Is chronic pain in degenerative joint disease maintained by central pain memory rather than ongoing peripheral pathology?

Abstract

Chronic pain is a key feature of degenerative joint disease however pain severity often shows poor correlation with the degree of structural damage seen on imaging. This is commonly referred to as pain–structure discordance. It challenges the traditional view that joint pathology alone determines symptom severity. A number of pieces of evidence from pain science suggests that central mechanisms, including central sensitisation and maladaptive neuroplasticity, may contribute to the persistence of pain beyond the initial peripheral condition. These processes are sometimes described as “pain memory”. This involves the amplification of nociceptive signalling within the spinal cord and brain, which leads to heightened pain perception that may potentially become partially independent of ongoing joint pathology. This narrative review explores the concept that chronic pain in degenerative joint disease may be maintained, at least in part, by central pain mechanisms rather than solely by peripheral structural changes. Evidence from clinical observations and outcomes following joint replacement surgery is discussed to illustrate how pain can persist despite stable disease or removal of damaged joint tissue. Understanding the role of central pain mechanisms is essential for patient assessment and supports a more integrated model of degenerative joint disease pain that incorporates both peripheral and central factors.