Decreased pain sensitivity and alterations of cerebrospinal fluid and plasma inflammatory mediators after total hip arthroplasty in patients with disabling osteoarthritis

• Published in: Pain practice Vol. 22; no. 1; pp. 66 - 82
• Main Authors: Bjurström, Martin F., Bodelsson, Mikael, Irwin, Michael R., Orbjörn, Camilla, Hansson, Oskar, Mattsson‐Carlgren, Niklas
• Format: Journal Article
• Language: English
• Published: United States 01.01.2022
• Subjects: Anestesi och intensivvård; Anesthesiology and Intensive Care; Arthroplasty; Arthroplasty, Replacement, Hip - adverse effects; blood; central sensitization; cerebrospinal fluid; Clinical Medicine; Hip/adverse effects; Hip/surgery; Humans; inflammation; Inflammation Mediators; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Neurologi; Neurology; Osteoarthritis; Osteoarthritis, Hip - surgery; Pain; Prospective Studies; quantitative sensory testing; Replacement; pain; inflammation; osteoarthritis; cerebrospinal fluid; central sensitization; blood; quantitative sensory testing
• ISSN: 1530-7085; 1533-2500; 1533-2500
• DOI: 10.1111/papr.13051

Background Proinflammatory mechanisms are implicated in pain states. Recent research indicates that patients with osteoarthritis (OA) with signs of central sensitization exhibit elevated cerebrospinal fluid (CSF) levels of interferon gamma‐induced protein 10 (IP‐10), Fms‐related tyrosine kinase 1 (Flt‐1), and monocyte chemoattractant protein 1 (MCP‐1). Methods The current prospective cohort study, including 15 patients with OA, primarily aimed to evaluate associations among alterations in CSF IP‐10, Flt‐1, MCP‐1, and pain sensitization following total hip arthroplasty (THA). Participants provided CSF and blood samples for analysis of 10 proinflammatory mediators, and underwent detailed clinical examination and quantitative sensory testing, immediately preoperative and 18 months after surgery. Results Neurophysiological measures of pain showed markedly reduced pain sensitivity long‐term postoperative. Increases in remote site pressure pain detection thresholds (PPDTs) and decreased temporal summation indicated partial resolution of previous central sensitization. Compared to preoperative, CSF concentrations of IP‐10 were increased (p = 0.041), whereas neither Flt‐1 (p = 0.112) nor MCP‐1 levels changed (p = 0.650). Compared to preoperative, plasma concentrations of IP‐10 were increased (p = 0.006), whereas interleukin (IL)‐8 was decreased (p = 0.023). Subjects who exhibited increases in arm PPDTs above median showed greater increases in CSF IP‐10 compared to those with PPDT increases below median (p = 0.028). Analyses of plasma IP‐10 and IL‐8 indicated higher levels of peripheral inflammation were linked to decreased pressure pain thresholds (unadjusted β = −0.79, p = 0.006, and β = −118.1, p = 0.014, respectively). Conclusions THA leads to long‐term decreases in pain sensitivity, indicative of resolution of sensitization processes. Changes in CSF and plasma levels of IP‐10, and plasma IL‐8, may be associated with altered pain phenotype.