Pain catastrophizing, anxiety, and depression in hip pathology

Abstract

Aims Psychological factors play a critical role in patient presentation, satisfaction, and outcomes. Pain catastrophizing, anxiety, and depression are important to consider, as they are associated with poorer outcomes and are potentially modifiable. The aim of this study was to assess the level of pain catastrophizing, anxiety, and depression in patients with a range of hip pathology and to evaluate their relationship with patient-reported psychosocial and functional outcome measures. Patients and Methods Patients presenting to a tertiary-centre specialist hip clinic were prospectively evaluated for outcomes of pain catastrophizing, anxiety, and depression. Validated assessments were undertaken such as: the Pain Catastrophizing Scale (PCS), the Hospital Anxiety Depression Scale (HADS), and the 12-Item Short-Form Health Survey (SF-12). Patient characteristics and demographics were also recorded. Multiple linear regression modelling, with adaptive least absolute shrinkage and selection operator (LASSO) variable selection, was used for analysis. Results A total of 328 patients were identified for inclusion, with diagnoses of hip dysplasia (DDH; n = 50), femoroacetabular impingement (FAI; n = 55), lateral trochanteric pain syndrome (LTP; n = 23), hip osteoarthrosis (OA; n = 184), and avascular necrosis of the hip (AVN; n = 16) with a mean age of 31.0 years (14 to 65), 38.5 years (18 to 64), 63.7 years (20 to 78), 63.5 years (18 to 91), and 39.4 years (18 to 71), respectively. The percentage of patients with abnormal levels of pain catastrophizing, anxiety, or depression was: 22.0%, 16.0%, and 12.0% for DDH, respectively; 9.1%, 10.9%, and 7.3% for FAI, respectively; 13.0%, 4.3%, and 4.3% for LTP, respectively; 21.7%, 11.4%, and 14.1% for OA, respectively; and 25.0%, 43.8%, and 6.3% for AVN, respectively. HADS Anxiety (HADSA) and Hip Disability Osteoarthritis Outcome Score Activities of Daily Living subscale (HOOS ADL) predicted the PCS total (adjusted R2 = 0.4599). Age, HADS Depression (HADSD), and PCS total predicted HADSA (adjusted R2 = 0.4985). Age, HADSA, patient’s percentage of perceived function, PCS total, and HOOS Quality of Life subscale (HOOS QOL) predicted HADSD (adjusted R2 = 0.5802). Conclusion Patients with hip pathology may exhibit significant pain catastrophizing, anxiety, and depression. Identifying these factors and understanding the impact of psychosocial function could help improve patient treatment outcomes. Perioperative multidisciplinary assessment may be a beneficial part of comprehensive orthopaedic hip care. Cite this article: Bone Joint J 2019;101-B:800–807.

Do psychological factors or radiographic severity play a role in the age of onset in symptomatic developmental dysplasia of hip and femoroacetabular impingement syndrome?

“…A secondary aim was to assess whether other radiographic and clinical variables were also related to age of onset in DDH and FAIS. It has been shown that elevated levels of pain catastrophizing, anxiety and depression are significantly present in those with DDH and FAIS [34]. Given the ability to negatively modulate an individual’s perception of pain and worsen outcome, it was predicted that a higher PCS score and HADS score would lead to a younger age of onset in FAI syndrome and DDH.…”

Functional improvement in hip pathology improves anxiety, depression, and pain catastrophizing: an intricate link between physical and mental well-being

“…Hip pain and dysfunction may play a signi cant role in a patient's psychological well-being. 11 We further con rmed this link between function and psychology; speci cally, a link between improved activity of daily living function and improved psychological factors.…”

“…2, 3, 7-9, 11, 36 Additionally, it has been previously shown that this relationship is quanti able, as higher reported subjective functioning in hip patients is associated with lower levels of pain catastrophizing, anxiety, and depression at time of presentation. 11,35 In our cohort, pain catastrophizing scores were particularly elevated in patients with lower function scores, as di culties with activities of daily living, and the resulting loss of self-su ciency, lend themselves to pain catastrophizing. 8,37 After assessing the psychological pro le of our cohort prior to treatment, we next determined how each measured psychological category changed following treatment.…”

The Effect of Pain Catastrophizing on Depression among Older Korean Adults with Chronic Pain: The Mediating Role of Chronic Pain Interference and Sleep Quality

“…Recently, a notable concept related to depression is pain catastrophizing [ 14 , 15 , 16 ], defined as sustained negative thoughts resulting from an excessive fear of pain and consisting of three subfactors: rumination, magnification, and helplessness [ 17 , 18 ]. Furthermore, pain catastrophizing was found to be a prediction factor not only for depression but also for chronic pain interference [ 12 ].…”