Understanding the pain experience in hip and knee osteoarthritis — An OARSI/OMERACT initiative

Division of Rheumatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
Osteoarthritis and Cartilage (Impact Factor: 4.17). 05/2008; 16(4):415-22. DOI: 10.1016/j.joca.2007.12.017
Source: PubMed


To examine the pain experience of people with hip or knee osteoarthritis (OA), particularly changes over time and most distressing features.
Focus groups in individuals aged 40+ years with painful hip or knee OA obtained detailed descriptions of OA pain from early to late disease. A modified Patient Generated Index (PGI) was used to assess the features of OA pain that participants found most distressing. Content analysis was performed to examine response patterns; descriptive statistics were used to summarize PGI responses.
Mean age of the 143 participants (52 hip OA; 91 knee OA) was 69.5 years (47-92 years); 60.8% were female and 93.7% Caucasian. Participants described two distinct types of pain - a dull, aching pain, which became more constant over time, punctuated increasingly with short episodes of a more intense, often unpredictable, emotionally draining pain. The latter, but not the former, resulted in significant avoidance of social and recreational activities. From PGI responses, distressing pain features were: the pain itself (particularly intense and unpredictable pain) and the pain's impact on mobility, mood and sleep.
Two distinct pain types were identified. Intermittent intense pain, particularly when unpredictable, had the greatest impact on quality of life.

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    • "Osteoarthritis (OA) is a common musculoskeletal condition and, as the population ages, it is becoming more prevalent (Arden and Nevitt, 2006). Pain and reduced physical function are the main symptoms of OA (Hawker et al., 2008; McHugh et al., 2008). Evidence suggests that psychological distress, including anxiety and depression, is often increased due to pain from "
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    ABSTRACT: The negative effects of osteoarthritis (OA), such as pain and depression, interfere with an individual's sleep quality. The main objective of the present study was to investigate the prevalence of poor quality of sleep in individuals with OA in Taiwan and identify potential predictors. A secondary objective was to examine agreement between objective and subjective measures of sleep quality. In a cross-sectional survey, OA outpatients in Taiwan completed a self-administered questionnaire, incorporating validated measurements for assessing quality of sleep (the Pittsburgh Sleep Quality Index (PSQI)), pain and physical functioning, anxiety and depression, and health-related quality of life. In a nested feasibility study, a sub-sample of participants wore an Actigraph wrist monitor to measure sleep objectively over a three-day period. Of 192 individuals with OA who completed the survey, 30 completed the Actigraph study. The mean PSQI global score was 9.0 (standard deviation 4.5); most participants (135, 70.3%) had poor quality of sleep (global PSQI >5). Key predictors of poor quality of sleep included role limitation due to poor physical functioning, poor social functioning, higher anxiety levels and higher pain levels. There were moderate correlations between subjective and objective measures of sleep quality, although participants underestimated their true sleeping time by two hours. Health professionals need to discuss sleep issues with individuals with OA and include strategies for coping with these difficulties. For reduced night-time pain which may interfere with sleep, additional and appropriate advice about medication is required. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.
    Full-text · Article · Dec 2014 · Musculoskeletal Care
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    • "Hawker et al. [70] "
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    ABSTRACT: Objectives Osteoarthritis (OA) is the leading cause of musculoskeletal pain and functional disability worldwide affecting a growing number of individuals in western society. Despite various conservative and interventional treatment approaches the overall management of the condition is problematic and pain – the major clinical problem of the disease – remains sub-optimally controlled. The objectives of this review are to present the pathophysiologic mechanisms underlying the complexity of pain in OA and to discuss the challenges for new treatment strategies aiming to translate experimental findings into daily clinical practice. Methods Narrative literature review of studies investigating the existence of a neuropathic component in OA pain. We searched PubMed, Embase and Scopus for English language publications. A hand-search of reference lists of relevant studies was also performed. Results Recent advances have shed additional light on the pathophysiology of osteoarthritic pain highlighting the contribution of central pain pathways together with the sensitization of peripheral joint receptors and changes of the nociceptive process induced by local joint inflammation and structural bone tissue changes. Thus a neuropathic pain component may be predominant in individuals with minor joint changes but high levels of pain refractory to analgesic treatment providing an alternative explanation for osteoarthritic pain perception. Conclusion A growing amount of evidence suggests that the pain in OA has a neuropathic component in some patients. The deeper understanding of multiple mechanisms of OA pain has led to the use of centrally acting medicines which may have a benefit on alleviating osteoarthritic pain. The ineffective pain management and the increasing rates of disability associated with OA mandate for change in our treatment paradigm.
    Full-text · Article · Oct 2014 · Seminars in Arthritis and Rheumatism
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    • "Of the 755 studies that were identified from our electronic database search, 34 were potentially eligible for inclusion (Figure 1). The full text of these studies was obtained and a further 18 were excluded as they examined self-management practices [15], the pain experience [16], ethnicity [17], musculoskeletal pain (not specifically knee pain) [18-21], walking speed [22], whole body pain intensity [23,24], OA in general (not specifically knee OA) [25-27], prediction of somatisation disorder [28] and the effect of pain on psychological health [29]. Of the three remaining studies, one was a validation study [30], the second was a literature review [31] and the third was a RCT which assessed patients with hip and knee OA together [32]. "
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    ABSTRACT: While it is recognized that psychosocial factors are important in the development and progression of musculoskeletal pain and disability, no systematic review has specifically focused on examining the relationship between psychosocial factors and knee pain. We aimed to systematically review the evidence to determine whether psychosocial factors, specifically depression, anxiety and poor mental health, are risk factors for knee pain. Electronic searches of MEDLINE, EMBASE and PsycINFO were performed to identify relevant studies published up to August 2012 using MESH terms and keywords. We included studies that met a set of predefined criteria and two independent reviewers assessed the methodological quality of the selected studies. Due to the heterogeneity of the studies, a best evidence synthesis was performed. Sixteen studies were included in the review, of which 9 were considered high quality. The study populations were heterogeneous in terms of diagnosis of knee pain. We found a strong level of evidence for a relationship between depression and knee pain, limited evidence for no relationship between anxiety and knee pain, and minimal evidence for no relationship between poor mental health and knee pain. Despite the heterogeneity of the included studies, these data show that depression plays a significant role in knee pain, and that a biopsychosocial approach to the management of this condition is integral to optimising outcomes for knee pain.
    Full-text · Article · Jan 2014 · BMC Musculoskeletal Disorders
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