The experience of living with patellofemoral pain—loss, confusion and fear-avoidance: a UK qualitative study

Smith, Brenda; Moffatt, Fiona; Hendrick, Paul; Bateman, Marcus; Rathleff, Michael Skovdal; Selfe, James; Smith, Toby O; Logan, Pip

doi:10.1136/bmjopen-2017-018624

Cited by 68 publications

(58 citation statements)

References 54 publications

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“…The psychological features in PFP are now recognised, with evidence suggesting that kinesiophobia is present in PFP (Maclachlan, Collins, Matthews, Hodges, & Vicenzino, 2017; Smith et al, 2018). Kinesiophobia is highly prevalent and shares relationships with pain and disability (Maclachlan et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Psychological and pain profiles in persons with patellofemoral pain as the primary symptom

Maclachlan

Collins

Hodges

et al. 2020

European Journal of Pain

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Background Patellofemoral pain (PFP) is defined biomechanically, but is characterized by features that fit poorly within nociceptive pain. Mechanisms associated with central sensitization may explain why, for some, symptoms appear nociplastic. This study compares psychological and somatosensory characteristics between those with persistent PFP and controls. Methods A total of 150 adults with PFP were compared to 61 controls. All participants completed a survey evaluating participant characteristics, PFP‐related constructs and psychological factors: anxiety, depression, pain catastrophizing, kinesiophobia, pain self‐efficacy. Participants also attended a session of somatosensory testing, which included knee and elbow thermal and mechanical detection and pain thresholds, conditioned pain modulation (CPM), and temporal summation of pain (TSP). Differences were evaluated using analysis of covariance (sex as covariate). Multivariate backward stepwise linear regression examined how psychological and somatosensory variables relate to PFP (knee injury and osteoarthritis outcome score‐patellofemoral [KOOS‐PF]). Results The PFP group had multimodal reduced pain thresholds at the knee and elbow (standardized mean difference [SMD], p: 0.86–1.2, <.001), reduced mechanical detection at the elbow (0.43, .01) and higher TSP (0.41, .01). CPM was not different. Psychological features demonstrated small effects (0.47–0.59, 0.01–0.04). The PFP group had a 55% (95% CI: 0.47–0.62) risk of kinesiophobia and an 11% (0.06–0.15) reduced pain self‐efficacy risk. Kinesiophobia, knee pressure pain threshold, pain self‐efficacy and pain catastrophizing explained 40% of KOOS‐PF variance (p = <.001). Conclusions Widespread hyperalgesia and evidence of symptom amplification may reflect nociplastic pain. Clinicians should be aware that kinesiophobia and the nociplastic pain may characterize the condition. Significance (a) Individuals with PFP have widespread reduced pain thresholds to pressure and thermal stimuli. (b) Mechanically induced pain is likely amplified in those with PFP. (c) Pain‐related fear is highly prevalent and helps explain PFP‐related disability.

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Section: Discussionmentioning

confidence: 99%

Psychological and pain profiles in persons with patellofemoral pain as the primary symptom

Maclachlan

Collins

Hodges

et al. 2020

European Journal of Pain

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“…Qualitative research tells us that many individuals with persistent pain are uncertain when it comes to pain and exercise 3 4. This is closely linked to pain-related fear and questions as to whether exercise is helpful or harmful.…”

Section: Exercise-related Pain: Why Is It Important?mentioning

confidence: 99%

“…As one patient framed it, ‘Are you making it worse? And that’s the crux of it really…if this is hurting should I really be doing this?’ 3…”

Section: Exercise-related Pain: Why Is It Important?mentioning

confidence: 99%

Elephant in the room: how much pain is ok? If physiotherapy exercise RCTs do not report it, we will never answer the question

et al. 2019

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“…It has traditionally been viewed as a self-limiting condition, however more recent research has shown that over 40% of those receiving treatment for PFP will still have symptoms after a year (4) with one in four reporting ongoing pain after 20 years (5). The impact of living with PFP is becoming clear, affecting activity levels (6), social participation (7,8) and…”

Section: Introductionmentioning

confidence: 99%

Investigating the prevalence of anxiety and depression in people living with patellofemoral pain in the UK: the Dep-Pf Study

Wride

Bannigan

2019

Scandinavian Journal of Pain

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Abstract Background and aims Patellofemoral pain (PFP) is a common knee condition causing pain around or behind the kneecap which is exacerbated by certain activities. Traditionally it has been viewed as a self-limiting condition. Recent research proves this is not the case and the evidence for poor long-term outcomes is growing. Whilst the evidence base for PFP treatment and the understanding of its aetiology is improving, it remains a complex and difficult to treat condition. In many physical conditions, it has been shown that anxiety and depression negatively affect both their management and duration. It is unclear how prevalent anxiety and depression are in PFP. This study aimed to identify the prevalence of anxiety and depression in people living with PFP in the UK. Methods In order to investigate this, a cross-sectional online survey was undertaken. Four hundred participants with self-reported symptoms of PFP were recruited through a tailored social media campaign, using modified snowball sampling. Eligibility criteria were (i) aged between 18 and 44, (ii) self-reported symptoms of PFP (using accepted criteria) (iii) resident in the UK. Exclusion criteria were previous history of patella dislocation or previous surgery to affected knee. The survey recorded demographic information, previous treatment for both PFP and anxiety and depression, the Hospital Anxiety and Depression Scale and the Anterior Knee Pain Scale. Ethical approval was gained from a University of Plymouth Ethics Committee. Results Half (49.5%; n=198) of respondents were classified as experiencing anxiety and 20.8% (n=83) as experiencing depression. The levels of anxiety and depression identified in this study are higher than those found in the general population (5.9–7.8% and 3.3–7.8%, respectively). This mirrors results which have been reported in other studies into PFP in different settings and with other musculoskeletal conditions, such as osteoarthritis and contracted shoulder. Conclusions Anxiety and depression are more common in people living with PFP than in the general population. These findings support the need for greater research into the effects of psychological factors, such as anxiety and depression, in PFP. A key area of future research will be to determine whether these psychological factors affect treatment outcomes in people living with PFP. Implications This is the first study to investigate the prevalence of anxiety and depression in people living with patellofemoral pain in the UK. This study shows that anxiety and depression are very common in people living with patellofemoral pain. The need for further work into the effects of psychological factors in patellofemoral pain is indicated.

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The experience of living with patellofemoral pain—loss, confusion and fear-avoidance: a UK qualitative study

Cited by 68 publications

References 54 publications

Psychological and pain profiles in persons with patellofemoral pain as the primary symptom

Psychological and pain profiles in persons with patellofemoral pain as the primary symptom

Elephant in the room: how much pain is ok? If physiotherapy exercise RCTs do not report it, we will never answer the question

Investigating the prevalence of anxiety and depression in people living with patellofemoral pain in the UK: the Dep-Pf Study

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