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To address this, we undertook the present study in order to identify central sensitization using neuroimaging and Pain<jats:styled-content style=\"fixed-case\">DETECT<\/jats:styled-content> and to relate it to postarthroplasty outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients awaiting arthroplasty underwent quantitative sensory testing, psychological assessment, and functional magnetic resonance imaging (<jats:styled-content style=\"fixed-case\">fMRI<\/jats:styled-content>). Neuroimaging (<jats:styled-content style=\"fixed-case\">fMRI<\/jats:styled-content>) was conducted during punctate stimulation (n = 24) and cold stimulation (n = 20) to the affected knee. The postoperative outcome was measured using the Oxford Knee Score, patient\u2010reported moderate\u2010to\u2010severe long\u2010term pain postarthroplasty, and a range of pain\u2010related questionnaires.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with neuropathic\u2010like pain presurgery (identified using Pain<jats:styled-content style=\"fixed-case\">DETECT<\/jats:styled-content>; n = 14) reported significantly higher pain in response to punctate stimuli and cold stimuli near the affected joint (<jats:italic>P<\/jats:italic> &lt; 0.05). Neural activity in these patients, compared to those without neuropathic\u2010like pain, was significantly lower in the rostral anterior cingulate cortex (<jats:italic>P<\/jats:italic> &lt; 0.05) and higher in the rostral ventromedial medulla (<jats:styled-content style=\"fixed-case\">RVM<\/jats:styled-content>) during punctate stimulation (<jats:italic>P<\/jats:italic> &lt; 0.05), with significant functional connectivity between these two areas (r = 0.49, <jats:italic>P<\/jats:italic> = 0.018). Preoperative neuropathic\u2010like pain and higher neural activity in the <jats:styled-content style=\"fixed-case\">RVM<\/jats:styled-content> were associated with moderate\u2010to\u2010severe long\u2010term pain after arthroplasty (<jats:italic>P<\/jats:italic> = 0.0356).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The psychophysical and neuroimaging data suggest that a subset of <jats:styled-content style=\"fixed-case\">OA<\/jats:styled-content> patients have centrally mediated pain sensitization. This was likely due to supraspinally mediated reductions in inhibition and increases in facilitation of nociceptive signaling, and was associated with a worse outcome following arthroplasty. The neurobiologic confirmation of central sensitization in patients with features of neuropathic pain, identified using PainDETECT, provides further support for the investigation of such bedside measures for patient stratification, to better predict postsurgical outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.40749","type":"journal-article","created":{"date-parts":[[2018,10,8]],"date-time":"2018-10-08T07:14:45Z","timestamp":1538982885000},"page":"550-560","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":157,"title":["Central Sensitization in Knee Osteoarthritis: Relating Presurgical Brainstem Neuroimaging and Pain<scp>DETECT<\/scp>\u2010Based Patient Stratification to Arthroplasty Outcome"],"prefix":"10.1002","volume":"71","author":[{"given":"Anushka","family":"Soni","sequence":"first","affiliation":[{"name":"University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishvarani","family":"Wanigasekera","sequence":"additional","affiliation":[{"name":"University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melvin","family":"Mezue","sequence":"additional","affiliation":[{"name":"University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrus","family":"Cooper","sequence":"additional","affiliation":[{"name":"University of Oxford, Oxford, UK, and University of Southampton  Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad K.","family":"Javaid","sequence":"additional","affiliation":[{"name":"University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew\u00a0J.","family":"Price","sequence":"additional","affiliation":[{"name":"University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Tracey","sequence":"additional","affiliation":[{"name":"University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,3,6]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"International Association for the Study of Pain.IASP terminology.2018. 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