Pain is the main impetus for seeking medical care among patients with osteoarthritis, with insomnia and depression acting as drivers for increased diversity in the types of health care use, according to recent findings in Arthritis Care & Research.
by Jason Laday, Healio August 29, 2018
“Given the complex interactions and mutual exacerbations among pain, insomnia and depression, it is possible that co-occurrence results in cost increases that are greater than simply the sum of the costs of these separate conditions,” Minhui Liu PhD RN of the Johns Hopkins University School of Nursing, and colleagues wrote. “It is important to understand how pain, insomnia and depression independently contribute to [health care use] in older adults with OA and whether there are synergistic effects that jointly drive the increased [health care use].”
To determine the independent and combined effects of pain, insomnia and depression symptoms on health care use among patients aged 60 years and older with OA, the researchers reviewed data from a study of older adults with concurrent OA and insomnia. In that study, which compared the efficacy of three behavioral group interventions to help patients manage their pain and insomnia, 8,057 patients at the Group Health Cooperative in Seattle received surveys regarding their OA pain and sleep problems.
For their own study, Liu and colleagues focused on 2,976 patients who were continuously enrolled in the Group Health Cooperative 1 year prior to survey screening, as well as those receiving primary care services at one of six regional participating clinics and at least one visit recorded in the electronic medical record for OA in the previous 3 years. For these patients, the researchers reviewed survey data related to pain, based on the Graded Chronic Pain Scale; insomnia, based on the Insomnia Severity Index; and depression, using the Patient Health Questionnaire for 3 years following the survey. Health care use, including office visits, length of stay, outpatient and inpatient costs, and hip or knee replacement, was also examined.
According to the researchers, approximately 34% of the 2,976 included participants demonstrated at least subclinical insomnia, while 29% presented with at least subclinical depression symptoms, in addition to moderate to severe pain. Among the patients, pain had the largest independent effect on increasing all types of health care use, with depression having moderate effects on increased office visits, length of stay, and outpatient and inpatient costs. Insomnia had mild effects on decreased length of stay. Combined effects of pain with insomnia, and pain with depression were significant for all types of health care use. This effect increased greatly with more severe insomnia and depression symptoms, save for hip or knee replacement.
“Pain, insomnia, and depression are common in older adults with [OA],” Liu said in a press release. “Unfortunately, they commonly occur together. To our knowledge, our study is the first to examine their effects on diverse health care use. We are glad to find that although their effects on health care use are substantial, their combined effects are not greater than the sum of their individual effects, which is good for patients.”
Effects of Osteoarthritis Pain, and Concurrent Insomnia and Depression on Health Care Use in a Primary Care Population of Older Adults, Liu M, McCurry SM, Belza B, Dobra A, Buchanan DT, Vitiello MV, and Von Korff M. Arthritis Care Res. (Hoboken). 2018 Aug 1. doi:10.1002/acr.23695
Association Between Knee Load and Pain: Within-Patient, Between-Knees, Case-Control Study in Patients with Knee Osteoarthritis, Birmingham TB, Marriott KA, Leitch KM, Moyer RF, Lorbergs AL, Walton DM, Willits K, Litchfield RB, Getgood A, Fowler PJ, Giffin JR. Arthritis Care Res (Hoboken). 2018 Jul 13. doi: 10.1002/acr.23704. [Epub ahead of print]
Frequency of comorbid insomnia, pain, and depression in older adults with osteoarthritis: predictors of enrollment in a randomized treatment trial, McCurry SM, Von Korff M, Vitiello MV, Saunders K, Balderson BH, Moore AL, Rybarczyk BD. J Psychosom Res. 2011 Nov;71(5):296-9. doi: 10.1016/j.jpsychores.2011.05.012. Epub 2011 Jul 1.
Dynamic Effects of Depressive Symptoms on Osteoarthritis Knee Pain, Rathbun AM, Stuart EA, Shardell M, Yau MS, Baumgarten M, Hochberg MC. Arthritis Care Res (Hoboken). 2018 Jan;70(1):80-88. doi: 10.1002/acr.23239. Epub 2017 Dec 6.
Pain severity as a mediator of the association between depressive symptoms and physical performance in knee osteoarthritis, Rathbun AM, Shardell MD, Stuart EA, Yau MS, Gallo JJ, Schuler MS, Hochberg MC. Osteoarthritis Cartilage. 2018 Aug 6. pii: S1063-4584(18)31393-1. doi: 10.1016/j.joca.2018.07.016. [Epub ahead of print]
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