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Does pain pattern matter? Association of intermittent, constant, predictable and unpredictable knee pain to
Gillian A Hawker1,2,3, Lisa Carlesso4, Ian Stanaitis2
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Objective:
People with knee osteoarthritis (OA) describe intermittent, constant, predictable, and unpredictable pain, but how different pain patterns affect symptom experience is unknown.
Design:
This secondary cohort analysis included individuals aged ≥30 years with knee OA referred for TKA consultation in Alberta, Canada. Pre-consult questionnaires assessed socio-demographics, health status, and knee symptoms (Intermittent and Constant Osteoarthritis Pain [ICOAP] measure assesses intermittent and constant pain severity, and frequency of predictable and unpredictable intermittent pain; Patient Acceptable Symptom State [PASS] assesses if current knee symptoms are 'acceptable' or 'unacceptable'). Multivariable robust Poisson regression assessed associations of intermittent and constant pain severity and frequency of predictable and unpredictable intermittent pain with unacceptable knee symptoms. We tested for an interaction between intermittent pain severity and unpredictable pain frequency, adjusting for age, sex, education, comorbidity, and troublesome joints.
Results:
Of 2360 participants, 1798 with intermittent pain scores >0 and PASS responses were included. 1293 reported intermittent, constant, predictable and unpredictable knee pain; 1268 reported 'unacceptable' symptoms. In bivariate analyses, all pain patterns were associated with risk for unacceptable symptoms. In the fully adjusted model, older age and greater intermittent and constant pain were associated with higher risk of unacceptable symptoms. No significant interaction was observed between intermittent pain severity and unpredictable pain frequency.
Conclusions:
Among people with advanced symptomatic knee OA, more than two-thirds reported predictable and unpredictable intermittent and constant knee pain. Associations between pain predictability and symptom state acceptability were explained by greater intermittent and constant pain severity. Further research is warranted to confirm these findings across a broader spectrum of knee OA severity.
