Table 6.
Studies examining the relationship between anxiety and knee pain
| Author (year) | Study design | Assessment of anxiety | Assessment of pain | Results | Conclusion | Quality score |
|---|---|---|---|---|---|---|
| Creamer (1999 – Baltimore study) |
Cross-sectional |
Arthritis Impact Measurement Scales (AIMS) Questionnaire: (Anxiety subscale) |
Pain on most days for at least one month (NHANES-1) |
Women reporting having knee pain had higher anxiety than those reporting never having knee pain (3.06 ± 0.26 vs 2.35 ± 0.17, p= 0.025). |
Anxiety was associated with pain in women, but not men. |
55 |
| Pain reporting was not related to anxiety in men (data not shown). |
Women reporting knee pain, in the absence of radiographic osteoarthritis, had higher anxiety scores than those without pain. |
|||||
| Analysis stratified by radiographic severity. It showed that differences in anxiety were confined to subjects reporting knee pain in the absence of radiographic change (i.e., KL grade 0) (statistics not available). | ||||||
| Creamer (1999) |
Cross-sectional |
State-Trait Anxiety Inventory (STAI) |
Pain Severity |
MPQ: r= 0.30 (p < 0.05). |
Anxiety was not found to be associated with pain in patients with knee OA. |
55 |
| (WOMAC, Visual Analogue Scale, |
VAS: r= 0.19 (NS) |
|||||
| WOMAC: r= 0.23 (NS) | ||||||
| McGill Pain Questionnaire (MPQ)) |
In the stepwise regression models after adjustment, anxiety did not remain. |
|||||
| Salaffi (1991) |
Cross-sectional |
Zung Anxiety Inventory |
Pain |
Stepwise multiple regression: |
Anxiety was found to be related to pain. |
45 |
| (McGill Pain Questionnaire (MPQ), Visual Analogue Scale (VAS)) |
MPQ: R= 0.19; t= 2.245 p < 0.05 |
|||||
| VAS: R= 0.21; t= 2.88; p < 0.01 | ||||||
| Van Baar (1998) |
Cross-sectional |
IRGL Questionnaire |
Severity of pain: Visual Analogue Scale |
Bivariate Correlation: |
Anxiety was not associated with knee pain although there was bivariate correlation between anxiety and pain. |
64 |
| Knee pain: r= 0.30 p ≤ 0.01 | ||||||
| Regression Analysis: NS | ||||||
| Peat (2009) |
Nested case control |
Hospital Anxiety and Depression Scale |
Characteristic pain intensity: Chronic Pain Grade |
Mean difference (95% CI) of anxiety between cases and controls at 18 months: 1.0 |
There was no significant association between knee pain and perceived anxiety. |
79 |
| Pain extent: areas of pain experienced in previous month shaded on whole-body manikin |
(−0.2 to 2.3) |
|||||
| Night pain: single item on WOMAC | ||||||
| Piva (2009) | Longitudinal | Beck Anxiety Index | 11 point Numerical Pain Rating Scale (NPRS) | Correlation with anxiety |
There was no significant association between anxiety and pain. | 85 |
| NPRS: r= 0.34; P ≤ 0.01 | ||||||
| Forward Multiple Regression- Not significant |
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).