In a recently published study in Osteoarthritis and Cartilage, researchers from the Nor-Hand study at the REMEDY Center and Diakonhjemmet Hospital have identified five distinct groups of patients with hand osteoarthritis. The different groups differ from each other in terms of the amount of pain they experience.
Elisabeth Mulrooney, researcher at the REMEDY Center at Diakonhjemmet Hospital, has investigated pain in hand osteoarthritis within a biopsychosocial framework. Photo: Diakonhjemmet Hospital/Nicolas Tourrenc
– The biopsychosocial approach has provided new knowledge about biological, psychological and social factors that are related to the amount of pain experienced by patients with hand osteoarthritis, says Elisabeth Mulrooney, the lead author of the study.
Heterogeneous pain experience
“Pain in hand osteoarthritis is complex,” she explains. “Traditionally, we have looked at structural joint damage and joint inflammation as the main causes of pain, but our findings show that it is much more complicated than that,” she states.
By analyzing data from 300 participants from the Nor-Hand study, the researchers conducted an analysis to identify different subgroups based on biological, psychological and social factors. The participants were followed up for an average period of 3.5 years.
Five distinct groups
Mulrooney explains that they identified five different groups that varied in various factors, such as the degree of osteoarthritis in the hands and in other joints, anxiety, depression, comorbidity, sleep problems, belief in self-control, catastrophic thinking, sensitivity to pain, age, gender, body mass index, education and work ability. In addition, the degree of pain varied significantly between the five groups.
“The most surprising finding was that those with the least severe hand osteoarthritis, but the most anxiety and depression, the highest degree of comorbidity, the highest body mass index, the poorest sleep quality and the highest sensitivity to pain reported significantly more hand pain than the group with the most severe hand osteoarthritis,” says Mulrooney. This tells us that the degree of osteoarthritis often has little to do with explaining the pain experienced by patients. This challenges previous understandings of pain mechanisms in hand osteoarthritis, she explains.
The importance of a holistic approach
The study shows that the pain of hand osteoarthritis cannot be understood only through joint damage and joint inflammation alone. Biological factors such as sensitivity to pain, degree of comorbidity and sleep, psychological factors such as anxiety and depression, coping beliefs and catastrophic thoughts, as well as social factors such as education and work attachment probably play a significant role. The factors probably have a role individually when it comes to pain and not least in interaction with each other, which emphasizes the importance of a holistic approach. Through this study we cannot say anything about what are the causes or consequences of pain, but it is likely that some of the factors that we have investigated affect pain and vice versa.
“Our research highlights the need for a more holistic approach to treating hand osteoarthritis,” explains Mulrooney. Assessing and addressing factors such as pain sensitivity, degree of comorbidity, sleep, and psychological aspects such as worst-case thinking, coping beliefs, anxiety, and symptoms of depression will make treatment more personalized and thus contribute to more effective pain management.
Clinical implications
Mulrooney points out that the findings may have great significance for how healthcare professionals approach the treatment of hand osteoarthritis.
“For example, people with high psychological burden may benefit more from a multimodal treatment plan, where one focuses on increasing coping or reducing worst-case thinking,” she says. In other cases, the patient may benefit from an increased focus on comorbidity. In addition, patients themselves will be able to use this knowledge.
The Way Forward
The research team hopes that these findings can contribute to the development of more individualized treatment strategies for hand osteoarthritis.
“Our goal is to improve the quality of life for patients with hand osteoarthritis by offering tailored treatment options that take into account the full range of factors that influence their pain experience,” concludes Mulrooney.
With this new knowledge, patients and therapists can gain an increased understanding of the pain associated with hand osteoarthritis.
Read the full article Hand osteoarthritis phenotypes based on a biopsychosocial approach, and their associations with cross-sectional and longitudinal pain
