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© Pernille Steen Pettersen, 2021
Series of dissertations submitted to the Faculty of Medicine, University of Oslo
ISBN 978-82-8377-928-8
All rights reserved. No part of this publication may be
reproduced or transmitted, in any form or by any means, without permission.
Cover: Hanne Baadsgaard Utigard.
Photo cover: Nicolas Tourrenc/Diakonhjemmet sykehus.
Print production: Reprosentralen, University of Oslo.
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9 Funding
This PhD-project was funded by grants from the South-Eastern Norway Regional Health Authority. Institutional support was provided by the administration at Diakonhjemmet Hospital. The data collection of the Nor-Hand study was supported by grants from Jan A.
Pahle’s foundation, Simon Fougner Hartmanns Family foundation and Trygve Gythfeldt´s research foundation.
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Pain sensitization, i.e. increased pain sensitivity, is believed contribute to chronic pain in many diseases, including osteoarthritis (OA). Hand OA is a serious, painful, and disabling disease. This doctoral thesis aimed to examine the relevance of peripheral and central pain sensitization in persons with hand OA.
Pain sensitization by pressure pain algometry and temporal summation was tested cross- sectionally in a large cohort and their relationships with pain severity as well as structural and inflammatory OA changes were analysed. Almost 300 participants were included, making it the largest study on the subject so far.
The results showed that central sensitization was common, and that peripheral and central sensitization was associated with higher hand pain intensity, independent of psychosocial factors and radiographic OA. The degree of structural and inflammatory changes in a finger joint was associated with pressure pain threshold of the same finger joint as a measure of peripheral and possibly also central sensitization in multilevel analyses. These results were not statistically significant in nonpainful joints alone. The overall amount of hand joint pathologies in a person with hand OA was not related to central sensitization except for presence of erosive hand OA. Disease duration was not associated with central sensitization.
The cross-sectional study design limited the ability to draw conclusions about causality.
Prospective studies are needed to better understand the risk factors for pain sensitization and the causal association between pain sensitization and hand pain. Further, reliability-testing of pain algometry and temporal summation showed variable results and efforts should be made to enhance the reliability of these tests in future studies.
The papers of this thesis confirm the clinical relevance of pain sensitization in hand OA. The results lay a groundwork for further exploration of how pain sensitization may be targeted to reduce chronic pain from hand OA.
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