Pain sensitisation and the risk of poor outcome following physiotherapy for patients with moderate to severe knee osteoarthritis: protocol for a prospective cohort study The efficacy of non-surgical treatment on pain and sensitization in patients with knee osteoarthritis: a pre-defined ancillary analysis from a randomized controlled trial. Intra-articular onabotulinumtoxinA in osteoarthritis knee pain: effect on human mechanistic pain biomarkers and clinical pain Management of osteoarthritis (OA) with an unsupervised home based exercise programme and/or patient administered assessment tools. A cluster randomised controlled trial with a 2x2 factorial design. Influence of Centrally Mediated Symptoms on Postoperative Pain in Osteoarthritis Patients Undergoing Total Knee Arthroplasty: A Prospective Observational Evaluation. Variability in conditioned pain modulation predicts response to NSAID treatment in patients with knee osteoarthritis Rationale, design and conduct of a comprehensive evaluation of a primary care based intervention to improve the quality of life of osteoarthritis patients. The PraxArt-project: a cluster randomized controlled trial [ISRCTN87252339] The impact of increased contact on psychosocial outcomes in patients with osteoarthritis: a randomized, controlled trial. Cohort profile: research on Osteoarthritis/Osteoporosis Against Disability study. Multidisciplinary and multifaceted outpatient management of patients with osteoarthritis: protocol for a randomised, controlled trial The effectiveness of self‐management educational interventions for osteoarthritis of the knee The effect of healing touch on the pain and mobility of persons with osteoarthritis: a feasibility study. MR imaging of erosions in interphalangeal joint osteoarthritis: is all osteoarthritis erosive? Osteoarthritis and its association with muscle hyperalgesia: an experimental controlled study A pilot study of the effectiveness of guided imagery with progressive muscle relaxation to reduce chronic pain and mobility difficulties of osteoarthritis. Current osteoarthritis treatment, prescribing influences and barriers to implementation in primary care. Effect of an education programme for patients with osteoarthritis in primary care - a randomized controlled trial
Introduction Pain is the dominant symptom of knee osteoarthritis ( OA ) , and recent evidence suggests factors outside of local joint pathology , such as pain sensitisation , can contribute significantly to the pain experience . It is unknown how pain sensitisation influences outcomes from commonly employed interventions such as physiotherapy . The aims of this study are , first , to provide a comprehensive description of the somatosensory characteristics of people with pain associated with knee OA . Second , we will investigate if indicators of pain sensitisation in patients with knee osteoarthritis are predictive of non-response to physiotherapy . Methods and analysis This is a multicentre prospect i ve cohort study with 140 participants . Eligible patients with moderate to severe symptomatic knee osteoarthritis will be identified at outpatient orthopaedic and rheumatology clinics . A baseline assessment will provide a comprehensive description of the somatosensory characteristics of each participant by means of clinical examination , quantitative sensory testing , and vali date d question naires measuring pain and functional capacity . Participants will then undergo physiotherapy treatment . The primary outcome will be non-response to physiotherapy on completion of the physiotherapy treatment programme as defined by the Osteoarthritis Research Society International treatment responder criteria . A principal component analysis will identify measures related to pain sensitisation to include in the predictive model . Regression analyses will explore the relationship between responder status and pain sensitisation while accounting for confounders . Ethics and dissemination This study has been approved by St James ’ Hospital/AMNCH Research Ethics Committee and by the St Vincent 's Healthcare Group Ethics and Medical Research Committee . The results will be presented at international conferences and published in a peer review journal . Trial registration number NCT02310945 OBJECTIVE To report the efficacy of a 3-month treatment program consisting of neuromuscular exercise , education , diet , insoles and pain medication ( MEDIC-treatment ) compared to usual care ( two leaflets with information and treatment advice ) in reducing pain-related measures and sensitization in patients with knee osteoarthritis ( OA ) not eligible for total knee replacement ( TKR ) . METHOD A pre-defined ancillary analysis of the results at 3 months of a r and omized controlled trial ( RCT ) of 100 patients r and omized to MEDIC-treatment or usual care . TRIAL REGISTRATION Clinical Trials.gov ( NCT01535001 ) . Outcomes were sensitization assessed at the knee , the lower leg and forearm using a h and held algometer , peak pain intensity in the previous 24 h , pain intensity after 30 min of walking , pain location and pattern , spreading of pain ( a region-divided body chart ) and the usage of pain medication . RESULTS The MEDIC group had larger improvements from baseline to 3 months in peak pain intensity ( P = 0.02 ) and pain after 30 min of walking ( P < 0.001 ) and in the number of body sites with pain ( P = 0.04 ) . There was no difference in the change in sensitization from baseline to 3 months between groups ( P = 0.87 ) , but sensitization decreased in both groups ( P < 0.001 ) . CONCLUSION A non-surgical treatment program is more efficacious in reducing pain-related measures than usual care , while both are equally efficacious in reducing sensitization , indicating that mechanisms other than pain sensitization contribute to the perceived pain . The patients did not have severe symptomatic knee OA and hence pain sensitization may not yet have developed into a clinical ly relevant parameter or subgroups with less sensitization may exist Objectives : OnabotulinumtoxinA ( onabotA ) attenuates peripheral nociceptive transduction and consequently neuronal firing . The aim of this mechanistic study was to evaluate the effect of intra-articular ( IA ) onabotA in patients with painful knee osteoarthritis ( OA ) . Method : We conducted a double-blind , r and omized , placebo-controlled , 12-week trial using a single ultrasound-guided IA injection of onabotA ( 200 U ) . Patients ( N = 121 ) were r and omized to receive onabotA ( n = 61 ) or placebo ( n = 60 ) . Mechanistic pain biomarkers and clinical outcomes were used for profiling the effect . The biomarkers were pressure pain thresholds ( PPTs ) from the knee joint ( localized sensitization ) and extra-articular sites ( widespread sensitization ) , and wind-up pain ( central sensitization ) . Clinical assessment s included the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , average daily pain ( ADP ) , patient global impression of change ( GIC ) , and rescue medication . The painDETECT question naire ( PD-Q ) was used for subgrouping patients ( nociceptive , neuropathic , and mixed/uncertain ) . Results : The nociceptive and non-nociceptive groups were identical with respect to all baseline data . No significant differences in clinical efficacy parameters were found between onabotA and placebo in the entire population . The nociceptive group showed significant improvement after IA onabotA at week 8 for all WOMAC outcomes , ADP at weeks 9 and 10 , and patient GIC at week 12 , and significant reduction in rescue medication counts within each 14-day period at weeks 9 and 10 . After 4 , 8 , and 12 weeks , significant correlations were obtained in the onabotA group between ADP ( both the entire group and the nociceptive group ) and various sensitization parameters . The nociceptive group showed pronounced effects on widespread sensitization . Conclusions : Intra-articular onabotA given to patients with nociceptive knee OA reduced pain sensitization together with improvement in pain and function BACKGROUND Diary recording of pain and disabling activities in osteoarthritis ( OA ) is widely recommended , but , to our knowledge , its impact on symptoms has not been investigated . Exercise programmes have been shown to be effective when patients are closely supervised by nurses or physiotherapists ; however , data are lacking on the efficacy of an unsupervised home based exercise regimen in patients with OA . OBJECTIVES To evaluate the clinical efficacy of patient administered assessment tools and an unsupervised home based exercise programme alone or in combination in patients with OA . METHODS The study was a 24 week , open cluster r and omised controlled trial with a factorial design . Rheumatologists ( n = 867 ) were assigned to four groups according to the treatment given : st and ardised tools ( ST ; n = 220 ) , exercises ( EX ; n = 213 ) , both tools and exercises ( ST+EX ; n = 213 ) , or usual care ( n = 221 ) . Each rheumatologist was to enroll four patients who met the American College of Rheumatology criteria for OA ( three with knee OA , one with hip OA ) . " Tools " consisted of weekly recording of pain and disabling activities in a diary . A home based exercise programme was performed daily at least four times per week with the aid of videotape and booklet . In addition to exercise and assessment , all patients received 12.5 mg or 25 mg of the non-steroidal anti-inflammatory drug rofecoxib once daily . Outcome variables were : pain ( measured on a visual analogue scale , 0 - 100 ) ; Western Ontario and McMaster Universities Osteoarthritis Index , function subscale ( 0 - 100 ) ; and patient assessment of the quality of care ( 0 - 100 ) . RESULTS Overall , 2957 patients with OA ( 2216 knee , 741 hip ) were included . After 24 weeks , both pain and function improved in the ST , EX , ST+EX , and usual care groups ( mean ( SD ) -17 ( 27 ) , -20 ( 29 ) , -15 ( 27 ) , -19 ( 29 ) ; and -11 ( 19 ) , -12 ( 19 ) , -10 ( 19 ) , -11 ( 20 ) , respectively ) , without significant differences between groups . However , patients in the EX and ST+EX groups were more likely to agree that their rheumatologist had done his best to preserve their functional and physical activities . CONCLUSION Although patients ' assessment s favoured the exercise programme , results from this study failed to demonstrate a short term symptomatic effect of the two non-pharmacological treatments ( weekly recording of condition and exercise ) in patients with OA concurrently receiving nonsteroidal anti-inflammatory drugs BACKGROUND Central sensitization plays an important role in the chronic pain experienced by osteoarthritis ( OA ) patients . In this prospect i ve observational study , we investigated the influence of the level of preoperative central ly mediated symptoms measured by the Central Sensitization Inventory ( CSI ) on pain intensity after total knee arthroplasty ( TKA ) for OA . METHODS Ninety-eight female OA patients undergoing TKA were enrolled in this study . We assessed CSI scores , pain-related data , and other clinical data preoperatively . All patients received spinal anesthesia and postoperative epidural analgesia .  Pain intensity ( at rest and on movement ) and rescue meperidine requirements were assessed during postoperative days 1 and 2 . Also , pain intensity and patient satisfaction were assessed 1 month and 3 months after surgery . After the completion of all postoperative assessment s , we separated the study population into a preoperative CSI score ≥40 and < 40 group . We assessed pain-related data between the 2 groups at each assessment time . RESULTS Ninety-one patients completed the postoperative assessment s ( a preoperative CSI ≥40 group ; n = 44 , CSI < 40 group ; n = 47 ) . Patients with preoperative CSI ≥40 complained of a greater pain intensity ( P = 0.001 ) during postoperative days 1 and 2 and required a higher dose of meperidine rescue ( P = 0.003 ) than those with a preoperative CSI < 40 . The high CSI score group also showed a less favorable outcome in terms of pain relief on follow-up at 1 month ( P = 0.006 ) and 3 months ( P = 0.002 ) after surgery . In multivariate analysis , a preoperative CSI score ≥40 was the strongest determinant with 5.091 of the highest odds ratio ( 95 % CI 1.324 to 19.523 , P = 0.016 ) for predicting a persistent pain 3 months after surgery among demographic and pain-related variables . CONCLUSIONS OA patients with high levels of comorbid central ly mediated symptoms showed severe pain and increased analgesic requirements after TKA in the early postoperative period . Moreover , these patients seemed to be at higher risk of persistent pain , and a high CSI score was predictive of low patient satisfaction in terms of pain relief after surgery Background Patients with painful knee osteoarthritis ( OA ) demonstrate hyperalgesia and altered pain-modulatory responses . While some prior work has demonstrated cross-sectional associations between laboratory and clinical pain measures , it is unknown whether individual variability in quantitative sensory testing ( QST ) responses at baseline can prospect ively predict analgesic treatment responses . Method Patients with knee OA ( n = 35 ) were compared on QST responses to a demographically-matched  pain-free control group ( n = 39 ) , after which patients completed a month-long treatment study of diclofenac sodium topical gel ( 1 % ) , applied up to 4 times daily . Results OA patients demonstrated reduced pain thresholds at multiple anatomic sites , as well as reduced conditioned pain modulation ( CPM ) and enhanced temporal summation of pain . The most pain-sensitive patients tended to report the most intense and neuropathic OA pain . Following diclofenac treatment , the knee OA cohort showed a roughly 30 % improvement in pain , regardless of the presence or absence of neuropathic symptoms . Baseline CPM scores , an index of endogenous pain-inhibitory capacity , were prospect ively associated with treatment-related changes in clinical pain . Specifically , participants with higher CPM at baseline ( i.e. , better functioning endogenous pain-inhibitory systems ) showed more reduction in pain at the end of treatment ( p < .05 ) . Conclusions These results support prior findings of amplified pain sensitivity and reduced pain-inhibition in OA patients . Moreover , the moderate to strong associations between laboratory-based measures of pain sensitivity and indices of clinical pain highlight the clinical relevance of QST in this sample . Finally , the prospect i ve association between CPM and diclofenac response suggests that QST-based phenotyping may have utility in explaining inter-patient variability in long-term analgesic treatment outcomes .Trial registration Clinical Trials . Gov Identifier : NCT01383954 . Registered June 22 , 2011 Background Osteoarthritis ( OA ) has a high prevalence in primary care . Conservative , guideline orientated approaches aim ing at improving pain treatment and increasing physical activity , have been proven to be effective in several context s outside the primary care setting , as for instance the Arthritis Self management Programs ( ASMPs ) . But it remains unclear if these comprehensive evidence based approaches can improve patients ' quality of life if they are provided in a primary care setting . Methods / Design PraxArt is a cluster r and omised controlled trial with GPs as the unit of r and omisation . The aim of the study is to evaluate the impact of a comprehensive evidence based medical education of GPs on individual care and patients ' quality of life . 75 GPs were r and omised either to intervention group I or II or to a control group . Each GP will include 15 patients suffering from osteoarthritis according to the criteria of ACR.In intervention group I GPs will receive medical education and patient education leaflets including a physical exercise program . In intervention group II the same is provided , but in addition a practice nurse will be trained to monitor via monthly telephone calls adherence to GPs prescriptions and advices and ask about increasing pain and possible side effects of medication . In the control group no intervention will be applied at all . Main outcome measurement for patients ' QoL is the GERMAN- AIMS 2-SF question naire . In addition data about patients ' satisfaction ( using a modified EUROPEP-tool ) , medication , health care utilization , comorbidity , physical activity and depression ( using PHQ-9 ) will be retrieved . Measurements ( pre data collection ) will take place in months I-III , starting in June 2005 . Post data collection will be performed after 6 months . Discussion Despite the high prevalence and increasing incidence , comprehensive and evidence based treatment approaches for OA in a primary care setting are neither established nor evaluated in Germany . If the evaluation of the presented approach reveals a clear benefit it is planned to provide this GP-centred interventions on a much larger scale After baseline in home interviews , 439 patients with osteoarthritis ( OA ) were r and omly assigned to the control or one of 3 intervention groups which differed only in method of delivery ( i.e. , phone , clinic , both ) . Trained non clinical interviewers review ed medications , problems with joint pain , gastrointestinal symptoms , early warning signs for common chronic diseases , scheduled outpatient visits , an evening/weekend clinic telephone number ,  barriers to care  , and suggestions to encourage participation during clinic visits . We hypothesized that the intervention would enhance social support , satisfaction with care , morale , and medication compliance . We found that none of the interventions had any effect upon these outcomes Since the proportion of the ageing population in Japan is increasing , a comprehensive and evidence based strategy is urgently required for the prevention of musculoskeletal diseases , including osteoarthritis ( OA ) and osteoporosis ( OP ) , both of which affect the activities of daily living ( ADL ) and quality of life ( QOL ) and increase morbidity and mortality . However , few prospect i ve , longitudinal studies for the purpose of developing such a strategy have been conducted , and little information is available regarding the prevalence and incidence of musculoskeletal disorders , including OA and OP , as well as pain and disability in the Japanese population . It is difficult to design rational clinical and public health approaches for the diagnosis , evaluation and prevention of OA and OP without such epidemiological data . The Research on Osteoarthritis/osteoporosis Against Disability ( ROAD ) study was established in 2005 by N.Y. , T.A. , H.O. , S.M. , H.K. and K.N. ( principal investigators ) . The principal investigators are affiliated with the 22nd Century Medical and Research Center , University of Tokyo Background Osteoarthritis ( OA ) is a prevalent joint disorder with a need for efficient and evidence -based management strategies . Objectives The primary purpose of this study is to compare the effects of a multidisciplinary outpatient clinic , including a brief group-based educational programme , with a traditional individual outpatient clinic for patients with hip , knee , h and or generalized OA . A secondary purpose is to investigate the effects of a telephone follow-up call . Methods This is a pragmatic r and omised single-blind controlled study with a total of 400 patients with hip , knee , h and or generalized OA between 40 and 80 years referred to an outpatient rheumatology hospital clinic . The r and omisation is stratified according to the diagnostic subgroups . The experimental group is exposed to a multidisciplinary and multifaceted intervention , including a 3.5 hour group-based patient education programme about OA in addition to individual consultations with members of a multidisciplinary team . The control intervention is based on regular care with an individual outpatient consultation with a rheumatologist ( treatment as usual ) . Primary outcomes are patient satisfaction measured at 4 months and cost-effectiveness measured at 12 months . Secondary outcomes are pain and global disease activity measured on a numeric rating scales ( NRS ) , generic and disease specific functioning and disability using Short Form-36 ( SF-36 ) health survey , the Western Ontario and McMaster Universities Osteoarthritis Index 3 ( WOMAC ) , the Australian/Canadian Osteoarthritis H and Index ( AUSCAN ) , and a patient-generated measure of disability ( Patient-Specific Functional scale , PSFS ) . Global perceived effect of change in health status during the study period is also reported . At 4-month follow-up , patients in both groups will be r and omly allocated to a 10-minute telephone call or no follow-up ( " treatment as usual " ) . After additional 8 months ( 12-month follow-up ) the four groups will be compared in a secondary analysis with regard to health outcomes and health care costs . Discussion This trial will provide results on how multidisciplinary and multifaceted management of patients with OA affects health outcomes and health care costs . Trial registration Current Controlled Trials IS RCT Background Osteoarthritis ( OA ) is a common cause of pain and disability , and is the most common form of arthritis in the Western world . The most common joint to be affected is the knee . Pain and functional disability are common symptoms , which can lead to reduced quality of life and increase the risk of further morbidity . Current treatment aims to educate patients about the management of OA , reduce pain , improve function , decrease disability and reduce the progression of the disease . Education with clients has been described as a set of planned educational activities design ed to improve patients ' health behaviours and /or health status . The purpose of self‐education is to maintain or improve health , or , in some cases , to slow deterioration by increasing participant 's perception of self efficacy defined as an ability to control or manage various aspects of OA . To date , there is no systematic review of the literature undertaken to identify the effectiveness of self‐management educational activities for osteoarthritis of the knee . Objective The objective of this systematic review is to evaluate the effectiveness of  self‐management educational interventions on function and quality of life for adult subjects with OA of the knee . Search strategy A comprehensive search strategy was undertaken on data bases available from University of South Australia from their inception to January 2007 . Selection criteria R and omised controlled trials or clinical controlled trials were sought which evaluated any self management interventions for osteoarthritis knee . Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments . Data extraction was via the Joanna Briggs Institute st and ard data extraction form for evidence of effectiveness , and Review Manager Software was used to calculate comparative statistics . Results Thirteen trials were included in the review . Trials were clinical ly and method ologically heterogeneous . Pooled results indicate evidence of a beneficial effect from  self management strategies with reducing pain ( SMD ‐0.25 , 95%CI ‐0.36 to ‐0.13 , 11 trials 1379 participants ) . There was no effect on physical function ( SMD 0.13 , 95%CI ‐0.33 to ‐0.08 , eight trials , 1156 subjects ) . No beneficial effects were found from self management interventions with improving quality of life . We also found the exercise component of self management ( four trials ) demonstrated a benefit with reducing pain , improving function and quality of life . Exercise also offered a benefit over no exercise  . Overall method ological quality was moderate . Discussion Pooled results indicate evidence of a beneficial effect from self management strategies with reducing pain and improving function . Significant heterogeneity was found between trials . This was controlled for in the analysis but may be explained by heterogeneity in both the intervention and control group . The exercise component of self management programmes appears to contribute a significant benefit . Conclusion There is encouraging evidence of a small benefit from exercise in self management programs . Clear guidelines can not be provided for practice regarding the exercise content due to heterogeneity but overall benefit suggests this component should be emphasized and implemented in primary care self management programmes The aims of this pilot study were to investigate the effects of Healing Touch ( HT ) on the pain level , joint function , mobility , and depression in persons with osteoarthritis ( OA ) of the knee joint(s ) . A r and omized controlled trial using a repeated measures design was used . Cognitively intact persons ( institutionalized and community ) with a diagnosis of OA of the knee joint(s ) received either HT sessions three times per week for 6 weeks ( n = 12 ) or weekly friendly visits ( FV ) ( n = 7 ) . The HT sessions were delivered by a team of two nurses certified as HT practitioners and the FV was conducted by a nurse . All subjects continued to receive their st and ard care including the methods they had been using to relieve their joint pain . The two groups were similar regarding demographic variables , number of knees affected , co-morbidities , pain medications used and outcome variables at baseline . Two pain outcome measures ( intensity and life interference ) produced significant interaction effects . Two joint outcome measures ( extension and extensor lag ) also produced significant interaction effects . Furthermore , the HT group demonstrated significant improvements in 9 of the 12 outcome variables ( 75 % ) while no significant improvements occurred in the FV group . The HT group exhibited sustained effects ( 3 weeks post treatments ) in three outcome variables . The reduction in joint pain and improvement in joint function suggest that biofield therapies could be effective non-pharmacological adjuncts to treatment of OA Objective Erosive osteoarthritis is usually considered as an inflammatory subset of osteoarthritis ( OA ) . However , an inflammatory component is now recognised in all subsets of OA , so this subgroup of erosive or inflammatory OA is more difficult to conceptualise . The aim of this study was to compare routine CR and MRI to investigate erosion numbers and morphology to determine whether h and OA in general is a more erosive disease than previously recognised . Design and methods Fifteen patients with clinical ( OA ) of the small joints of the h and underwent MRI of one of the affected proximal interphalangeal ( PIP ) or distal interphalangeal ( DIP ) joints .  Conventional radiographs ( CR ) of the h and were also obtained . The MR images were review ed by two observers for the presence of central and marginal erosions . The site and morphology of any erosions was recorded . CR images of the same h and joint were scored independently for central and marginal erosions by the same observers . Results There was 100 % agreement between the observers for scoring erosions on CR . Agreement for the MRI scores was also excellent ( kappa = 0.84 ) . MRI detected 37 erosions , of which only 9 were seen on CR . The increase in sensitivity using MRI was much greater for marginal erosions ( 1 detected on CR , 19 on MRI ) than for central erosions ( 8 on CR , 18 on MRI ) . Using MRI 80 % of joints examined showed 1 or more erosions compared with 40 % using CR . If only marginal erosions were considered 80 % of joints were still considered erosive by MRI criteria , but only 1 showed evidence of erosion on CR . Morphologically central erosions appeared to represent areas of subchondral collapse and pressure atrophy . In contrast , marginal erosions resembled those seen in inflammatory arthritides . Conclusion Erosions , and particularly marginal erosions typical of those seen in inflammatory arthritis , are a more common feature of small joint OA than conventional radiographs have previously indicated & NA ; Hypertonic saline effectively excites muscle nociceptors . Muscle hyperalgesia was assessed in osteoarthritis ( OA ) by intramuscular infusion of 0.5 ml hypertonic saline ( 6 % ) into the tibialis anterior muscle in humans . Patients ( n=14 ) with OA in the lower extremities were compared with an equal number of age‐ and sex‐matched healthy controls . Ten of the 14 OA patients had pain in the knee joint as the most common presenting complaint . Visual analogue scale ( VAS ) pain intensity and assessment of pain areas were recorded before infusion and immediately , 2 , 5 , 10 and 20 min after infusion , and then every 10 min , until the pain vanished . The mean pain offset time in OA patients ( 11.3±7.9 min ) was larger as compared with the control subjects ( 6.04±2.1 min ) ( P=0.025 ) . OA patients had increased pain intensity VAS after the infusion in the right leg compared with controls ( P<0.05 ) . Referred and radiating pain areas at 2 min post‐infusion increased in OA patients and not in controls as compared with the local pain areas ( P<0.05 ) . It is concluded that muscle hyperalgesia and extended pain areas might be due to central sensitization caused by painful osteoarthritis Osteoarthritis ( OA ) is a common , chronic condition that affects most older adults . Adults with OA must deal with pain that leads to limited mobility and may lead to disability and difficulty maintaining independence . A longitudinal , r and omized clinical trial pilot study was conducted to determine whether Guided Imagery ( GI ) with Progressive Muscle Relaxation ( PMR ) would reduce pain and mobility difficulties of women with OA . Twenty-eight older women with OA were r and omly assigned to either the treatment or the control group . The treatment consisted of listening twice a day to a 10-to-15-minute audiotaped script that guided the women in GI with PMR . Repeated- measures ANOVA revealed a significant difference between the two groups in the amount of change in pain and mobility difficulties they experienced over 12 weeks . The treatment group reported a significant reduction in pain and mobility difficulties at week 12 compared to the control group . Members of the control group reported no differences in pain and non-significant increases in mobility difficulties . The results of this pilot study justify further investigation of the effectiveness of GI with PMR as a self-management intervention to reduce pain and mobility difficulties associated with OA AIM To explore general practitioners ' ( GPs ) management of  osteoarthritis ( OA ) .  BACKGROUND OA represents a large burden on primary care . Little is known about GPs ' current management of OA , especially influences on their prescribing quality care and the barriers they face while doing so . METHODS A total of 1006 GPs were r and omly selected and invited to participate in an online survey on assessment and treatment of OA , on factors influencing their management , burden on their practice , and on the need for improving care . FINDINGS There were 232 respondents ( 23 % ) . National Institute for Health and Clinical Excellence ( NICE ) guidance ( 65 % ) and professional experience ( 64 % ) were the biggest influences on OA management . When assessing patients , pain and mobility were most frequently assessed , with quality of life , independent living , sleep and depression addressed by over half of them . In all , 52 % did not use educational material s ; only a third of users rated their current educational material as good or very good . Treatments employed were largely in line with NICE recommendations . Prescription review was reported by a high proportion ( 74 % ) . Achieving adequate pain control and lack of time were the most frequently cited challenges , whereas more time with patients , collaboration with specialist colleagues and improved communication tools were the most common needs identified to improve OA management . In summary , national guidelines are an important influence for GP treatment of OA . This survey has highlighted issues about the adequacy of information available for OA , about GPs ' need for more time with OA patients and their interaction with specialist colleagues Background Osteoarthritis ( OA ) is a degenerative disease , considered to be one of the major public health problems . Research suggests that patient education is feasible and valuable for achieving improvements in quality of life , in function , well-being and improved coping . Since 1994 , Primary Health Care in Malmö has used a patient education programme directed towards OA . The aim of this study was to evaluate the effects of this education programme for patients with OA in primary health care in terms of self-efficacy , function and self-perceived health . Method The study was a single-blind , r and omized controlled trial ( RCT ) in which the  EuroQol-5D and Arthritis self-efficacy scale were used to measure self-perceived health and self-efficacy and function was measured with Grip Ability Test for the upper extremity and five different functional tests for the lower extremity . Results We found differences between the intervention group and the control group , comparing the results at baseline and after 6 months in EuroQol-5D ( p < 0.001 ) and in st and ing one leg eyes closed ( p = 0.02 ) in favour of the intervention group . No other differences between the groups were found . Conclusion This study has shown that patient education for patients with osteoarthritis is feasible in a primary health care setting and can improve self-perceived health as well as function in some degree , but not self-efficacy . Further research to investigate the effect of exercise performance on function , as well as self-efficacy is warranted . Trial registration The trial is registered with Clinical Trials.gov . Registration number :
Results There is good evidence for a role of central sensitisation in chronic OA pain in a subgroup of patients .
Biomarkers may be helpful for confirming the presence of central sensitisation , especially when there is diagnostic uncertainty .
Several non‐pharmacological and pharmacological treatments may be effective in OA patients with central sensitisation features .
Multimodal therapy may be required to achieve control of symptoms .
Summary Aims The aim of this non‐ systematic review was to provide a practical guide for clinicians on the evidence for central sensitisation in chronic osteoarthritis ( OA ) pain and how this pain mechanism can be addressed in terms of clinical diagnosis , investigation and treatment .
Clinical ly , a central sensitisation component in chronic OA pain can be suspected based on characteristic pain features and non‐pain features seen in other conditions involving central sensitisation .