Osteoarthritis pain. Recent advances and controversies

Purpose of review Osteoarthritis is one of the most frequent causes of chronic pain. Because there is no causal treatment of osteoarthritis, sufficient pain control is of uppermost importance but often not met. The review reports recent advances and controversies in our understanding of osteoarthritis pain and its treatment. Recent findings Osteoarthritis pain is determined by processes at different levels. An important local factor of pain generation in the joint is inflammation such as synovitis, and neuropathic components of osteoarthritis pain are being discussed. Neuroplastic changes in the nociceptive system such as peripheral and central sensitization facilitate pain processing. Osteoarthritis pain may also be aggravated by general factors such as metabolic changes and diabetes mellitus, genetic and psychological factors. The review will also address mediators involved in osteoarthritis pain and treatment options. Summary Recent research is increasing our understanding of osteoarthritis pain by elucidating local factors in the joint which cause pain, by showing neuroplastic changes in the nociceptive system and by addressing the significance of general factors in pain such as metabolic changes. The weight of such factors may determine the pain pattern in individual patients. Correspondence to Hans-Georg Schaible, Institute of Physiology 1/Neurophysiology, Jena University Hospital, Friedrich Schiller University Jena, Teichgraben 8, 07743 Jena, Germany. Tel: +0049 3641 938810; e-mail: Hans-Georg.Schaible@med.uni-jena.de Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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