Psychological Symptoms Affect Self-Reported Pain in Hand Osteoarthritis
Among patients with hand osteoarthritis (OA), psychological symptoms and cognitive patterns contributed to levels of self-reported pain but not pain sensitization. These findings were published in Osteoarthritis and Cartilage Open.
Data for this analysis were sourced from the Nor-Hand study which was a hospital-based, observational cohort study following 300 patients with hand OA in Norway between 2016 and 2017. Responses to Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), and Arthritis Self Efficacy Scale (ASES) were related with Numeric Rating Scale (NRS) of pain and quantitative sensory testing.
The patient cohort comprised 89% women, aged median 61 (interquartile range [IQR], 57-66) years, BMI was 26.5 (standard deviation [SD], 5.0) kg/m2, and the median comorbidity index was 7 (IQR, 5-11).
During testing, the median ASES sum score was 69 (IQR, 60.78), PCS sum score was 9 (IQR, 5-15), HADS sum score was 6 (IQR, 3-10), mean NRS hand pain was 3.8 (SD, 2.3), NRS all joint pain was 4.1 (SD, 2.3), and the median number of painful joints was 4 (IQR, 2-8).
Greater self-reported anxiety, depression, pain catastrophizing, and reduced self-efficacy were related with higher levels of self-reported pain.
In the multivariate analysis, NRS hand pain was significantly associated with PCS (β, 0.24; 95% CI, 0.16-0.56; P <.05) and ASES (β, -0.42; -0.71 to -0.07; P <.05) scores. NRS all joint pain was also associated with PCS (β, 0.24; 95% CI, 0.001-0.56; P <.05) and ASES (β, -0.56; -0.85 to -0.28; P <.05) scores.
The association between HADS and pain variables tended to be stronger among younger individuals with higher comorbidity burden and with pain catastrophizing among younger patients, with higher comorbidity, and those who were overweight or obese.
No significant relationships were observed between psychological symptoms and cognitive patterns with central sensitization.
The major limitation of this study was the cross-sectional design. Additional study is needed to evaluate causal relationships between self-reported pain and psychological symptoms and cognitive patterns.
These findings suggest that “management of pain in hand OA patients should not only focus on joint pathology but consider psychological symptoms and cognitive patterns, in addition to modifiable factors such as overweight/obesity, comorbidities and sleep,” the study authors stated.
Cognitive therapy to develop pain coping skills may also beneficial for hand osteoarthritis pain.