title: Understanding the pain experience in hip and knee osteoarthritis--an OARSI/OMERACT initiative.
abstract: OBJECTIVE
  To examine the pain experience of people with hip or knee osteoarthritis (OA), particularly changes over time and most distressing features.
  
  
  METHODS
  Focus groups in individuals aged 40+ years with painful hip or knee OA obtained detailed descriptions of OA pain from early to late disease. A modified Patient Generated Index (PGI) was used to assess the features of OA pain that participants found most distressing. Content analysis was performed to examine response patterns; descriptive statistics were used to summarize PGI responses.
  
  
  RESULTS
  Mean age of the 143 participants (52 hip OA; 91 knee OA) was 69.5 years (47-92 years); 60.8% were female and 93.7% Caucasian. Participants described two distinct types of pain - a dull, aching pain, which became more constant over time, punctuated increasingly with short episodes of a more intense, often unpredictable, emotionally draining pain. The latter, but not the former, resulted in significant avoidance of social and recreational activities. From PGI responses, distressing pain features were: the pain itself (particularly intense and unpredictable pain) and the pain's impact on mobility, mood and sleep.
  
  
  CONCLUSIONS
  Two distinct pain types were identified. Intermittent intense pain, particularly when unpredictable, had the greatest impact on quality of life.
authors.affiliation: Division of Rheumatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada. gillian.hawker@wchospital.ca
authors.forename: G A
authors.initials: GA
authors.lastname: Hawker
authors.forename: L
authors.initials: L
authors.lastname: Stewart
authors.forename: M R
authors.initials: MR
authors.lastname: French
authors.forename: J
authors.initials: J
authors.lastname: Cibere
authors.forename: J M
authors.initials: JM
authors.lastname: Jordan
authors.forename: L
authors.initials: L
authors.lastname: March
authors.forename: M
authors.initials: M
authors.lastname: Suarez-Almazor
authors.forename: R
authors.initials: R
authors.lastname: Gooberman-Hill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000503:physiopathology*; D020370:Osteoarthritis, Knee / Q000503:physiopathology*; D010146:Pain / Q000523:psychology*; D010358:Patient Participation; D036301:Qualitative Research; D011788:Quality of Life; D012720:Severity of Illness Index