165: Exploring if adiposity and metabolic health impact endogenous pain modulation in knee osteoarthritis

Topic: Clinical Science
Subtopic:

Background and Aims: Pain modulation in people with knee osteoarthritis (KOA) is complex and insufficiently understood. Conditioned pain modulation (CPM) is a widely used measure for assessing the efficiency of descending pain modulation. Greater adiposity, metabolic syndrome and its components, have been reported to weaken pain modulation in healthy adults. However their impact on pain modulation in people with KOA is unknown. Therefore, this study aimed to assess the association of levels of adiposity, metabolic syndrome and its components, with CPM in people with KOA.

Methods: Adults aged ≥40 years with diagnosed KOA, were recruited from the community. Metabolic syndrome was defined by waist circumference, triglyceride and HDL cholesterol levels, fasting glucose, and blood pressure, with at least three criteria required. Adiposity was assessed using X-ray absorptiometry. CPM was evaluated with an Algomed algometer at the index knee, using a 4 °C conditioning stimulus for one minute. Three age- and sex-adjusted logistic regression models examined CPM efficiency: total and visceral adiposity levels, metabolic syndrome stratified by adiposity, and metabolic syndrome components stratified by adiposity. Analyses were conducted in RStudio, with significance set at p < 0.05.

Results: Eighty-nine individuals were included (mean age 58.3 ± 9.8 years; BMI 30.5 ± 5.5 kg/m²). Compared to individuals with low levels of adiposity, those with high total adiposity (OR = 2.48; 95% CI: 0.57–10.84) or high visceral adiposity (OR = 1.70; 95% CI: 0.55–5.23) were not associated with efficient CPM. Stratified analyses revealed no significant associations between CPM efficiency and metabolic syndrome across adiposity strata (all p > 0.05). Individual metabolic parameters were not associated with CPM efficiency high or low levels of total or visceral adiposity (all p > 0.05).

Conclusions: In this exploratory analysis of people with KOA, endogenous pain modulation assessed by CPM appears largely independent of the level of total and visceral adiposity, as well as the influence of metabolic syndrome, and individual metabolic parameters. The limitations of the small sample size warrant further study to confirm these findings.

References: Casonato NA, Sette FE, da Silva MG, Venturini PJF, Aily JB, Mattiello SM. Association between body fat indices and pain perception: implications for self-reported pain and pressure pain threshold in people with knee osteoarthritis. J Bodyw Mov Ther. 2025;45:555–561. doi:10.1016/j.jbmt.2025.09.018
Carlesso LC, Law LF, Wang N, Nevitt M, Lewis CE, Neogi T, et al; Multicenter Osteoarthritis Study Group. Association of pain sensitization and conditioned pain modulation with pain patterns in knee osteoarthritis. Arthritis Care Res (Hoboken). 2022;74(1):107–112.

Presenting Author: Lisa Carlesso
Submitting Author: Lisa Carlesso

Senior Author: Lisa Carlesso

IASP 2026 Global Year theme of Neuropathic Pain: No

• Natalia Casonato: MSc - Department of Physiotherapy at the Federal University of São Carlos, São Paulo, Brazil.
• Stela Mattiello: PhD - Department of Physiotherapy at the Federal University of São Carlos, São Paulo, Brazil.