Is There an Association Between Whole-body Pain With Osteoarthritis-related Knee Pain, Pain Catastrophizing, and Mental Health?

Abstract

Background Greater levels of self-reported pain, pain catastrophizing, and depression have been shown to be associated with persistent pain and functional limitation after surgeries such as TKA. It would be useful for clinicians to be able to measure these factors efficiently. Questions/purposes We asked: (1) What is the association of whole-body pain with osteoarthritis (OA)-related knee pain, function, pain catastrophizing, and mental health? (2) What is the sensitivity and specificity for different cutoffs for body pain diagram region categories in relation to pain catastrophizing? Methods Patients (n = 267) with knee OA undergoing elective TKA at one academic center and two community orthopaedic centers were enrolled before surgery in a prospective cohort study. Questionnaires included the WOMAC Pain and Function Scales, Pain Catastrophizing Scale (PCS), Mental Health Inventory-5 (MHI-5), and a pain body diagram. The diagram documents pain in 19 anatomic areas. Based on the distribution of the anatomic areas, we established six different body regions. Our analyses excluded the index (surgically treated) knee. Linear regression was used to evaluate the association between the total number of nonindex painful sites on the whole-body pain diagram and measures of OA-related pain and function, mental health, and pain catastrophizing. Generalized linear regression was used to evaluate the association between the number of painful nonindex body regions (categorized as 0; 1-2; or 3-6) with our measures of interest. All models were adjusted for age, sex, and number of comorbid conditions. The cohort included 63% females and the mean age was 66 years (SD, 9 years). With removal of the index knee, the median pain diagram score was 2 (25 th , 75 th percentiles, 1, 4) with a range of 0 to 15. The median number of painful body regions was 2 (25 th , 75 th percentiles, 1, 3). Results After adjusting for age, sex, and number of comorbid conditions, we found modest associations between painful body region categories and mean scores for WOMAC physical function (r = 0.22, p \ 0.001), WOMAC pain (r = 0.20, p = 0.001), MHI-5 (r = À0.31, p\ 0.001), and PCS (r = 0.27, p \ 0.001). A nonindex body pain region score greater than 0 had 100% (95% CI, 75%-100%) sensitivity for a pain catastrophizing score greater than 30 but a specificity of just 23% (95% CI, 18%-29%) . A score of 3 or greater had greater specificity (73%; 95% CI, 66%-79%) but lower sensitivity (53%; 95% CI, 27%-78%). Conclusions We found modest associations between the number of painful sites on a whole-body pain diagram and the number of painful body regions and measures of OArelated pain, function, pain catastrophizing, and mental health. Patients with higher self-reported body pain region scores might benefit from further evaluation for depression and pain catastrophizing. Level of Evidence Level III, therapeutic study.

The association of pre-operative body pain diagram scores with pain outcomes following total knee arthroplasty

“…In our initial study on the association of widespread body pain with known predictors of TKA outcome, 11 we found that widespread preoperative body pain as measured by a whole body pain diagram was associated cross-sectionally with preoperative pain catastrophizing. In this paper, we found that measures of widespread preoperative body pain were associated prospectively with a WOMAC pain score > 15 at 12-months follow-up as well as with failure to achieve the estimated MCID.…”

“…This finding suggests that the effect of the pain diagram score on outcome is not entirely explained by its documented association with pain catastrophizing. 11 Participants with widespread body pain might have additional musculoskeletal conditions aside from knee OA that do not respond to TKA (such as contralateral knee OA, hip OA, spinal stenosis, foot problems, etc.). A recent carefully-done study by Brummett and colleagues assessed the association between outcomes from knee and hip arthroplasty with pre-operative scores on a fibromyalgia survey.…”

“…10 In a pre-surgical cohort of subjects with knee osteoarthritis (OA) undergoing elective unilateral TKA, widespread body pain as depicted by the whole body pain diagram was associated cross-sectionally with validated measures of OA-related pain, mental health, and pain catastrophizing. 11 These associations between widespread pain and OA-related pain, mental health, and pain catastrophizing persisted after adjustment for age, sex, and comorbid medical conditions. We did not include review of pre-operative knee imaging in our study.…”

“…From the number and location of painful areas reported on the body pain diagram, we derived both the total number of painful sites and the number of painful body regions. Similar to our previously reported technique, 11 we established eight different body regions but excluded the surgically-treated or index region so as to best capture widespread pain; thus, possible scores ranged from 0 to 7. The eight body regions were defined as follows: right upper extremity (shoulder girdle, upper arm, and lower arm), left upper extremity (shoulder girdle, upper arm, and lower arm), right lower extremity (upper leg and lower leg), left lower extremity (upper leg and lower leg), right hip (hip and buttock), left hip (hip and buttock), back/neck (upper back, lower back, and neck), and chest (abdomen and chest).…”

Disparities in Total Knee Replacement: Population Losses in Quality‐Adjusted Life‐Years Due to Differential Offer, Acceptance, and Complication Rates for African Americans

“…24 Pain reductions from TKR were derived from the Study of Knee Arthroplasty Responses (STARs) and the Adding Value in Knee Arthroplasty (AViKA) study, two longitudinal studies of knee arthroplasty patients. 25,26 …”