Meniscus Lesions Tied to Neuropathic Pain in Knee OA

http://www.medpagetoday.com/Rheumatology/Arthritis/

The finding of a greater likelihood of NP in patients with meniscal extrusion and lateral meniscal tears suggests that knee OA patients with a neuropathic pain component have more severe symptoms, they wrote. This, to a certain extent, was reflected by a trend towards greater use of non-steroidal anti-inflammatory drugs (NSAIDS), they added (12% of those unlikely to have neuropathic pain were taking these drugs compared with 31% of those with likely neuropathic pain)…

The exact mechanisms underlying neuropathic pain-like symptoms in OA are poorly understood, but the authors noted that OA pain likely includes both nociceptive and neuropathic components. It has been suggested that local damage to innervation as well as other joint structures may cause damage to peripheral nerves, they said…

This finding is clinically relevant for various reasons, they added. Not only does it support the examination for meniscal extrusion in knee OA patients with neuropathic pain, but the predominance of a neuropathic component in such patients should encourage physicians to consider using MRI to establish a proper diagnosis.

A diagnosis of meniscal extrusion may also help identify patients who might benefit from treatment aimed at controlling their symptoms. “There is hope that this ‘personalized therapeutic management’ would avoid the prolonged use of anti-inflammatory drugs or even narcotic analgesics, preventing potential side effects” the authors wrote.

“Treatment aimed at controlling their symptoms”… If they’re not talking about drugs, then they must be talking about surgery, especially if an MRI is necessary.  Wonderful — the answer is surgery.

The observational study was limited by a relatively small sample size, the arbitrary determination of the sample, and the diagnosis of neuropathic pain based solely on the PainDETECT questionnaire.

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