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Table 5 Studies examining the relationship between depression and knee pain

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

Author (year)

Study design

Assessment of depression

Assessment of pain pain/OA

Results

Conclusion

Quality score

Creamer (1999- Baltimore study)

Cross-sectional

Arthritis Impact Measurement Scales (AIMS) Questionnaire (Depression subscale)

Pain on most days for at least one month (National Health and Nutrition Examination Survey (NHANES-1))

Pain reporting was not related to depression (statistics not provided).

Depression was not associated with knee pain.

55

Depression scores were higher in subjects reporting ‘ever’ pain in the presence of normal radiographs than in those without reported knee pain (1.70 ± 0.27 versus 1.16 ± 0.09), but this was not statistically significant (P= 0.06).

Creamer (1999)

Cross-sectional

Centre for Epidemiological Studies Depression Scale (CES-D)

Pain Severity

Unadjusted Correlations: MPQ: r= 0.31 (p < 0.05).

There was no association between depression and pain severity after adjustment.

55

(WOMAC, Visual Analogue Scale,

VAS: r= 0.19 (NS)

McGill Pain Questionnaire (MPQ))

WOMAC: r= 0.15 (NS)

In the stepwise regression models after adjustment, depression did not remain in the model.

Salaffi (1991)

Cross-sectional

Zung Depression Inventory

Pain

Stepwise multiple regression:

Depression was found to be associated with the pain experience.

45

(McGill Pain Questionnaire (MPQ), Visual Analogue Scale (VAS))

MPQ: R= 0.41; t= 2.99; p < 0.01

VAS R= 0.39; t= 2.77; p < 0.01

van Baar (1998)

Cross-sectional

IRGL Questionnaire

Severity of pain: Visual Analogue Scale

Bivariate Correlation:

Depression was not associated with knee pain.

64

Knee pain: r= 0.28 p ≤ 0.01

Regression Analysis: NS (not remain in the model)

Wright (2008)

Cross-sectional

CES-D

WOMAC pain scale

WOMAC: mean= 17.76 ± 14.47

There was an association between knee pain and depressive symptoms.

82

Psychological Disability subscale of AIMS

Depressive Sx: mean= 1.80 ± 2.79

Neuroticism: mean= 2.26 ± 0.59

Negative affect: mean= 1.67 ± 0.51

Correlation between pain and depressive Sx: r= 0.21; p < 0.01

Correlation between pain and negative affect: r= 0.15; p < 0.05

Pells (2008)

Cross-sectional

Psychological Disability subscale of AIMS

AIMS

Correlation between psychosocial disability and AIMS pain scale: r= 0.24; p < 0.01.

Pain did not demonstrate an association with psychological disability.

64

Multiple regression: NS

Peat (2009)

Nested case-controlled

Hospital Anxiety and Depression Scale

Characteristic pain intensity: Chronic Pain Grade

Mean difference (95% CI) of depression between cases and controls at 18 months: 2.2 (1.2 to 3.1)

Substantial deterioration of knee pain is accompanied by an increase in depressive symptoms.

79

Pain extent: areas of pain experienced in previous month shaded on whole-body manikin

Cases were subjects who had mild knee pain at study entry and become severe at 18 months follow up.

Night pain: single item on WOMAC

Controls were subjects who still had mild knee pain at 18 months follow up and were selected from similar cohort as cases).

Riddle (2011)

Longitudinal Cohort Study

20-item CES-D

Knee Pain: WOMAC pain scale

dichotomised CES-D score (≥16)

Baseline depression is the most consistent psychological predictor of yearly worsening of pain. Association exists after adjusting for confounding variables.

92

Disability: WOMAC disability scale

Univariate analysis: WOMAC Pain: Estimate (95% CI)= 0.36 (0.16 to 0.56); p < 0.001

Multivariate analysis: WOMAC Pain: Estimate (95% CI)= 0.59 (0.18 to 1.01); p= 0.005

Chappell

Randomised Controlled Trial(RCT) investigating the effect of antidepressant (Duloxetine) on knee OA

Beck Depression Inventory-II (BDI-II) Hospital Anxiety and Depression Scale anxiety subscale (HADS-A)

Knee Pain: Brief Pain Inventory (BPI); WOMAC pain and stiffness subscales Perceived improvement: Clinical Global Impressions of Severity (CGI-S)

Mean change in pain score from baseline (at 13 weeks)

Treatment with duloxetine 60 to 120 mg was associated with significant pain reduction in patients with pain due to knee OA.

8*

(USA, 2011)

BPI average pain (% response)

≥30%= 65.3 (antidepressant group= I) & 44.1 (placebo= C); p ≤ 0.001

WOMAC: -13.74 (I) -17.51 (C); p ≤0.05

CGI-S: -0.40 (I) & -0.70(C); p ≤ 0.01

Chappell

RCT investigating the effect of antidepressant (Duloxetine) on knee OA

Beck Depression Inventory-II

Knee Pain: Weekly 24-h worst pain; WOMAC pain subscale

Mean change (SD) in pain score from baseline (at 13 weeks)

Duloxetine demonstrated statistically significant pain reduction compared with placebo.

9*

(USA, 2009)

Hospital Anxiety and Depression Scale (HADS)

BPI-S(Average pain): –2.82 ±0.21(C) –1.85 ± 0.21(C); p < .001

Severity: BPI-S, Brief Pain Inventory-Severity; CGI-S, Clinical Global Impressions of Severity

WOMAC: –4.64 ± 0.35 (I)

−3.24 ± 0.35(C); p= 0.003

CGI-S: -0.65 ±0.08(I) & –0.29 ± 0.08(C); p= 0.001

Abou-Raya

RCT investigating the effect of antidepressant (Duloxetine) on knee OA

Geriatric depression scale

Knee Pain Visual analogue pain scale; WOMAC pain score

WOMAC pain score

Duloxetine has a dual beneficial effect of improving depression and pain symptoms in older adults with knee OA.

10*

(Egypt, 2012)

(0–20): Mean (SD)

At baseline: Intervention - 9.1(4.6)

Placebo - 8.9(5.1); p= 0.44

At 16 weeks : Intervention - 6.0 (4.1) Placebo - 8.4 (5.4); p= 0.05

  1. NHANES, National Health and Nutritional Examination Survey; PFS, Physical Functioning Score; WOMAC, Western Ontario and McMaster University Osteoarthritis Index; PCI, Pain Coping Inventory; 4DSQ, Four Dimensional Symptom Questionnaire; CES-D, Centre for Epidemiological Studies Depression Scale; QOL, Quality of Life; SF-36, Short-Form-36 Health Survey; SSS - Social Support Scale; VAS, Visual Analogue Scale; OA, osteoarthritis; K/L scale, Kellgren and Lawrence Atlas of Standard Radiographs of Arthritis; WOMAC, Western Ontario and McMaster University Arthritis Index; MPQ, McGill Pain Questionnaire; AIMS, Arthritis Impact Measurement Scales; ACR, American College of Rheumatology; NA, not available; PFS, Physical Functioning Scale; IRGL, Invloed van Reuma op Gezondheid en Leefwijze (Dutch version of the Arthritis Impact Measurement Scale) *Indicates quality scores for RCTs as per the PEDro scale.