How people with knee pain understand why their pain changes or remains the same over time: A qualitative study.

Objectives: Guidelines recommend knee osteoarthritis pain management based on biopsychosocial mechanisms. Treatment adherence and effectiveness may be affected if there is a mismatch between patient perspectives and treatment focus. We therefore examined patient perspectives on mechanisms of their knee pain, why it persisted or changed over the past year, whether their understanding had changed, and whether their understanding aligned with that of others with whom they interact.
Methods: Individuals with chronic knee pain (n ​= ​50) were purposively recruited from the Knee Pain and related health In the Community (KPIC) cohort to represent worsened, improved, or unchanged pain or anxiety between baseline and one year later. Framework analysis, a comparative form of thematic analysis, was used across transcripts of semi-structured telephone interviews.
Results: Data were collapsed into themes of diagnosis, joint structure, ageing, physical activity, weight management, and treatment. Participants focused on biomechanical rather than psychological pain mechanisms. Some participants attributed pain improvement to increased and others to decreased physical activity. Participants reported no change in their understanding of their pain during the preceding year, but that their attitudes to pain, for example acceptance, had changed. Participants reported that they and others around them lacked understanding of their pain and why it did or did not change.
Conclusion: People report a predominantly biomechanical understanding of why their knee pain remains constant or changes over time. Clinicians should support patients to develop a biopsychosocial understanding of knee pain aligned to treatment across the range of biological, psychological, and social modalities.
Competing Interests: DAW declares a personal financial interest in his employment by the 10.13039/501100000837University of Nottingham who receive funding for his salary from the 10.13039/100013986UK Government, Sherwood Forest Hospitals NHS Foundation Trust and 10.13039/100014013UKRI. DAW declares non-personal financial interests in consultancy through his employment with the 10.13039/501100000837University of Nottingham to Pfizer Ltd, Eli Lilly, AbbVie Ltd, Galapagos and Reckitt Benckiser Health Ltd, AKL Research and Development Ltd, and 10.13039/100004330GlaxoSmithKline Plc, and responsibilities for investigator-led grants outside this work by the 10.13039/501100000837University of Nottingham from Pfizer, Eli Lilly and UCB Biopharma UK. RdN has received Speakers' Bureau payments from Biogen, Novartis, and Merck. DMcW declares a personal financial interest in his employment by the 10.13039/501100000837University of Nottingham, who receive funding for his salary from 10.13039/100011330Nottingham University Hospitals NHS Trust and 10.13039/501100000272National Institute for Health and Care Research (NIHR), and non-personal financial interests in investigator-led grants outside this work held by the 10.13039/501100000837University of Nottingham from Pfizer, Eli Lilly and UCB Biopharma UK. WZ declares personal financial interests outside this work in Advisory Board memberships for Eli Lilly and Regeneron, and Speaker Bureaus for Harbin Rheumatology Society and 10.13039/501100004791Shenzhen Rheumatology and Inflammation Forum, and non-personal financial interests in investigator-led grants outside this work held by the 10.13039/501100000837University of Nottingham from Foundation for Research in Rheumatology (FOREUM), Football Association (FA) and the Professional Footballers’ Association (PFA). EF declares personal financial interests outside this work in royalties or licenses from GL Assessment for the Paediatric Index of Emotional Distress (PI-ED), and consultancy for 10.13039/501100000780European Union, and non-personal financial interests in investigator-led grants outside this work held by the 10.13039/501100000837University of Nottingham from 10.13039/501100012041Versus Arthritis, 10.13039/100014013UKRI, 10.13039/501100013589Research England, 10.13039/501100000272NIHR, 10.13039/501100000286British Academy, 10.13039/100009033NHSBT Trust Fund, Pfizer, 10.13039/501100009187Medical Research Foundation, FA and PFA.
(© 2023 Published by Elsevier Ltd on behalf of Osteoarthritis Research Society International (OARSI).)