Pain in focus in patients with osteoarthritis

Introduction. Peripheral joint osteoarthritis is the leading cause of musculoskeletal pain and functional limitation. Osteoarthritis has a high prevalence and incidence and, therefore great socioeconomic importance. Clinical presentation. Pain in osteoarthritis results from a complex interaction of sensory, affective, and cognitive processes that include numerous abnormal cellular mechanisms at the affected joints and different levels of the nervous system involved in the pathophysiological mechanisms of chronic pain (spinal and supraspinal). In chronic pain states, central nervous system factors are particularly prominent. Although there are several ways to determine pain sensitivity, data suggest that assessing pressure pain threshold (i.e., tenderness to palpation) is the most reliable and reproducible method for identifying individuals with a centralized pain state. Conclusion. Significant advances in our understanding of pain pathophysiology and pain biomarkers are finally making the vision of ?personalized analgesia?. Clinicians can identify the sub-sets of individuals with what were once considered purely ?peripheral? pain syndromes and treat these patients with approaches directed more centrally than peripherally.