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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2014

Open Access 01-12-2014 | Research article

Are depression, anxiety and poor mental health risk factors for knee pain? A systematic review

Authors: Pyae P Phyomaung, Julia Dubowitz, Flavia M Cicuttini, Sanduni Fernando, Anita E Wluka, Paul Raaijmaakers, Yuanyuan Wang, Donna M Urquhart

Published in: BMC Musculoskeletal Disorders | Issue 1/2014

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Abstract

Background

While it is recognized that psychosocial factors are important in the development and progression of musculoskeletal pain and disability, no systematic review has specifically focused on examining the relationship between psychosocial factors and knee pain. We aimed to systematically review the evidence to determine whether psychosocial factors, specifically depression, anxiety and poor mental health, are risk factors for knee pain.

Methods

Electronic searches of MEDLINE, EMBASE and PsycINFO were performed to identify relevant studies published up to August 2012 using MESH terms and keywords. We included studies that met a set of predefined criteria and two independent reviewers assessed the methodological quality of the selected studies. Due to the heterogeneity of the studies, a best evidence synthesis was performed.

Results

Sixteen studies were included in the review, of which 9 were considered high quality. The study populations were heterogeneous in terms of diagnosis of knee pain. We found a strong level of evidence for a relationship between depression and knee pain, limited evidence for no relationship between anxiety and knee pain, and minimal evidence for no relationship between poor mental health and knee pain.

Conclusions

Despite the heterogeneity of the included studies, these data show that depression plays a significant role in knee pain, and that a biopsychosocial approach to the management of this condition is integral to optimising outcomes for knee pain.
Appendix
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Literature
1.
Jinks C, Jordan K, Ong BN, Croft P: A brief screening tool for knee pain in primary care (KNEST). 2. Results from a survey in the general population aged 50 and over. Rheumatology. 2004, 43 (1): 55-61. 10.1093/rheumatology/keg438.CrossRefPubMed
2.
Bennell KL, Bowles KA, Payne C, Cicuttini F, Williamson E, Forbes A: Lateral wedge insoles for medial knee osteoarthritis: 12 month randomised controlled trial. BMJ. 2011, 342: d2912-10.1136/bmj.d2912.CrossRefPubMedPubMedCentral
3.
Wang Y, Wluka A, Berry P, Siew T, Teichtahl A, Urquhart D: Increase in vastus medialis cross-sectional area is associated with reduced pain, cartilage loss, and joint replacement risk in knee osteoarthritis. Arthritis Rheum. 2012, 64 (12): 3917-3925. 10.1002/art.34681.CrossRefPubMed
4.
Pincus T, Burton AK, Vogel S, Field AP: A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine (Phila Pa 1976). 2002, 27 (5): E109-E120. 10.1097/00007632-200203010-00017.CrossRef
5.
Christensen J, Knardahl S: Work and neck pain: a prospective study of psychological, social, and mechanical risk factors. Pain. 2010, 151 (1): 162-173. 10.1016/j.pain.2010.07.001.CrossRefPubMed
6.
van Dijk G, Dekker J, Veenhof C, van den Ende C, Group FtCS: Course of functional status and pain in osteoarthritis of the hip or knee: a systematic review of the literature. Arth Rheum. 2006, 55 (5): 779-785. 10.1002/art.22244.CrossRef
7.
Blagojevic M, Jinks C, Jeffery A, Jordan K: Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2010, 18 (1): 24-33. 10.1016/j.joca.2009.08.010.CrossRefPubMed
8.
Pells JJ, Shelby RA, Keefe FJ, Dixon KE, Blumenthal JA, Lacaille L: Arthritis self-efficacy and self-efficacy for resisting eating: relationships to pain, disability, and eating behavior in overweight and obese individuals with osteoarthritic knee pain. Pain. 2008, 136 (3): 340-347. 10.1016/j.pain.2007.07.012.CrossRefPubMed
9.
van Baar ME, Dekker J, Lemmens JA, Oostendorp RA, Bijlsma JW: Pain and disability in patients with osteoarthritis of hip or knee: the relationship with articular, kinesiological, and psychological characteristics. J Rheumatol. 1998, 25 (1): 125-133.PubMed
10.
Salaffi F, Cavalieri F, Nolli M, Ferraccioli G: Analysis of disability in knee osteoarthritis. Relationship with age and psychological variables but not with radiographic score. J Rheumatol. 1991, 18 (10): 1581-1586.PubMed
11.
Wright LJ, Zautra AJ, Going S: Adaptation to early knee osteoarthritis: the role of risk, resilience, and disease severity on pain and physical functioning. Ann Behav Med. 2008, 36 (1): 70-80. 10.1007/s12160-008-9048-5.CrossRefPubMedPubMedCentral
12.
Alessandro L, Douglas GA, Jennifer T, Cynthia M, Peter CG, John PAI: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009, 339: b2700-10.1136/bmj.b2700.CrossRef
13.
Lievense A, Bierma-Zeinstra S, Verhagen A, Verhaar J, Koes B: Influence of work on the development of osteoarthritis of the hip: a systematic review. J Rheum. 2001, 28 (11): 2520-2528.PubMed
14.
de Morton NA: The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009, 55 (2): 129-133. 10.1016/S0004-9514(09)70043-1.CrossRefPubMed
15.
Damush TM, Wu J, Bair MJ, Sutherland JM, Kroenke K: Self-management practices among primary care patients with musculoskeletal pain and depression. J Behav Med. 2008, 31 (4): 301-307. 10.1007/s10865-008-9156-5.CrossRefPubMed
16.
Hawker GA, Stewart L, French MR, Cibere J, Jordan JM, March L: Understanding the pain experience in hip and knee osteoarthritis–an OARSI/OMERACT initiative. Osteoarthritis Cartilage. 2008, 16 (4): 415-422. 10.1016/j.joca.2007.12.017.CrossRefPubMed
17.
Ibrahim SA, Burant CJ, Mercer MB, Siminoff LA, Kwoh CK: Older patients’ perceptions of quality of chronic knee or hip pain: differences by ethnicity and relationship to clinical variables. J Gerontol A Biol Sci Med Sci. 2003, 58 (5): M472-M477. 10.1093/gerona/58.5.M472.CrossRefPubMed
18.
Nahit ES, Pritchard CM, Cherry NM, Silman AJ, Macfarlane GJ: The influence of work related psychosocial factors and psychological distress on regional musculoskeletal pain: a study of newly employed workers. J Rheumatol. 2001, 28 (6): 1378-1384.PubMed
19.
Kroenke K, Wu J, Bair MJ, Krebs EE, Damush TM, Tu W: Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. J Pain. 2011, 12 (9): 964-973. 10.1016/j.jpain.2011.03.003.CrossRefPubMedPubMedCentral
20.
Ang D, Bair M, Damush T, Wu J, Tu W, Kroenke K: Predictors of pain outcomes in patients with chronic musculoskeletal pain co-morbid with depression: results from a randomized controlled trial. Pain Med. 2010, 11 (4): 482-491. 10.1111/j.1526-4637.2009.00759.x.CrossRefPubMed
21.
Bair M, Wu J, Damush T, Sutherland J, Kroenke K: Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med. 2008, 70 (8): 890-897. 10.1097/PSY.0b013e318185c510.CrossRefPubMedPubMedCentral
22.
Tiedemann A, Sherrington C, Lord SR: Physiological and psychological predictors of walking speed in older community-dwelling people. Gerontology. 2005, 51 (6): 390-395. 10.1159/000088703.CrossRefPubMed
23.
Chou K-L, Chi I: Reciprocal relationship between pain and depression in elderly Chinese primary care patients. Int J Geriatr Psychiatry. 2005, 20 (10): 945-952. 10.1002/gps.1383.CrossRefPubMed
24.
Chou KL: Reciprocal relationship between pain and depression in older adults: evidence from the English Longitudinal study of ageing. J Affect Disord. 2007, 102 (1–3): 115-123.CrossRefPubMed
25.
Vriezekolk J, Eijsbouts A, Evers A, Stenger A, van den Hoogen F, van Lankveld W: Poor psychological health status among patients with inflammatory rheumatic diseases and osteoarthritis in multidisciplinary rehabilitation: need for a routine psychological assessment. Disabil Rehabil. 2010, 32 (10): 836-844. 10.3109/09638280903323250.CrossRefPubMed
26.
de Filippis LG, Gulli S, Caliri A, D’Avola G, Lo Gullo R, Morgante S: Factors influencing pain, physical function and social functioning in patients with osteoarthritis in southern Italy. Int J Clin Pharmacol Res. 2004, 24 (4): 103-109.PubMed
27.
Lin E, Katon W, von Korff M, Tang L, Williams JJ, Kroenke K: Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial. JAMA. 2003, 290 (18): 2428-2429. 10.1001/jama.290.18.2428.CrossRefPubMed
28.
Howard KJ, Ellis HB, Wang J, von der Gruen JK, Bucholz R: Evaluating the effects of somatization disorder for patients with severe End-stage lower-extremity osteoarthritis. J Appl Biobehav Res. 2012, 17 (2): 79-93. 10.1111/j.1751-9861.2012.00079.x.CrossRef
29.
Woo J, Leung J, Lau E: Prevalence and correlates of musculoskeletal pain in Chinese elderly and the impact on 4-year physical function and quality of life. Public Health. 2009, 123 (8): 549-556. 10.1016/j.puhe.2009.07.006.CrossRefPubMed
30.
Perrot S, Poiraudeau S, Kabir M, Bertin P, Sichere P, Serrie A: Active or passive pain coping strategies in hip and knee osteoarthritis? Results of a national survey of 4,719 patients in a primary care setting. Arthritis Rheum. 2008, 59 (11): 1555-1562. 10.1002/art.24205.CrossRefPubMed
31.
Macfarlane GJ, Pallewatte N, Paudyal P, Blyth FM, Coggon D, Crombez G: Evaluation of work-related psychosocial factors and regional musculoskeletal pain: results from a EULAR Task Force. Ann Rheum Dis. 2009, 68 (6): 885-891. 10.1136/ard.2008.090829.CrossRefPubMed
32.
Sullivan MD, Bentley S, Fan M-Y, Gardner G: A single-blind, placebo Run-in study of duloxetine for activity-limiting osteoarthritis pain. J Pain. 2009, 10 (2): 208-213. 10.1016/j.jpain.2008.08.009.CrossRefPubMed
33.
O’Reilly SC, Muir KR, Doherty M: Knee pain and disability in the Nottingham community: association with poor health status and psychological distress. Br J Rheumatol. 1998, 37 (8): 870-873. 10.1093/rheumatology/37.8.870.CrossRefPubMed
34.
Creamer P, Lethbridge-Cejku M, Hochberg MC: Determinants of pain severity in knee osteoarthritis: effect of demographic and psychosocial variables using 3 pain measures. J Rheumatol. 1999, 26 (8): 1785-1792.PubMed
35.
Creamer P, Lethbridge-Cejku M, Costa P, Tobin JD, Herbst JH, Hochberg MC: The relationship of anxiety and depression with self-reported knee pain in the community: data from the Baltimore longitudinal study of aging. Arthritis Care Res. 1999, 12 (1): 3-7. 10.1002/1529-0131(199902)12:1<3::AID-ART2>3.0.CO;2-K.CrossRefPubMed
36.
Harcombe H, McBride D, Derrett S, Gray A: Physical and psychosocial risk factors for musculoskeletal disorders in New Zealand nurses, postal workers and office workers. Inj Prev. 2010, 16 (2): 96-100. 10.1136/ip.2009.021766.CrossRefPubMed
37.
Matsudaira K, Palmer KT, Reading I, Hirai M, Yoshimura N, Coggon D: Prevalence and correlates of regional pain and associated disability in Japanese workers. Occup Environ Med. 2011, 68 (3): 191-196. 10.1136/oem.2009.053645.CrossRefPubMed
38.
Davis MA, Ettinger WH, Neuhaus JM, Barclay JD, Segal MR: Correlates of knee pain among US adults with and without radiographic knee osteoarthritis. J Rheumatol. 1992, 19 (12): 1943-1949.PubMed
39.
Peat G, Thomas E: When knee pain becomes severe: a nested case-control analysis in community-dwelling older adults. J Pain. 2009, 10 (8): 798-808. 10.1016/j.jpain.2009.01.323.CrossRefPubMedPubMedCentral
40.
Piva SR, Fitzgerald GK, Wisniewski S, Delitto A: Predictors of pain and function outcome after rehabilitation in patients with patellofemoral pain syndrome. J Rehabil Med. 2009, 41 (8): 604-612. 10.2340/16501977-0372.CrossRefPubMed
41.
Chappell AS, Desaiah D, Liu-Seifert H, Zhang S, Skljarevski V, Belenkov Y: A double-blind, randomized, placebo-controlled study of the efficacy and safety of duloxetine for the treatment of chronic pain due to osteoarthritis of the knee. Pain Pract. 2011, 11 (1): 33-41. 10.1111/j.1533-2500.2010.00401.x.CrossRefPubMed
42.
Chappell AS, Ossanna MJ, Liu-Seifert H, Iyengar S, Skljarevski V, Li LC: Duloxetine, a centrally acting analgesic, in the treatment of patients with osteoarthritis knee pain: a 13-week, randomized, placebo-controlled trial. Pain. 2009, 146 (3): 253-260. 10.1016/j.pain.2009.06.024.CrossRefPubMed
43.
Abou-Raya S, Abou-Raya A, Helmii M: Duloxetine for the management of pain in older adults with knee osteoarthritis: randomised placebo-controlled trial. Age Ageing. 2012, 41 (5): 646-652. 10.1093/ageing/afs072.CrossRefPubMed
44.
Riddle DL, Kong X, Fitzgerald GK: Psychological health impact on 2-year changes in pain and function in persons with knee pain: data from the osteoarthritis initiative. Osteoarthritis Cartilage. 2011, 19 (9): 1095-1101. 10.1016/j.joca.2011.06.003.CrossRefPubMedPubMedCentral
45.
Hayley S, Poulter MO, Merali Z, Anisman H: The pathogenesis of clinical depression: stressor- and cytokine-induced alterations of neuroplasticity. Neuroscience. 2005, 135 (3): 659-678. 10.1016/j.neuroscience.2005.03.051.CrossRefPubMed
46.
Maletic V, Raison CL: Neurobiology of depression, fibromyalgia and neuropathic pain. Front Biosci. 2009, 14: 5291-5338. 10.2741/3598.CrossRef
47.
Narasimhan M, Campbell N: A tale of two comorbidities: understanding the neurobiology of depression and pain. Indian J. Psychiatry. 2010, 52 (2): 127-130. 10.4103/0019-5545.64586.CrossRefPubMedPubMedCentral
48.
Pace TW, Hu F, Miller AH: Cytokine-effects on glucocorticoid receptor function: relevance to glucocorticoid resistance and the pathophysiology and treatment of major depression. Brain Behav Immun. 2007, 21 (1): 9-19. 10.1016/j.bbi.2006.08.009.CrossRefPubMed
49.
Ross RL, Jones KD, Bennett RM, Ward RL, Druker BJ, Wood LJ: Preliminary evidence of increased pain and elevated cytokines in fibromyalgia patients with defective growth hormone response to exercise. Open Immunol J. 2010, 3: 9-18.CrossRefPubMedPubMedCentral
50.
D’Andrea G, Leon A: Pathogenesis of migraine: from neurotransmitters to neuromodulators and beyond. Neurol Sci. 2010, 31 (Suppl 1): S1-S7.CrossRefPubMed
51.
Yoshimura M, Furue H: Mechanisms for the anti-nociceptive actions of the descending noradrenergic and serotonergic systems in the spinal cord. J Pharmacol Sci. 2006, 101 (2): 107-117. 10.1254/jphs.CRJ06008X.CrossRefPubMed
52.
Millan MJ: Descending control of pain. Prog Neurobiol. 2002, 66 (6): 355-474. 10.1016/S0301-0082(02)00009-6.CrossRefPubMed
53.
Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW: The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007, 30 (1): 77-94. 10.1007/s10865-006-9085-0.CrossRefPubMed
54.
Vlaeyen JW, Linton SJ: Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000, 85 (3): 317-332. 10.1016/S0304-3959(99)00242-0.CrossRefPubMed
55.
Hurley M: The role of muscle weakness in the pathogenesis of osteoarthritis. Rheum Dis Clin North Am. 1999, 25 (2): 283-298. 10.1016/S0889-857X(05)70068-5.CrossRefPubMed
56.
57.
Scopaz KA, Piva SR, Wisniewski S, Fitzgerald GK: Relationships of fear, anxiety, and depression with physical function in patients with knee osteoarthritis. Arch Phys Med Rehabil. 2009, 90 (11): 1866-1873. 10.1016/j.apmr.2009.06.012. [Research Support, N.I.H., Extramural]CrossRefPubMedPubMedCentral
58.
Arola H, Nicholls E, Mallen C, Thomas E: Self-reported pain interference and symptoms of anxiety and depression in community-dwelling older adults: can a temporal relationship be determined?. Eur J Pain. 2010, 14 (9): 966-971. 10.1016/j.ejpain.2010.02.012.CrossRefPubMed
59.
Jinks C, Jordan K, Croft P: Osteoarthritis as a public health problem: the impact of developing knee pain on physical function in adults living in the community: (KNEST 3). Rheumatology. 2007, 46 (877): 81-
60.
Donald I, Foy C: A longitudinal study of joint pain in older people. Rheumatology. 2004, 43 (1256): 60-
Metadata
Title
Are depression, anxiety and poor mental health risk factors for knee pain? A systematic review
Authors
Pyae P Phyomaung
Julia Dubowitz
Flavia M Cicuttini
Sanduni Fernando
Anita E Wluka
Paul Raaijmaakers
Yuanyuan Wang
Donna M Urquhart
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2014
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-15-10

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