk test time and MEP was surprising, as it suggests that greater MEP was associated with faster walking times. Upon further consideration, it is possible that those individuals not using assistive devices or those with faster speeds may have experienced greater pain due to increased effort/exertion. Future studies of MEP-related factors, such as motivation and perceived effort, may provide additional information to better understand the nuances of MEP and function.
Ultimately, the study by Lozano-Meca et al. contributes to the emerging science of MEP and highlights the need for consensus regarding definitions and standardization of provocation tasks intended to capture the impact of pain on natural human movements (Butera et al., 2024). We support the authors' conclusion that PAR and MEP are indeed distinct constructs and that both should be considered for optimizing pain management. However, study findings should be interpreted with caution and additional research is needed to replicate these findings and better understand MEP and its impact on KOA.
The authors have no financial disclosures to report.
期刊介绍:
European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered.
Regular sections in the journal are as follows:
• Editorials and Commentaries
• Position Papers and Guidelines
• Reviews
• Original Articles
• Letters
• Bookshelf
The journal particularly welcomes clinical trials, which are published on an occasional basis.
Research articles are published under the following subject headings:
• Neurobiology
• Neurology
• Experimental Pharmacology
• Clinical Pharmacology
• Psychology
• Behavioural Therapy
• Epidemiology
• Cancer Pain
• Acute Pain
• Clinical Trials.