Table 5.
Author (year) | Study design | Assessment of depression | Assessment of pain pain/OA | Results | Conclusion | Quality score |
---|---|---|---|---|---|---|
Creamer (1999- Baltimore study) |
Cross-sectional |
Arthritis Impact Measurement Scales (AIMS) Questionnaire (Depression subscale) |
Pain on most days for at least one month (National Health and Nutrition Examination Survey (NHANES-1)) |
Pain reporting was not related to depression (statistics not provided). |
Depression was not associated with knee pain. |
55 |
Depression scores were higher in subjects reporting ‘ever’ pain in the presence of normal radiographs than in those without reported knee pain (1.70 ± 0.27 versus 1.16 ± 0.09), but this was not statistically significant (P= 0.06). | ||||||
Creamer (1999) |
Cross-sectional |
Centre for Epidemiological Studies Depression Scale (CES-D) |
Pain Severity |
Unadjusted Correlations: MPQ: r= 0.31 (p < 0.05). |
There was no association between depression and pain severity after adjustment. |
55 |
(WOMAC, Visual Analogue Scale, |
VAS: r= 0.19 (NS) |
|||||
McGill Pain Questionnaire (MPQ)) |
WOMAC: r= 0.15 (NS) |
|||||
In the stepwise regression models after adjustment, depression did not remain in the model. | ||||||
Salaffi (1991) |
Cross-sectional |
Zung Depression Inventory |
Pain |
Stepwise multiple regression: |
Depression was found to be associated with the pain experience. |
45 |
(McGill Pain Questionnaire (MPQ), Visual Analogue Scale (VAS)) | ||||||
MPQ: R= 0.41; t= 2.99; p < 0.01 | ||||||
VAS R= 0.39; t= 2.77; p < 0.01 | ||||||
van Baar (1998) |
Cross-sectional |
IRGL Questionnaire |
Severity of pain: Visual Analogue Scale |
Bivariate Correlation: |
Depression was not associated with knee pain. |
64 |
Knee pain: r= 0.28 p ≤ 0.01 | ||||||
Regression Analysis: NS (not remain in the model) | ||||||
Wright (2008) |
Cross-sectional |
CES-D |
WOMAC pain scale |
WOMAC: mean= 17.76 ± 14.47 |
There was an association between knee pain and depressive symptoms. |
82 |
Psychological Disability subscale of AIMS | ||||||
Depressive Sx: mean= 1.80 ± 2.79 | ||||||
Neuroticism: mean= 2.26 ± 0.59 | ||||||
Negative affect: mean= 1.67 ± 0.51 | ||||||
Correlation between pain and depressive Sx: r= 0.21; p < 0.01 | ||||||
Correlation between pain and negative affect: r= 0.15; p < 0.05 | ||||||
Pells (2008) |
Cross-sectional |
Psychological Disability subscale of AIMS |
AIMS |
Correlation between psychosocial disability and AIMS pain scale: r= 0.24; p < 0.01. |
Pain did not demonstrate an association with psychological disability. |
64 |
Multiple regression: NS | ||||||
Peat (2009) |
Nested case-controlled |
Hospital Anxiety and Depression Scale |
Characteristic pain intensity: Chronic Pain Grade |
Mean difference (95% CI) of depression between cases and controls at 18 months: 2.2 (1.2 to 3.1) |
Substantial deterioration of knee pain is accompanied by an increase in depressive symptoms. |
79 |
Pain extent: areas of pain experienced in previous month shaded on whole-body manikin | ||||||
Cases were subjects who had mild knee pain at study entry and become severe at 18 months follow up. | ||||||
Night pain: single item on WOMAC |
Controls were subjects who still had mild knee pain at 18 months follow up and were selected from similar cohort as cases). |
|||||
Riddle (2011) |
Longitudinal Cohort Study |
20-item CES-D |
Knee Pain: WOMAC pain scale |
dichotomised CES-D score (≥16) |
Baseline depression is the most consistent psychological predictor of yearly worsening of pain. Association exists after adjusting for confounding variables. |
92 |
Disability: WOMAC disability scale |
Univariate analysis: WOMAC Pain: Estimate (95% CI)= 0.36 (0.16 to 0.56); p < 0.001 |
|||||
Multivariate analysis: WOMAC Pain: Estimate (95% CI)= 0.59 (0.18 to 1.01); p= 0.005 | ||||||
Chappell |
Randomised Controlled Trial(RCT) investigating the effect of antidepressant (Duloxetine) on knee OA |
Beck Depression Inventory-II (BDI-II) Hospital Anxiety and Depression Scale anxiety subscale (HADS-A) |
Knee Pain: Brief Pain Inventory (BPI); WOMAC pain and stiffness subscales Perceived improvement: Clinical Global Impressions of Severity (CGI-S) |
Mean change in pain score from baseline (at 13 weeks) |
Treatment with duloxetine 60 to 120 mg was associated with significant pain reduction in patients with pain due to knee OA. |
8* |
(USA, 2011) | ||||||
BPI average pain (% response) | ||||||
≥30%= 65.3 (antidepressant group= I) & 44.1 (placebo= C); p ≤ 0.001 | ||||||
WOMAC: -13.74 (I) -17.51 (C); p ≤0.05 | ||||||
CGI-S: -0.40 (I) & -0.70(C); p ≤ 0.01 | ||||||
Chappell |
RCT investigating the effect of antidepressant (Duloxetine) on knee OA |
Beck Depression Inventory-II |
Knee Pain: Weekly 24-h worst pain; WOMAC pain subscale |
Mean change (SD) in pain score from baseline (at 13 weeks) |
Duloxetine demonstrated statistically significant pain reduction compared with placebo. |
9* |
(USA, 2009) | ||||||
Hospital Anxiety and Depression Scale (HADS) | ||||||
BPI-S(Average pain): –2.82 ±0.21(C) –1.85 ± 0.21(C); p < .001 | ||||||
Severity: BPI-S, Brief Pain Inventory-Severity; CGI-S, Clinical Global Impressions of Severity | ||||||
WOMAC: –4.64 ± 0.35 (I) | ||||||
−3.24 ± 0.35(C); p= 0.003 | ||||||
CGI-S: -0.65 ±0.08(I) & –0.29 ± 0.08(C); p= 0.001 | ||||||
Abou-Raya |
RCT investigating the effect of antidepressant (Duloxetine) on knee OA | Geriatric depression scale | Knee Pain Visual analogue pain scale; WOMAC pain score | WOMAC pain score |
Duloxetine has a dual beneficial effect of improving depression and pain symptoms in older adults with knee OA. | 10* |
(Egypt, 2012) | (0–20): Mean (SD) |
|||||
At baseline: Intervention - 9.1(4.6) | ||||||
Placebo - 8.9(5.1); p= 0.44 | ||||||
At 16 weeks : Intervention - 6.0 (4.1) Placebo - 8.4 (5.4); p= 0.05 |
NHANES , National Health and Nutritional Examination Survey; PFS , Physical Functioning Score; WOMAC , Western Ontario and McMaster University Osteoarthritis Index; PCI , Pain Coping Inventory; 4DSQ , Four Dimensional Symptom Questionnaire; CES-D , Centre for Epidemiological Studies Depression Scale; QOL , Quality of Life; SF-36 , Short-Form-36 Health Survey; SSS - Social Support Scale; VAS , Visual Analogue Scale; OA , osteoarthritis; K/L scale , Kellgren and Lawrence Atlas of Standard Radiographs of Arthritis; WOMAC , Western Ontario and McMaster University Arthritis Index; MPQ , McGill Pain Questionnaire; AIMS , Arthritis Impact Measurement Scales; ACR , American College of Rheumatology; NA , not available; PFS , Physical Functioning Scale; IRGL , Invloed van Reuma op Gezondheid en Leefwijze (Dutch version of the Arthritis Impact Measurement Scale) *Indicates quality scores for RCTs as per the PEDro scale.