Chronic widespread pain and its associations with quality of life and function at a 20- year follow-up of individuals with chronic knee pain at inclusion

Stefan Bergman,Maria L E Andersson,Carina Thorstensson

doi:10.1186/s12891-019-2976-3

Stefan Bergman, Maria L E Andersson + Show 1 more

Open Access

https://doi.org/10.1186/s12891-019-2976-3

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Abstract

ObjectiveTo study the prevalence of chronic widespread pain (CWP) and chronic regional pain (CRP), and their association to quality of life, pain, physical function at a 20-year follow-up in a population based cohort with chronic knee pain at inclusion.Methods121 individuals (45% women, mean age 64 years, range 54–73) with chronic knee pain from a population-based cohort study, answered a questionnaire and had radiographic knee examination at a 20-year follow-up. The responders were divided into three groups according to reported pain; individuals having no chronic pain (NCP), chronic widespread pain (CWP) and chronic regional pain (CRP). Pain and physical function were assessed using Knee injury and Osteoarthritis Outcome Score (KOOS). Health related quality of life (HRQL) was assessed with Euroqol-5D-3 L (EQ5D) and Short form 36 (SF36). The associations between pain groups and KOOS, EQ5D, and SF36 were analysed by multiple logistic regression, controlled for age, gender and radiographic changes indicating knee osteoarthritis (OA).ResultsThe prevalence of CWP was 30%, and CWP was associated to worse scores in all KOOS subscales, controlled for age, gender and radiographic changes. CWP was also associated to worse scores in EQ-5D and in seven of the SF-36 subgroups, controlled for age, gender and radiographic changes.ConclusionOne third of individuals with chronic knee pain met the criteria for CWP. CWP was associated with patient reported pain, function and HRQL. This suggest that it is important to assess CWP in the evaluation of patients with chronic knee pain, with and without radiographic knee OA.

Highlights

Pain is the most disabling symptom of osteoarthritis (OA), resulting in disability and inactivity, and a common reason to search medical care
Thirty-five individuals rejected participation, with no significant difference in age, gender distribution or Body mass index (BMI) compared to the participants
In the present study 6% reported that they had fibromyalgia, which is somewhat lower than previously reported in patients with OA [2], but higher than the prevalence in the general population, reported to be between 1 to 5% [3,4,5]

Summary

Introduction

Pain is the most disabling symptom of osteoarthritis (OA), resulting in disability and inactivity, and a common reason to search medical care. Several studies have shown associations between OA and fibromyalgia, with a fibromyalgia prevalence of 5 to 10% in individuals with OA compared. The association between radiographic knee OA and reported pain has shown to be weak [7], there is an association between presence of pain and synovitis, bone marrow oedema, and bone marrow lesions [8]. Associations have been seen between radiographic severity, assessed with Kellgren & Lawrence score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Bergman et al BMC Musculoskeletal Disorders (2019) 20:592 pain score, especially with regard to OA severity in the patellofemoral compartment [9]. Studies of pain trajectories in knee OA have identified a group of individuals with severe pain, not improving over time, which could represesent a group with a more chronic widespread pain [13, 14]

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