Walsh David A, Rathbone James, Akin-Akinyosoye Kehinde, Fernandes Gwen S, Valdes Ana M, McWilliams Daniel F, Zhang Weiya, Doherty Michael, Hancox Jennie E, Vedhara Kavita, das Nair Roshan, Ferguson Eamonn
Pain Centre Versus Arthritis, University of Nottingham, UK.
Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, UK.
Osteoarthr Cartil Open. 2023 Feb 10;5(2):100345. doi: 10.1016/j.ocarto.2023.100345. eCollection 2023 Jun.
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.
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.
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.
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.
指南建议基于生物心理社会机制进行膝关节骨关节炎疼痛管理。如果患者观点与治疗重点不匹配，治疗依从性和有效性可能会受到影响。因此，我们研究了患者对其膝关节疼痛机制的看法、过去一年疼痛持续或变化的原因、他们的理解是否发生了变化，以及他们的理解是否与他们互动的其他人一致。
从社区膝关节疼痛及相关健康（KPIC）队列中特意招募了50名慢性膝关节疼痛患者，以代表基线和一年后疼痛、焦虑加剧、改善或无变化的情况。在半结构化电话访谈的文字记录中使用了框架分析，这是一种主题分析的比较形式。
数据归纳为诊断、关节结构、衰老、体育活动、体重管理和治疗等主题。参与者关注生物力学而非心理疼痛机制。一些参与者将疼痛改善归因于体育活动增加，另一些参与者则归因于体育活动减少。参与者报告说，他们对自己疼痛的理解在前一年没有变化，但他们对疼痛的态度，例如接受程度，发生了变化。参与者报告说，他们和周围的人对他们的疼痛以及疼痛为何有或没有变化缺乏了解。
人们报告说，他们对膝关节疼痛为何持续或随时间变化的理解主要是生物力学方面的。临床医生应支持患者从生物心理社会角度理解膝关节疼痛，并使其与生物、心理和社会等一系列治疗方法保持一致。
