The Psychology Of Arthritis Pain

Pain varies over the long term and the short term, irrespective of changes seen on x-ray examination of the joint in question. A patient can experience practically no pain in the knee or hip one day, and experience excruciatingly severe pain the next, despite no change in the physical activity patterns of that patient. Researchers wished to determine whether the psychological well-being-or lack thereof-plays a significant role in the pain one feels in the arthritic joint.

By studying a sample of 266 subjects, the researchers searched for associations between mental health and osteoarthritis pain. Study participants had hip and/or knee osteoarthritis; but the overwhelming majority suffered primarily from arthritis involving the knee. The mean age was 65 years.

Mental health inventory questionnaires and pain scales were used to evaluate these patients over a 12-week period. The investigators were able to determine associations between mental health status and change in pain one week later, after adjustment for age, sex, body mass index and medication use.

Of course, pain is difficult to study; differences in experiences and the reporting of pain varies widely from one individual to the next. These differences may have their origins in variations in the central or peripheral nervous systems, or in cultural traits that affect the perception of pain. It can be a heroic task to compare degrees of pain across individuals.

Nevertheless, the researchers were able to conclude that worsening pain was associated with worse scores on the mental health surveys. And the odds of a pain flare were more than two times greater in periods with the worst mental health scores versus periods when the mental health scores were better.

Increased levels of pain were associated with worse mental health at baseline. Pain flares were associated with worse mental health during the week prior to the flare-up of arthritic pain.

As the elderly patient is disproportionately affected by osteoarthritis, and because of his or her age more at risk for side effects when taking drugs to treat the pain of that arthritis, perhaps mental health will prove to be a safer therapeutic target for the pain of osteoarthritis. Chronic joint pain is a significant problem in the older patient, as are other problems such as poor sleep hygiene, social isolation and a generalized dysphoria. There is a chance that some patients would benefit from psychotherapeutic interventions that improve the mental and social functioning of the individual, and in turn reduce the chronic pain.

Now, it is just a matter of convincing the patient, and the insurance companies, that the commitment to mental health is a worthwhile investment.

Mark Borigini M.D.

Overcoming Pain