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Pain in hand osteoarthritis: a puzzle of biopsychosocial factors

In a recently published study in Osteoarthritis and Cartilage, researchers from the Nor-Hand study at the REMEDY center and Diakonhjemmet hospital have uncovered five distinct groups of patients with hand osteoarthritis. The various groups differ from each other in relation to how much pain they experience.

Elisabeth Mulrooney, researcher at the REMEDY center at Diakonhjemmet hospital has investigated pain in hand osteoarthritis in 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 that patients with hand osteoarthritis experience, says Elisabeth Mulrooney, the lead author of the study.

Heterogeneous pain experience

- Pain in hand osteoarthritis is complex, she explains. Traditionally, we have seen 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 over a period of 3.5 years on average.

Five distinct groups

Mulrooney explains that they identified five different groups that varied in different factors, such as degree of osteoarthritis in hands and other joints, anxiety, depression, co-morbidity, sleep difficulties, coping beliefs, catastrophic thoughts, sensitivity to pain, age, gender, body mass index, education and ability to work . 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 co-morbidity, the highest body mass index, the worst sleep quality and the highest sensitivity to pain, reported significantly more hand pain than the group with the most pronounced hand osteoarthritis, says Mulrooney. This tells us that the degree of osteoarthritis can often explain to a small extent the pain experienced by the patients. It 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 co-morbidity and sleep, psychological factors such as anxiety and depression, coping beliefs and thoughts of disaster, as well as social factors such as education and work connections play a significant role. The factors probably have a separate role 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 emphasizes the need for a more holistic approach to the treatment of hand osteoarthritis, explains Mulrooney. Assessing and addressing factors such as sensitivity to pain, degree of co-morbidity, sleep and psychological aspects such as worst-case thinking, coping beliefs, anxiety and symptoms of depression will make the treatment more personalized and thus contribute to more effective pain management.

Clinical implications

Mulrooney points out that the findings can be of great importance for how healthcare personnel relate to the treatment of hand osteoarthritis.

- For example, people with a high psychological burden can benefit more from a multimodal treatment plan, where you focus on increasing coping or reducing worst-case thinking, she says. In other cases, the patient may benefit from an increased focus on co-morbidity. In addition, the patients themselves will be able to make use of 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, which take into account the full range of factors that affect their pain experience, concludes Mulrooney.

With this new knowledge, patients and practitioners 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

Read more about Nor-Hand!