Original Article
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Staging joint pain and disability: A brief method using persistence and global severity
George Peat,
Elaine Thomas,
Peter Croft,
Corresponding Author
George Peat
Keele University, Keele, Staffordshire, United Kingdom
Primary Care Sciences Research Centre, Keele University, Keele, Staffordshire, United Kingdom, ST5 5BGSearch for more papers by this authorElaine Thomas
Keele University, Keele, Staffordshire, United Kingdom
Search for more papers by this authorPeter Croft
Keele University, Keele, Staffordshire, United Kingdom
Search for more papers by this authorGeorge Peat,
Elaine Thomas,
Peter Croft,
Corresponding Author
George Peat
Keele University, Keele, Staffordshire, United Kingdom
Primary Care Sciences Research Centre, Keele University, Keele, Staffordshire, United Kingdom, ST5 5BGSearch for more papers by this authorElaine Thomas
Keele University, Keele, Staffordshire, United Kingdom
Search for more papers by this authorPeter Croft
Keele University, Keele, Staffordshire, United Kingdom
Search for more papers by this authorAbstract
Objective
Joint pain in older adults is a problem commonly presented to primary care. In contrast to methods for defining and staging the most likely underlying disease (osteoarthritis), clinically practicable methods for staging pain and associated disability are lacking. Our objective was to test a method of brief pain assessment and clinical staging based on recognized focal features of chronic pain and preexisting measurement tools.
Methods
A total of 781 adults ages ≥50 years who were registered with 3 general practices and were experiencing knee pain within the previous 6 months attended research clinics between August 2002 and September 2003. Pain and associated disability were staged on the basis of self-completed questions on knee pain persistence and global severity (Chronic Pain Grade). These were then compared with participants' appraisals of their knee problem, its perceived importance, negative health states, and consultation behavior.
Results
Knee pain global severity was associated with symptom dissatisfaction, patient prioritizing, oral analgesic intake, mood, mobility limitation, poorer general health, and consultation behavior. Fewer independent associations were found with knee pain persistence. Staging could be performed using only 4 simple questions.
Conclusion
Although the usefulness of this approach still needs to be determined in routine clinical settings and across other joint pain sites, our findings suggest that focal characteristics of chronic pain (persistence, global severity) can be used as the basis of brief, simple assessment and staging of joint pain in older adults.
REFERENCES
- 1 World Health Organization. The burden of musculoskeletal conditions at the start of the new millenium: report of a WHO scientific group. WHO Technical Report Series No. 919. Geneva: World Health Organization; 2003. URL: http://whqlibdoc.who.int/trs/WHO_TRS_919.pdf.
- 2 Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ 2003; 81: 646–56.
- 3 Guccione AA, Felson DT, Anderson JJ, Anthony JM, Zhang Y, Wilson PW, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health 1994; 84: 351–8.
- 4 McCormick A, Fleming D, Charlton J. Morbidity statistics from general Practice: fourth national study 1991–1992. London: Office of Population Censuses and Surveys, HMSO; 1995. Series MB5 No. 3.
- 5 Mantyselka P, Kumpusalo E, Ahonen R, Kumpusalo A, Kauhanen J, Viinamaki H, et al. Pain as a reason to visit the doctor: a study in Finnish primary health care. Pain 2001; 89: 175–80.
- 6 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16: 494–502.
- 7 Felson DT, McAlindon TE, Anderson JJ, Naimark A, Weissman BW, Aliabadi P, et al. Defining radiographic osteoarthritis for the whole knee. Osteoarthritis Cartilage 1997; 5: 241–50.
- 8 Lanyon P, O'Reilly S, Jones A, Doherty M. Radiographic assessment of symptomatic knee osteoarthritis in the community: definitions and normal joint space. Ann Rheum Dis 1998; 57: 595–601.
- 9 The Primary Care Rheumatology Society. Partnership in practice: the management of osteoarthritis. Northallerton (UK): Primary Care Rheumatology Society; January 1995.
- 10 Bellamy N, Kirwan J, Boers M, Brooks P, Strand V, Tugwell P, et al. Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip, and hand osteoarthritis: consensus development at OMERACT III. J Rheumatol 1997; 24: 799–802.
- 11 Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003; 62: 1145–55.
- 12 Hadorn DC, Holmes AC. The New Zealand priority criteria project. Part 1: overview. BMJ 1997; 314: 131–4.
- 13 The Primary Care Rheumatology Society. Knee osteoarthritis: management options. Northallerton (UK): Primary Care Rheumatology Society; February 1999.
- 14 National Institute for Clinical Excellence. Referral advice: a guide to appropriate referral from general to specialist services, 2001. URL: http://www.nice.org.uk/pdf/Referraladvice.pdf.
- 15 Dieppe P, Brandt KD. What is important in treating osteoarthritis? Whom should we treat and how should we treat them? Rheum Dis Clin North Am 2003; 29: 687–716.
- 16 Mantyselka P, Kumpusalo E, Ahonen R, Takala J. Patients' versus general practitioners' assessments of pain intensity in primary care patients with non-cancer pain. Br J Gen Pract 2001; 51: 995–7.
- 17 Suarez-Almazor ME, Conner-Spady B, Kendall CJ, Russell AS, Skeith K. Lack of congruence in the ratings of patients' health status by patients and their physicians. Med Decis Making 2001; 21: 113–21.
- 18 Campbell J. Presidential address. American Pain Society Annual Scientific Meeting; 1995 Nov. 11; Los Angeles, California.
- 19 American Geriatric Society Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc 2002; 50 Suppl 6: S205–24.
- 20 Woolf AD, Akesson K. Understanding the burden of musculoskeletal conditions: the burden is huge and not reflected in national health priorities [editorial]. BMJ 2001; 322: 1079–80.
- 21 Von Korff M, Jensen MP, Karoly P. Assessing global pain severity by self-report in clinical and health services research. Spine 2000; 25: 3140–51.
- 22 Von Korff M, Dworkin SF, le Resche L, Kruger A. An epidemiologic comparison of pain complaints. Pain 1988; 32: 173–83.
- 23 Von Korff M, Dworkin SF, le Resche L. Graded chronic pain status: an epidemiologic evaluation. Pain 1990; 40: 279–91.
- 24 Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain 1992; 50: 133–49.
- 25 Cote P, Cassidy JD, Carroll L. The Saskatchewan Health and Back Pain Survey: the prevalence of neck pain and related disability in Saskatchewan adults. Spine 1998; 23: 1689–98.
- 26 Cote P, Cassidy JD, Carroll L. The factors associated with neck pain and its related disability in the Saskatchewan population. Spine 2000; 25: 1109–17.
- 27 Gureje O, von Korff M, Simon GE, Gater R. Persistent pain and well-being: a World Health Organization study in primary care [published erratum appears in JAMA 1998;280:1142]. JAMA 1998; 280: 147–51.
- 28 Peat G, Croft P, Hay E. Clinical assessment of the osteoarthritis patient. Best Pract Res Clin Rheumatol 2001; 15: 527–44.
- 29 Bellamy N. WOMAC osteoarthritis index: a user's guide. Ontario: London Health Services Centre, McMaster University; 1996.
- 30 Pincus T, Summey JA, Soraci SA Jr, Wallston KA, Hummon NP. Assessment of patient satisfaction in activities of daily living using a modified Stanford Health Assessment Questionnaire. Arthritis Rheum 1983; 26: 1346–53.
- 31 Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30: 473–83.
- 32 Peat G, Thomas E, Handy J, Wood L, Dziedzic K, Myers H, et al. The Knee Clinical Assessment Study: CAS(K): a prospective study of knee pain and knee osteoarthritis in the general population. BMC Musculoskelet Disord [serial online] 2004; 5: 4. URL: www.biomedcentral.com.
- 33 Thomas E, Wilkie R, Peat G, Hill S, Dziedzic K, Croft P. The North Staffordshire Osteoarthritis Project: NorStOP: prospective, 3-year study of the epidemiology and management of clinical osteoarthritis in a general population of older adults. BMC Musculoskeletal Dis [serial online] 2004; 5: 2. URL: www.biomedcentral.com.
- 34 Thomas R. Income: Question Bank topic commentary on income, 1999. Surrey, UK: University of Surrey; 1999. URL: http://qb.soc.surrey.ac.uk/topics/income/thomas_wealth.htm.
- 35 Office for National Statistics. Standard occupational classification 2000. Vol. 2. The coding index. London: Office for National Statistics; 2000.
- 36 Office for National Statistics. The National Statistics socio-economic classification user manual. Version 1. London: Office for National Statistics; 2002.
- 37 Ware J Jr, Kosinski M, Keller SD. A 12-item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34: 220–33.
- 38 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361–70.
- 39 MacFarlane GJ, Croft PR, Schollum J, Silman AJ. Widespread pain: is an improved classification possible? J Rheumatol 1996; 23: 1628–32.
- 40 Jinks C, Jordan K, Croft P. Measuring the population impact of knee pain and disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain 2002; 100: 55–64.
- 41 Cherkin DC, Deyo RA, Street JH, Barlow W. Predicting poor outcomes for back pain seen in primary care using patients' own criteria. Spine 1996; 21: 2900–7.
- 42 De Vet HC, Heymans MW, Dunn KM, Pope DP, van der Beek AJ, Macfarlane GJ, et al. Episodes of low back pain: a proposal for uniform definitions to be used in research. Spine 2002; 27: 2409–16.
- 43 Smith BH, Penny KI, Purves AM, Munro C, Wilson B, Grimshaw J, et al. The Chronic Pain Grade questionnaire: validation and reliability in postal research. Pain 1997; 71: 141–7.
- 44 Zelman DC, Hoffman DL, Seifeldin R, Dukes EM. Development of a metric for a day of manageable pain control: derivation of pain severity cutpoints for low back pain and osteoarthritis. Pain 2003; 106: 35–42.
- 45 Dieppe P. Osteoarthritis: time to shift the paradigm: this includes distinguishing between severe disease and common minor disability. BMJ 1999; 318: 1299–300.
- 46 McAlindon TE. The knee [editorial]. Baillieres Clin Rheumatol 1999; 13: 329–44.
- 47 Hadler NM. Knee pain is the malady, not osteoarthritis [editorial]. Ann Intern Med 1992; 116: 598–9.
- 48 Szklo M. Population-based cohort studies. Epidemiol Rev 1998; 20: 81–90.
- 49 Von Korff M. Epidemiological and survey methods: assessment of chronic pain. In: DC Turk, R Melzack, editors. Handbook of pain assessment. 2nd ed. New York: The Guildford Press; 2001. p. 603–18.
- 50 National Pharmaceutical Council. Pain: current understanding of assessment, management, and treatments. URL: http://www.jcaho.org/news+room/health+care+issues/pain_mono_npc.pdf.
