Enhancing the Measurement of Pain in Individuals with Hip or Knee Osteoarthritis

Osteoarthritis (OA) significantly impacts quality of life, ranking among the top ten causes of disability world-wide. Among people with OA, pain is the #1 reason for doctor visits and for joint replacement surgery (TJR). Despite this, little is known about the quality and characteristics of OA pain, or the changes over time with disease progression. Greater understanding of the key features of pain that trigger changes in physical activity and/or mood and that drive decision making around the use of treatments, such as TJR, would facilitate the development of tools to assist clinicians. It would also provide information to base the development of outcome measures for clinical trials of new treatments in OA.

Focus Groups

This study used focus groups to increase our understanding of the natural progression of pain in OA and one-on-one interviews to determine which aspects of the pain experience are most distressing. From data collected in this study, we developed scenarios that describe the typical OA patient’s pain experience from early to late disease.

Participants clearly described two distinct types of pain as their OA progressed – a dull aching pain, which became more constant over time, punctuated increasingly with short episodes of a more intense, often unpredictable, emotionally draining pain. These scenarios provided the basis for development of a new pain measure for OA that assessing both constant and intermittent pain experiences.

New Pain Tool

Based on data collected during the focus groups, we developed and tested a new tool to assess OA pain. This new 11-item OA pain measure comprehensively evaluates the experience of pain among people living with hip and knee OA. It evaluates both constant and intermittent pain and takes into account not only pain intensity but related distress and the impact of OA pain on quality of life.

Preliminary psychometric testing suggests that the measure is reliable and valid. Further studies are required to confirm these preliminary findings and to evaluate the responsiveness of this measure over time and in response to interventions. This tool has been translated into several languages and is available for use.

OARSI-OMERACT Initiative: New OA Pain Measure

As this is a new instrument and further testing is ongoing, please contact the author, Gillian Hawker, MD, MSc if you intend to use the instrument. Please indicate the setting and for what purpose. Contact: g.hawker@utoronto.ca.

Investigators

Gillian Hawker, Aileen Davis, Monique Gignac

International Collaborators

Paul Dieppe (UK), Jolanda Cibere (Canada), Lyn March (Australia), Maria Suarez Almazor (USA), Joanne Jordan (USA)

Consumer Collaborators

Patricia Cooper, Olive Thorne, Marg Elliott, Gail Webster

Staff

Lindsay Stewart, Angela Wall, Joanna Sale, Melissa French, Shalini Misir

Funding

Orthopaedic and Arthritic Hospital Musculoskeletal Research Competition (Toronto site)

Date

2005+
  • Maillefert JF, Kloppenburg M, Fernandes L, Punzi L, Günther KP, Mola EM, Lohmander LS, Pavelka K, Lopez-Olivo MA, Dougados M, Hawker GA. Coauthor. Multi-language translation and cross-cultural adaptation of the OARSI/OMERACT measure of Intermittent and Constant OsteoArthritis Pain (ICOAP). Osteoarthritis & Cartilage, April 2009. In Press.
  • Hawker GA, Davis AM, French MR, Cibere J, Jordan JM, March L, Suarez-Almazor M, Katz JN, Dieppe P. Development and preliminary psychometric testing of a new OA pain measure – an OARSI/OMERACT initiative. Osteoarthritis and Cartilage 2008;16:409-414.
  • Hawker GA, Stewart L, French MR, Cibere J, Jordan JM, March L, Suarez-Almazor M, Gooberman-Hill R. Understanding the Pain Experience in Hip and Knee Osteoarthritis – An OARSI/OMERACT Initiative. Osteoarthritis and Cartilage 2008;16: 415-422.
  • Hawker GA, Stewart L, French MR, Cibere J, Jordan JM, March L, Suarez-Almazor M, Dieppe PA. Understanding the Pain Experience in Hip and Knee OA. Poster presentation to the 2007 Annual Scientific Meeting of the American College of Rheumatology; Nov 6-11, Boston, 2007.
  • Hawker GA, French MR, Cibere J, Jordan JM, Davis AM, March L, Suarez-Almazor M, Dieppe PA. Preliminary Psychometric Testing of a New Osteoarthritis Pain Measure. Poster presentation to the 2007 Annual Scientific Meeting of the American College of Rheumatology; Nov 6-11, Boston, 2007.
  • Hawker GA, French MR, Cibere J, Jordan JM, Davis AM, March L, Suarez-Almazor M, Dieppe P. Preliminary Psychometric Testing of a New Osteoarthritis Pain Measure. Submitted to the 2007 Annual Scientific Meeting of the American College of Rheumatology. May 2007.
  • Hawker GA, Stewart L, French MR, Cibere J, Jordan JM, March L, Suarez-Almazor M, Dieppe P. Understanding the Pain Experience in Hip and Knee OA. Submitted to the 2007 Annual Scientific Meeting of the American College of Rheumatology. May 2007.
  • Hawker G, Dieppe PA, Cibere J, Jordan J, March L, Suarez-Almazor M. Pain Severity Scoring System in Osteoarthritis (OA) (Oral presentation). OARSI 11th World Congress on Osteoarthritis, Prague, December 7-10, 2006.
Last modified: September 6, 2009