Integration of Pain Theories to Guide Knee Osteoarthritis Care

Osteoarthritis is one of the four leading causes of pain. To date, clinicians providing health care to people with knee osteoarthritis pain focus on evaluating pain intensity and its effect on physical function and provide management with foundations in theories of pain including gate control and specificity. Pain theories such as these have been driving pain management and pain research since the seventeenth century, when Rene Descartes proposed his reflex theory of pain. The purpose of this paper is to describe the evolution of pain theories leading up to the gate control theory and the neuromatrix theory, provide a critical review of these two theories specifically, and discuss the strengths and challenges of integrating these two theories in the guidance of knee osteoarthritis pain management. Integration of the gate control theory, which focuses on the spinal processing of pain, and the neuromatrix theory, which focuses on central processing of pain, gives a broader model for understanding and addressing the multiple dimensions of pain phenomena. The integrated gate control−neuromatrix model presented in this paper provides a theoretical basis for considering the cognitive and affective aspects in addition to the sensory aspects of osteoarthritis pain. Discussion of the multidimensional aspects of pain includes clinical implications and recommendations for evaluation and treatment approaches. Finally, future directions for research are recommended to test the proposed model and improve the management of osteoarthritis pain.