Mechanism-directed therapy for pain in osteoarthritis
E.S. Filatova¹, A.E. Karateev¹, E.G. Filatova<sup>2

1</sup> Nasonova Research Institute of Rheumatology, Moscow
² Sechenov University, Moscow

About 30% of patients with osteoarthritis (OA) have a mixed nature of pain: inflammatory pain combined with central sensitization (CS). Pain in CS is determined by the ineffectiveness of therapy with nonsteroidal anti-inflammatory drugs (NSAIDs), the presence of neuropathic descriptors, the absence of the somatosensory nervous system impairment and clinically significant depression or anxiety, as well as the effectiveness of using drugs with the central mode of action (antiepileptic agents).
Aim: evaluation of the effectiveness of the antiepileptic agent pregabalin in the treatment of chronic pain syndrome of a mixed nature in patients with OA of the knee.
Patients and Methods: 60 patients with OA of the knee were involved in the study. The median age was 59.82±4.46 years. The patients were divided into two groups of 30 people. Groups were randomly formed. Group I received NSAIDs + pregabalin therapy and group II only NSAIDs monotherapy. Clinical neurological status, functional index WOMAC, pain intensity during movement, pain diagnosis (DN4 questionnaire and Pain DETECT), emotional-affective sphere assessment (HADS questionnaire), pain intensity assessment on a visual analogue scale (VAS) at rest, quality of life assessment (questionnaire EQ-5D).
Results: the clinical neurological study did not reveal a pathology of the peripheral or central nervous system capable of explaining the occurrence of neuropathic pain in the patients. In this regard, the presence of neuropathic pain descriptors, detected using DN4, was regarded as a CS. A study of the treatment of patients with OA with a mixed mechanism of pain (inflammatory + CS) showed a more pronounced and long-lasting effect of therapy, aimed at both mechanisms compared with anti-inflammatory monotherapy. In the group receiving pregabalin and NSAIDs, a stable and significantly greater decrease in the intensity of pain on VAS and a more pronounced change in the functional activity of the WOMAC test were observed compared with NSAIDs monotherapy.
Conclusion: the study confirms the need to determine the signs of CS in patients with OA and conduct in this subgroup a complex mechanism-directed therapy, including NSAIDs and drugs with the central mode of action.

Key words: osteoarthritis, central sensitization, NSAIDs, pregabalin, chronic pain syndrome.
For citation: Filatova E.S., Karateev A.E., Filatova E.G. Mechanism-directed therapy for pain in osteoarthritis // RMJ. 2018. № 12(II). P. 82–86.