title: When knee pain becomes severe: a nested case-control analysis in community-dwelling older adults.
abstract: Mild knee pain is a common symptom in later life. Despite this fact, there are few data on the impact of it worsening or how individuals alter their appraisals and behavior when it becomes severe. We sought to describe the changes that accompany a substantial deterioration in characteristic knee pain. A nested case-control analysis of existing cohort data identified 57 adults aged over 50 years experiencing progression from mild to severe characteristic pain intensity 18 months later and compared them, before and after this transition, with 228 controls whose knee pain did not progress. Worsening knee pain was accompanied by a marked increase in pain frequency and extent, functional limitation, depressive symptoms, catastrophising, praying and hoping, and use of oral and topical analgesia. Most individuals consulted a general practitioner either during or after this episode. Although relatively rare, substantial deterioration in knee pain has a major impact on those affected. Timely presentation to primary care, addressing potentially unhelpful appraisals and coping strategies, reinforcing core nonpharmacological management, and future research to identify triggering events for substantial deterioration and loss of adequate pain control should be part of an agenda to improve care for this important minority of older adults with knee pain.
  
  
  CONCLUSIONS
  This article describes what happens when the common symptom of mild knee pain in later life becomes significantly worse. The results may help clinicians understand the health impact, changes in patient appraisal and coping, and treatments that typically accompany this change in symptoms.
authors.affiliation: Arthritis Research Campaign, National Primary Care Centre, Keele University, Keele, United Kingdom. g.m.peat@cphc.keele.ac.uk
authors.forename: George
authors.initials: G
authors.lastname: Peat
authors.forename: Elaine
authors.initials: E
authors.lastname: Thomas
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007717:Knee; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology*; D010146:Pain / Q000453:epidemiology* / Q000503:physiopathology*; D010147:Pain Measurement; D010342:Patient Acceptance of Health Care; D012651:Self Medication; D013997:Time Factors