title: Is there an association between whole-body pain with osteoarthritis-related knee pain, pain catastrophizing, and mental health?
abstract: BACKGROUND
  Greater levels of self-reported pain, pain catastrophizing, and depression have been shown to be associated with persistent pain and functional limitation after surgeries such as TKA. It would be useful for clinicians to be able to measure these factors efficiently.
  
  
  OBJECTIVE
  We asked: (1) What is the association of whole-body pain with osteoarthritis (OA)-related knee pain, function, pain catastrophizing, and mental health? (2) What is the sensitivity and specificity for different cutoffs for body pain diagram region categories in relation to pain catastrophizing?
  
  
  METHODS
  Patients (n = 267) with knee OA undergoing elective TKA at one academic center and two community orthopaedic centers were enrolled before surgery in a prospective cohort study. Questionnaires included the WOMAC Pain and Function Scales, Pain Catastrophizing Scale (PCS), Mental Health Inventory-5 (MHI-5), and a pain body diagram. The diagram documents pain in 19 anatomic areas. Based on the distribution of the anatomic areas, we established six different body regions. Our analyses excluded the index (surgically treated) knee. Linear regression was used to evaluate the association between the total number of nonindex painful sites on the whole-body pain diagram and measures of OA-related pain and function, mental health, and pain catastrophizing. Generalized linear regression was used to evaluate the association between the number of painful nonindex body regions (categorized as 0; 1-2; or 3-6) with our measures of interest. All models were adjusted for age, sex, and number of comorbid conditions. The cohort included 63% females and the mean age was 66 years (SD, 9 years). With removal of the index knee, the median pain diagram score was 2 (25(th), 75(th) percentiles, 1, 4) with a range of 0 to 15. The median number of painful body regions was 2 (25(th), 75(th) percentiles, 1, 3).
  
  
  RESULTS
  After adjusting for age, sex, and number of comorbid conditions, we found modest associations between painful body region categories and mean scores for WOMAC physical function (r = 0.22, p < 0.001), WOMAC pain (r = 0.20, p = 0.001), MHI-5 (r = -0.31, p < 0.001), and PCS (r = 0.27, p < 0.001). A nonindex body pain region score greater than 0 had 100% (95% CI, 75%-100%) sensitivity for a pain catastrophizing score greater than 30 but a specificity of just 23% (95% CI, 18%-29%) . A score of 3 or greater had greater specificity (73%; 95% CI, 66%-79%) but lower sensitivity (53%; 95% CI, 27%-78%).
  
  
  CONCLUSIONS
  We found modest associations between the number of painful sites on a whole-body pain diagram and the number of painful body regions and measures of OA-related pain, function, pain catastrophizing, and mental health. Patients with higher self-reported body pain region scores might benefit from further evaluation for depression and pain catastrophizing.
  
  
  METHODS
  Level III, therapeutic study.
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.|Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis Street, PBB-B3, Boston, MA, 02115, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Amish J
authors.initials: AJ
authors.lastname: Dave
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Faith
authors.initials: F
authors.lastname: Selzer
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Klara
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Jamie E
authors.initials: JE
authors.lastname: Collins
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Ilana
authors.initials: I
authors.lastname: Usiskin
authors.affiliation: Department of Biochemistry and Molecular Pharmacology, NYU Langone Orthopaedic Surgery, NYU School of Medicine, New York, NY, USA.|NYU Langone Orthopaedic Surgery, NYU School of Medicine, New York, NY, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Band
authors.affiliation: Department of Orthopaedic Surgery, University of Maryland St Joseph Medical Center, Towson, MD, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Dalury
authors.affiliation: NYU Langone Orthopaedic Surgery, NYU School of Medicine, New York, NY, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
authors.affiliation: Orthopaedic Center of the Rockies, Fort Collins, CO, USA.
authors.forename: Kirk
authors.initials: K
authors.lastname: Kindsfater
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA. jnkatz@partners.org.|Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis Street, PBB-B3, Boston, MA, 02115, USA. jnkatz@partners.org.|Harvard Medical School, Boston, MA, USA. jnkatz@partners.org.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D019645:Arthroplasty, Replacement, Knee; D058443:Catastrophization / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery; D010147:Pain Measurement; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States