Management of knee osteoarthritis in primary care: Pain and depression are the major obstacles

Depression and Osteoarthritis: Impact on Disability

“…Moreover, an approach directed at symptom management, which does not have the side effects of pharmaceutical therapies, may be especially valuable for heightening optimal health outcomes, regardless of whether clinical or surgical intervention approaches are employed as outlined by Axford et al [104] and Lin et al [105], and Ang et al [106]. Early intervention may also reduce symptoms of hypertension and heart disease and asthma caused by psychological distress, excess body weight and pain and disability, which in turn can cause depression, high rates of health care utilization and excess analgesic drug use [24,30,80,96].…”

Internet Cognitive–Behavioral Therapy for Depression in Older Adults With Knee Osteoarthritis: A Randomized Controlled Trial

“…The mechanism by which iCBT has a positive impact on OA outcomes is still unclear, and future studies should examine whether iCBT reduces pain-related catastrophic cognitions (46,47) or sensitivity to pain (48,49), as well as improves a person's estimations of ability (50), patientpractitioner relationship (51), adherence to effective pain management (12,13), and/or treatment benefits when regimens are followed (14). The outcomes of these studies may provide insight into why there were no significant changes in global physical functioning, and no betweengroup differences for arthritis-related self-efficacy, pain, stiffness, and physical function, directly following the program; yet differences emerged 3 months later.…”

“…A biopsychosocial approach is consistent with the recent emphasis on the holistic assessment of a person with OA (17). This approach could include routine depression screening in assessment of older patients with OA, especially those with risk factors, including being under the care of a general practitioner (52), low education status (52), perceiving or experiencing greater pain and fatigue, being female, and experiencing stressful life events (4,14,15). Medical management of OA of the knee could be supplemented with integrated evidence-based depression treatment, including iCBT, to maximize functional status and mental health well-being.…”

“…In addition, depression is predicted to account for the highest level of disability accorded to any physical or mental disorder worldwide by 2030 (10). In patients with OA, concomitant depression leads to increased use of pain medication (11), reduced adherence to treatment recommendations (12,13), reduced treatment benefits when regimens are followed (14), higher health care utilization, and increased burden regardless of age, disease duration, education level, or body mass index (15,16).…”

Influence of Psychological Factors on Pain and Disability in Anterior Knee Pain Patients

“…28 Regarding its influence on the disability, several studies show that depression reduces the functional capacity of patients with osteoarthritis and rheumatoid arthritis. 6,62,89 Furthermore, in patients with depression and chronic pain, if the pain is reduced, the depression symptoms improve. 28,63,130 The relationship between depression and pain is reinforced by the fact that antidepressant drugs have an analgesic effect in musculoskeletal pain patients even without depression.…”