• Sophie Vervullens, Lotte Meert, Mira Meeus, Christiaan H W Heusdens, Peter Verdonk, Anthe Foubert, Emmanuel Abatih, Lies Durnez, Jonas Verbrugghe, and SmeetsRob J E MRJEMResearch School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands.Pain in Motion International Research Group (PiM), Antwerp, Belgium.REVAL-Rehabilitation Research Center, Faculty of Rehab.
• Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
• Clin J Pain. 2024 Oct 1; 40 (10): 563577563-577.

ObjectivesThis study aimed to apply the International Association for the Study of Pain (IASP) grading system for identifying nociplastic pain in knee osteoarthritis (KOA) awaiting total knee arthroplasty (TKA) and propose criteria to fine-tune decision-making. In addition, the study aimed to characterize a "probable" versus "no or possible" nociplastic pain mechanism using biopsychosocial variables and compare both groups in their 1-year post-TKA response.MethodsA secondary analysis of baseline data of a longitudinal prospective study involving 197 patients with KOA awaiting total TKA in Belgium and the Netherlands was performed. Two approaches, one considering 4 and the other 3 pain locations (step 2 of the grading system), were presented. Linear mixed model analyses were performed to compare the probable and no or possible nociplastic pain mechanism groups for several preoperative biopsychosocial-related variables and 1-year postoperative pain. Also, a sensitivity analysis, comparing 3 pain mechanism groups, was performed.ResultsThirty (15.22%-approach 4 pain locations) and 46 (23.35%-approach 3 pain locations) participants were categorized under probable nociplastic pain. Irrespective of the pain location approach or sensitivity analysis, the probable nociplastic pain group included more woman, was younger, exhibited worse results on various preoperative pain-related and psychological variables, and had more pain 1-year post-TKA compared with the other group.DiscussionThis study proposed additional criteria to fine-tune the grading system for nociplastic pain (except for discrete/regional/multifocal/widespread pain) and characterized a subgroup of patients with KOA with probable nociplastic pain. Future research is warranted for further validation.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

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