When Knee Pain Becomes Severe: A Nested Case-Control Analysis in Community-Dwelling Older Adults

Abstract

Mild knee pain is a common symptom in later life. Despite this fact, there are few data on the impact of it worsening or how individuals alter their appraisals and behavior when it becomes severe. We sought to describe the changes that accompany a substantial deterioration in characteristic knee pain. A nested case-control analysis of existing cohort data identified 57 adults aged over 50 years experiencing progression from mild to severe characteristic pain intensity 18 months later and compared them, before and after this transition, with 228 controls whose knee pain did not progress. Worsening knee pain was accompanied by a marked increase in pain frequency and extent, functional limitation, depressive symptoms, catastrophising, praying and hoping, and use of oral and topical analgesia. Most individuals consulted a general practitioner either during or after this episode. Although relatively rare, substantial deterioration in knee pain has a major impact on those affected. Timely presentation to primary care, addressing potentially unhelpful appraisals and coping strategies, reinforcing core nonpharmacological management, and future research to identify triggering events for substantial deterioration and loss of adequate pain control should be part of an agenda to improve care for this important minority of older adults with knee pain.PerspectiveThis article describes what happens when the common symptom of mild knee pain in later life becomes significantly worse. The results may help clinicians understand the health impact, changes in patient appraisal and coping, and treatments that typically accompany this change in symptoms.

Prognosis of Pain and Physical Functioning in Patients With Knee Osteoarthritis: A Systematic Review and Meta‐Analysis

“…Twenty‐seven studies included patients with radiographically and/or clinically diagnosed knee OA , and 31 studies included patients who were at high risk of developing knee OA . Thirty‐four studies reported results on pain , and 45 studies reported results on physical functioning . (For details of the included studies, see Supplementary Table 2, available on the Arthritis Care & Research web site at http://onlinelibrary.wiley.com/doi/10.1002/acr.22693/abstract).…”

“…Twenty‐one studies reported on the course of pain . Because of overlapping data from cohorts and inappropriateness of reported data, only 9 studies were included in the meta‐analysis on the course of pain (Figure ).…”

“…Twenty‐eight studies assessed a total of 80 prognostic factors of deterioration in pain . A meta‐analysis could be performed for only 2 prognostic factors (higher knee pain intensity at baseline and female sex).…”

“…A meta‐analysis could be performed for only 2 prognostic factors (higher knee pain intensity at baseline and female sex). Of 6 studies evaluating baseline pain as a prognostic factor , 3 studies could be included in the meta‐analysis . The results indicate that a higher level of knee pain at baseline is a prognostic factor for higher levels of pain in the future (B = −0.48 [95% CI −0.52, −0.44]).…”

The relationship between the presence of depressive symptoms and the severity of self-reported knee pain in the middle aged and elderly

“…Such a relationship persisted when the subjects were stratified by the radiographic severity of knee OA and was evident in both the mild and moderate OA groups. Several previous studies have investigated the factors contributing to the severity of knee pain, and some reports describe significant relationships between depressive symptoms and the extent of knee pain [11,22,30,32,33,43]. However, conflicting results have also been reported [8,9,31].…”