Background & Aims

Individuals with knee osteoarthritis often experience worsening pain with movement, a determining factor to pursue knee arthroplasty. Studies have highlighted the importance of evaluating pain with movement rather than focusing on pain at rest, as different underlying mechanisms may be involved.1-5 Multiple assessments capture pain with movement, most commonly relying on patient recall of past movement-evoked pain (MEP) or pain-related activity interference. Emerging evidence suggests evaluating MEP provides a more standardized measurement and improved understanding of the impact of pain on function.6 However, it is unclear whether recalled MEP with questionnaires is a different construct than performance-based MEP assessment, or if each have similar predictors.7-9 Thus, the aim of this study was to examine the relations between recalled and performance-based MEP, and their associations with quantitative sensory testing (QST) and other predictor variables.

Methods

The Acute to Chronic Pain Signatures (A2CPS) is a longitudinal, multi-site, observational study to identify candidate and novel biomarkers and biosignatures that predict development of or resilience to chronic pain 6 months after knee replacement or thoracotomy surgery. Baseline data from the knee replacement cohort were used. Performance-based MEP was assessed as maximum knee pain during a 5 Times Sit-to-Stand (5xSTS) and 10-meter walk test (10mwt) using a 0-10 numerical rating scale, using half or whole numbers. Both absolute and difference relative to resting pain were considered. Recalled MEP was evaluated using components of the pain interference scales from the Brief Pain Inventory (BPI) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Predictors included QST: temporal summation (TS), conditioned pain modulation (CPM) and pressure pain thresholds (PPTs); and self-report PROMIS and other validated surveys. Correlations and linear regression analyses were performed.

Results

603 participants (65.0±8.5yr; 231M, 364F, 8unknown) were included. Pain increased during 10mwt (0.7±1.4) and 5xSTS (1.8±1.9). Recalled MEP was scale specific: BPI interference ~5.1-5.5 out of 10, ±1.9; KOOS interference ~1.6-2.7 out of 4, ±1.0. Weak correlations occurred between 10mwt and 5xSTS MEP difference to the BPI (r=.11,p=.008; r=.22,p<.001) and KOOS (r=.10,p=.023; r=.13,p=.002) composite, but increased with absolute MEP (BPI: r=.47,p<.001, r=.44,p<.001; KOOS: r=.54,p<.001, r=.50,p<.001). Correlations among BPI and KOOS were moderate (r=.61,p<.001), 10mwt and 5xSTS MEP difference were weak (p=.28,p<.001) and strong (r=.71,p<.001) for absolute. Multiple regression indicated unique variables predicted each MEP measure: 10mwt (TS, CPM, PROMIS physical function (PF)); 5xSTS (PF, emotional support, cognitive impairment, catastrophizing); BPI (PF, PainDETECT, fear avoidance beliefs, CPM, symptom severity, cognitive impairment); KOOS (PF, PainDETECT, catastrophizing, resilience).

Conclusions

Recalled and performance-based MEP are weakly related to each other and exhibit distinct predictors, suggesting they represent distinct constructs in individuals undergoing knee replacement. However, the PROMIS PF score was a significant factor for each MEP variable, suggesting it is a common factor amongst each aspect of MEP. Notably correlations within recalled-based measures were moderate and weak-to-strong for performance-based measures, suggesting similar information is captured despite the different assessments used within each domain. Measures of recalled interference and performance-based MEP may each provide important insights to the pain experience, however, may be capturing unique dimensions of pain with movement. Further research is necessary to determine the unique roles each may play in the pain experience, the validity and reliability of each measure, and sensitivity to change with treatment.

References

1. Corbett DB, Simon CB, Manini TM, George SZ, Riley JL, 3rd, Fillingim RB. Movement-evoked pain: transforming the way we understand and measure pain. Pain. 2019;160(4):757-61.
2. Srikandarajah S, Gilron I. Systematic review of movement-evoked pain versus pain at rest in postsurgical clinical trials and meta-analyses: a fundamental distinction requiring standardized measurement. Pain. 2011;152(8):1734-9.
3. Fullwood D, Means S, Merriwether EN, Chimenti RL, Ahluwalia S, Booker SQ. Toward Understanding Movement-evoked Pain (MEP) and its Measurement: A Scoping Review. Clin J Pain. 2021;37(1):61-78.
4. Camiré D, Erb J, Kehlet H, Brennan T, Gilron I. Movement-Evoked Pain Versus Pain at Rest in Postsurgical Clinical Trials and Meta-Analyses: Protocol for a Follow-Up Systematic Review. JMIR Res Protoc. 2020;9(1):e15309-e.
5. Treister R, Suzan E, Lawal OD, Katz NP. Staircase-evoked Pain May be More Sensitive Than Traditional Pain Assessments in Discriminating Analgesic Effects: A Randomized, Placebo-controlled Trial of Naproxen in Patients With Osteoarthritis of the Knee. Clin J Pain. 2019;35(1):50-5.
6. Merkle SL, Sluka KA, Frey-Law LA. The interaction between pain and movement. J Hand Ther. 2020;33(1):60-6.
7. Estévez-López F. Assessment of physical function: considerations in chronic pain populations. Pain. 2017;158(7):1397.
8. Karayannis NV. A Focus on the Science of Behavior Change Would Provide a Deeper Understanding of Pain-Related Activity Interference and Ability to Sustain Engagement in Valued Physical Activities. Pain Med. 2019;20(2):210-1.
9. Farrar JT. Pain Interference on Quality of Life Is Not Just About Physical Function. Pain Med. 2019;20(2):211-2.

Presenting Author

Giovanni Berardi

Poster Authors

Giovanni Berardi

DPT, PhD

University of Iowa

Lead Author

Laura Frey Law

The University of Iowa

Lead Author

Dana Dailey

University of Iowa

Lead Author

Carol Vance

University of Iowa

Lead Author

John Burns

PhD

Rush University

Lead Author

Robert J McCarthy

Pharm D

Rush University

Lead Author

Michael Charters

MD

Henry Ford Health System

Lead Author

Andrew Urquhart

MD

University of Michigan

Lead Author

Elizabeth Dailey

MD

University of Michigan

Lead Author

Martin Lindquist

PhD

Johns Hopkins University

Lead Author

Briha Ansari

MPH

Johns Hopkins

Lead Author

Kathleen Sluka

PT

University of Iowa, Carver College of Medicine

Lead Author

Giovanni Berardi

DPT

The University of Iowa

Lead Author

Topics

  • Assessment and Diagnosis