FORT LAUDERDALE, FLA. – Pain catastrophizing and pain-related fear are associated with increased disability and worse physical functioning among overweight patients with osteoarthritis, according to a study presented at the World Congress on Osteoarthritis.
“In the cognitive-behavioral area, what people are thinking about pain while they are having it can have a significant effect,” said Francis J. Keefe, Ph.D. “We need to be thinking about pain-related cognitions. These can increase the patient perception of pain.”
Researchers assessed pain among 106 patients with knee osteoarthritis. They also evaluated psychological disability, physical impairment, and walking velocity while controlling for pain levels. They measured walking velocity, stride length, and knee range of motion. Mean body mass index was 35 kg/m
Dr. Keefe and his associates sought to assess how pain catastrophizing and pain-related fear might affect psychological and physical functioning in this patient population. It already is well accepted that increased body weight can increase severity of knee osteoarthritis, he said.
People who catastrophize focus on their pain and magnify it. They can misinterpret pain as more threatening than it is and underestimate their ability to manage it. “Pain catastrophizing tends to increase the pain experience and disability. The reason people do this is it tends to pull other people into their situation,” said Dr. Keefe, who is with the medical psychology division, psychiatry and behavioral sciences department, Duke University, Durham, N.C.
Pain-related fear includes excessive fear of experiencing pain during movement, or kinesiophobia. This phenomenon “is especially important in the obese with osteoarthritis if they are afraid to move,” Dr. Keefe said at the meeting, which was sponsored by Osteoarthritis Research Society International.
“Clinicians need to be aware of the effects of pain catastrophizing,” he said.
All participants completed the Coping Strategies Questionnaire to assess pain catastrophizing, the Tampa Scale for Kinesiophobia to measure pain-related fear, and the Arthritis Self-Efficacy Scale. Self-efficacy for pain management was associated with improved physical functioning in the study.
Catastrophizing and pain-related fear were associated with higher psychological distress and lower pain self-efficacy. Pain-related fear, but not catastrophizing, was associated with worse physical functioning.
“Pain cognition, even after controlling for demographics and medical severity, does contribute significantly to pain,” Dr. Keefe said. “The degree of catastrophizing was among the greatest we've seen. We've also studied this in oncology.”
Addressing pain catastrophizing among overweight people with knee osteoarthritis might improve psychological functioning, Dr. Keefe said. An intervention aimed at improving pain-related fear could improve physical functioning as well. “Coping skills training or cognitive-behavioral therapy could improve these cognitions, but they are challenging to do.”
Dr. Keefe and his associates plan to launch a new study that will randomize obese patients with osteoarthritis to behavioral weight management, pain coping skills training, both interventions, or control group.