Psychological Profiles and Pain Characteristics of Older Adults With Knee Osteoarthritis

Abstract

Objective To identify psychological profiles in persons with knee osteoarthritis (OA) and to determine the relationship between these profiles and specific pain and sensory characteristics, including temporal summation and conditioned pain modulation. Methods Individuals with knee OA (n = 194) completed psychological, health, and sensory assessments. Hierarchical cluster analysis was used to derive psychological profiles that were compared across several clinical pain/disability and experimental pain responses. Results Cluster 1 had high optimism with low negative affect, pain vigilance, anger, and depression, along with the lowest self-reported pain/disability and the lowest sensitivity to mechanical, pressure, and thermal pain (P < 0.01 for all). Cluster 2 had low positive affect with high somatic reactivity, while cluster 3 showed high pain vigilance with low optimism. Clusters 2 and 3 had intermediate levels of self-reported pain/disability and cluster 3 experienced central sensitization to mechanical stimuli. Participants in cluster 3 also displayed significant pain facilitation (P < 0.05). Cluster 4 exhibited the highest pain vigilance, reactivity, negative affect, anger, and depression. These individuals experienced the highest self-reported pain/disability, including widespread pain (P < 0.001 for all). Cluster 4 was most sensitive to mechanical, pressure, and thermal stimuli, and showed significant central sensitization to mechanical and thermal stimuli (P < 0.001 for all). Conclusion Our findings demonstrate the existence of homogeneous psychological profiles displaying unique sets of clinical and somatosensory characteristics. Multidisciplinary treatment approaches consistent with the biopsychosocial model of pain should provide significant advantages if targeted to profiles such as those in our OA sample.

Psychological Factors and Pain Exacerbation in Knee Osteoarthritis: A Web Based Case-Crossover Study

“…The significant relationship of higher negative affect scores to the increased risk of pain exacerbations in the sample of 149 supports the association between OA pain and low mood/depression shown in previous studies [30][31][32][33][34][35][36][37][38][39][40] and important role of depression as a predictive factor for OA treatment outcomes such as pain and function [34,37,39,40]. However, these studies have largely focused on the association between chronic OA pain and depressive/low mood as well as the effect of chronic pain on the increased risk of depression rather than the predictive effect of low mood on acute pain exacerbations as examined in our study.…”

Assessment and manifestation of central sensitisation across different chronic pain conditions

“…For simple bedside testing, temporal summation evoked by repeated mechanical punctate pain stimuli has been used in OA (Cruz-Almeida et al, 2013;Finan et al, 2013;King et al, 2013b), and the summation has shown association with the pain severity but not the radiographic severity (Neogi et al, 2015). The subgroup of OA patients with 'high knee pain and low knee radiographic grade' showed more facilitated temporal summation to punctate pain stimuli than the other groups (Finan et al, 2013).…”

A study protocol for the profile of pain in older women: assessing the multi dimensional nature of the experience of pain in arthritis

“…Multiple dimensions of pain are to be explored and analyzed, and these dimensions will be taken into consideration to group women to define "profiles" of pain. Recent work has investigated the psychological profiles in persons with knee osteoarthritis and found homogenous profiles with unique sets of characteristics [83]. Women with arthritis may also group into unique profiles based on their multidimensional experience of pain.…”