Pain elsewhere and the impact of knee pain in older people

Objective. To investigate how often knee pain is accompanied by pain elsewhere and to determine whether the presence of "pain elsewhere" than the knee influences either knee-related disability or the impact of knee pain on health and psychological status. Methods. A survey was mailed to 8,995 individuals (age :50 years) registered with 3 general practices in North Staffordshire in the UK. Patients recorded pain on a manikin and completed the Short-Form 36 health survey, the Hospital Anxiety and Depression Scale, and the Western Ontario and McMaster Universities Osteoarthritis Index. Responders were categorized as having no pain, knee pain with or without pain elsewhere, or other pain (no knee pain, but pain elsewhere). Those with knee pain or other pain were subdivided by the extent of pain elsewhere. Results. The adjusted survey response rate was 70%. Fifty-seven percent of responders with knee pain had pain in at least 2 other joint areas. Pain elsewhere was associated with lower physical function and with anxiety and depression both in the knee-pain group and in the other-pain group (associations were stronger in the knee-pain group). Knee pain and disability were less severe in those with knee pain alone than in those with knee pain and pain elsewhere, even after adjusting for age, sex, obesity, laterality of pain, and depression. Conclusion. Most people with knee pain have multiple joint site pain. The importance of this to clinicians and researchers is that the severity of knee pain and related disability is worse in the presence of pain elsewhere. This finding has implications for the management and treatment of older people with knee pain.