Physiotherapist Elisabeth Mulrooney (PhD) at Diakonhjemmet Hospital has researched the connection between pain and biological, psychological and social factors in patients with hand osteoarthritis.
The doctoral thesis explores how the degree of osteoarthritis, sensitization, disease burden, anxiety, depression and coping skills can affect the experience of pain in people with this condition.
The thesis is titled, “ Pain in hand osteoarthritis in a biopsychosocial framework .” Pain is a dominant symptom of osteoarthritis and has a major impact on patients' quality of life.
Hand osteoarthritis is a condition about which there is limited knowledge, and treatment options are few. Those who have it are encouraged to exercise on their own. In addition, they can take pain- and anti-inflammatory medications. Several also receive customized orthoses. These are aids that can relieve pain, improve function or help correct a misalignment.
Biopsychosocial factors and pain experience
Mulrooney's findings show that patients with high levels of anxiety, depressive symptoms, and catastrophizing experience more pain than those with lower levels of these factors.
She also found that people with a high degree of other disease burden experienced more pain than those without a similar disease burden.
Five possible subgroups of patients were identified, based on biological, psychological and social factors. Patients with high stress levels, poor sleep and multiple comorbidities experienced significantly more pain than those with more severe joint damage but otherwise low disease burden. 
Elisabeth Mulrooney received her PhD on 11 December 2024.
– We cannot conclude whether these factors are causes or consequences of pain, but our findings indicate that biopsychosocial factors, individually or in combination, can worsen the pain experience in people with hand osteoarthritis, explains Mulrooney.
She believes that the results clearly show the need for individually tailored treatment.
“We need to find the risk factors that can be influenced and help patients with them,” says Mulrooney.
This research may have consequences for how pain management is individually tailored in patients with hand osteoarthritis, and it provides important perspectives for future studies.
The Nor-Hand study
The research project is part of the Nor-Hand study. The observational cohort study of men and women with hand osteoarthritis has been followed at Diakonhjemmet Hospital since 2016. The study has collected extensive information about pain experience, including psychological factors, pain sensitivity and comorbidities.
The doctoral exam
Title of the trial lecture: “The role of metabolic syndrome in hand OA. Underlying mechanisms and potential treatment”
Supervisors:
Main supervisor Ida K. Haugen. Co-supervisors Hanne Dagfinrud, Hilde Berner Hammer, Karin Magnusson, Tore K. Kvien
Assessment committee:
First opponent: Associate Professor Lisa Carlesso, McMaster University, Canada
Second opponent: Professor Martin van der Esch, Amsterdam University of Applied Sciences, Netherlands
Chair of the committee: Associate Professor Maren Falch Lindberg, University of Oslo
Dissertation supervisor:
Stephan Röhrl, University of Oslo
The thesis is funded by South-Eastern Health and is based on the University of Oslo in collaboration with Diakonhjemmet Hospital, which has also been responsible for data collection through the Nor-Hand study.
Elisabeth Mulrooney together with the assessment committee, dissertation chair and main supervisor.
