Development of a Composite Pain Sensitivity Index and Its Relationships with Knee Pain Severity and Patterns in People with or at Risk for Knee Osteoarthritis: The Multicenter Osteoarthritis Study.

Authors

Kosaku Aoyagi, Kathryn Bacon, Michael LaValley, Laura A Frey-Law, Cora E Lewis, Michael Nevitt, Tuhina Neogi

Published in

Osteoarthritis and cartilage. Oct 28, 2026. Epub Oct 28, 2026.

Abstract

Altered ascending and descending nociceptive signaling in the nervous system is associated with pain severity and patterns in knee osteoarthritis (OA). Because alterations across multiple nociceptive pathways can co-occur, a composite assessment may yield better insight than examining individual pathways separately. We therefore developed a composite pain sensitivity index (PSI) and evaluated its relation to the pain outcomes in those with or at risk of knee OA.
Using data from the Multicenter Osteoarthritis (MOST) Study, a NIH-funded longitudinal cohort, we developed an age- and sex-specific composite PSI incorporating quantitative sensory testing (QST) measures of ascending pain facilitation and descending pain modulation, including pressure pain threshold (PPT) at the knee and wrist, temporal summation (TS), and conditioned pain modulation (CPM). PSI was scaled to range 0-100 such that higher scores indicate greater pain sensitivity. Pain outcome measures included WOMAC pain severity, frequent knee pain (FKP), and constant pain, assessed with the Intermittent and Constant Osteoarthritis Pain (ICOAP). We evaluated the relations of the PSI and each individual QST measure to these pain outcomes cross-sectionally and longitudinally over two years using log-binomial, Poisson, and linear regression models as appropriate, adjusting for potential confounders.
We included 2679 participants. Cross-sectionally, each 10-unit increase in PSI had greater WOMAC pain severity (adjusted β: 0.45, 95%CI: 0.38-0.52), a 20% greater risk of FKP (95%CI: 1.15-1.26), and a 27% greater risk of constant pain (95% CI 1.14-1.41); these associations were generally larger than for the individual QST measures. Longitudinally, baseline PSI was associated with WOMAC pain severity 2 years later (adjusted β: 0.40, 95%CI: 0.33-0.49) and development of constant pain (aRR: 1.18, 95%CI: 0.99-1.40), whereas its association with incident FKP was minimal and not statistically significant (aRR: 1.06, 95%CI: 0.98-1.14), similar to that of wrist PPT (aRR: 1.05, 95%CI: 1.00-1.10).
A composite PSI combining QST measures of ascending (PPT/TS) and descending (CPM) nociceptive signaling had generally stronger associations than individual QST measures cross-sectionally, and to a lesser extent longitudinally. A composite PSI may provide better insights into capturing concurrent pain status than individual QST measures, whereas its predictive utility over time appears to be more pain outcome-specific.

PMID:
42951058
Bibliographic data and abstract were imported from PubMed on 29 Oct 2026.

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