Evaluating the Effects of Somatization Disorder for Patients With Severe End-Stage Lower-Extremity Osteoarthritis

Are cognitive and behavioural factors associated with knee pain? A systematic review

OBJECTIVES

Although studies that have examined the relationship between cognitive and behavioural factors and knee pain report conflicting results, no systematic review has been performed to summarise the evidence. The aim of this systematic review was to examine the relationship between cognitive and behavioural factors and pain at the knee.

METHODS

Electronic searches of MEDLINE, EMBASE and PsycINFO were performed to identify relevant studies published up to April 2014 using MeSH terms and keywords. Studies that met a set of predefined criteria were included. Coping, self-efficacy, somatising, pain catastrophising and helplessness were grouped together as "cognitive factors," while kinesiophobia and pain-related fear-avoidance were considered "behavioural factors." Two independent reviewers extracted the data and assessed the methodological quality of the selected studies. Due to the heterogeneity of the studies, a best-evidence synthesis was performed.

RESULTS

A total of 14 studies were included in the review, of which nine examined cognitive factors, one investigated behavioural factors and four studied both cognitive and behavioural factors. Eight of 14 studies were of high quality. The best-evidence synthesis showed moderate evidence for a relationship between cognitive factors and knee pain and limited evidence for no association between the behavioural factors and knee pain.

CONCLUSION

This review found evidence for a relationship between cognitive factors, but not behavioural factors, and knee pain. These findings will need to be confirmed with high-quality longitudinal studies, but the data suggest that cognitive factors may be important to target in the management of knee pain.

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

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.