A longitudinal study to explain the pain‐depression link in older adults with osteoarthritis

Abstract

Objective. To evaluate whether osteoarthritis (OA) pain determines depressed mood, taking into consideration fatigue and disability and controlling for other factors. Methods. In a community cohort with hip/knee OA, telephone interviews assessed OA pain and disability (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), fatigue (Multidimensional Fatigue Symptom Inventory), depressed mood (Center for Epidemiologic Studies Depression Scale), and covariates (demographics, self-rated health, comorbidity, pain coping, pain catastrophizing, and social support) at 3 time points over 2 years. Drawing on previous research, a path model was developed to test the interrelationships among the key concepts (pain, depression, fatigue, disability) over time, controlling for covariates. Results. The baseline mean age was 75.4 years; 78.5% of the subjects were women, 37.2% were living alone, and 15.5% had >3 comorbid conditions. WOMAC scores indicated moderate OA symptoms and disability. From the final model with 529 subjects, adjusting for covariates, we found that current OA pain strongly predicted future fatigue and disability (both short and long term), that fatigue and disability in turn predicted future depressed mood, that depressed mood and fatigue were interrelated such that depressed mood exacerbated fatigue and vice versa, and that fatigue and disability, but not depressed mood, led to worsening of OA pain. Conclusion. Controlling for other factors, OA pain determined subsequent depressed mood through its effect on fatigue and disability. These effects led to worsening of pain and disability over time. These results support the need for improved pain management in OA to prevent or attenuate the downstream effects of pain on disability and mood.

Fatores preditores de dor em idosos do Município de São Paulo, Brasil: Estudo SABE 2006 e 2010

“…Saúde Pública 2017; 33(9):e00098416 crônica generalizada 7,8,11,31,33 . Contudo, na presente pesquisa, o sexo feminino perdeu significância estatística após ajuste por variáveis socioeconômicas.…”

“…A dor é internacionalmente reconhecida como um agravo recorrente na vida dos idosos, e alguns estudos identificaram os seguintes fatores como associados à dor na velhice: idade e sexo 2,5,6 , obesidade 4,7,8,9 , ansiedade e depressão 6,7,9,10,11,12 , doenças osteoarticulares 11 , distúrbios do sono e fadiga 7,8,12 , algumas doenças crônicas como hipertensão, diabetes, doenças cardiovasculares e pulmonares, bem como quedas e fraturas 8 . No Brasil, ainda são escassas as pesquisas sobre fatores preditores de dor em idosos, sobretudo estudos epidemiológicos realizados com amostras representativas da população, capazes de comparações com estudos internacionais 3,4,13 .…”

Depression and Perceived Quality of Sleep in Older Adults with Knee Osteoarthritis

“…Overweight increases the load on the knees during weight bearing activities, which may lead to pain and activity limitations. Fatigue [7,37] may explain the association between depressed mood and knee pain and activity limitations. Fatigue is associated with depressed mood and pain [7], and may lead to decreased motor activity resulting in activity limitations [37].…”

“…Fatigue [7,37] may explain the association between depressed mood and knee pain and activity limitations. Fatigue is associated with depressed mood and pain [7], and may lead to decreased motor activity resulting in activity limitations [37]. The interrelations between BMI, depressed mood and knee pain may be explained by low-grade inflammation and dysregulation of the hypothalamic-pituitary-adrenal axis (HPA axis).…”

“…Overweight and depressed mood are more common in knee osteoarthritis (OA) than in the general population [1][2][3], and are both positively associated with pain and activity limitations [4][5][6][7][8][9][10][11][12][13]. There is growing evidence that overweight, as indicated by body-mass index (BMI) ≥ 25 kg/m 2 , and depressed mood are interrelated [14,15], and that common biological and psychological mechanisms underlie the development of both overweight and depressed mood [16].…”