Relationship of anxiety with joint pain and its management: A population survey.
OBJECTIVES
The aims of the present study was to examine the associations between the severity of pain and anxiety in a community population reporting joint pain, and to investigate the management of joint pain in the presence of comorbid anxiety.


METHODS
A population survey was carried out of people aged ≥45 years, registered with eight general practices in Cheshire, Shropshire and Staffordshire, UK. Respondents were asked to report pain intensity in their hands, hips, knees and feet (on a numerical rating scale), anxiety symptoms (Generalized Anxiety Disorder seven-item [GAD-7] scale) and guideline-recommended treatments used to manage pain. Clinical anxiety was defined by a GAD-7 score of 10 or more.


RESULTS
A total of 11,222 respondents with joint pain were included in the analysis, with 1,802 (16.1%) reporting clinical anxiety. Respondents reporting more severe pain were more likely to report clinical anxiety (severe versus mild pain, odds ratio [OR] 5.36, 95% confidence interval [CI] 4.56 to 6.31). The number of pain sites was also positively associated with clinical anxiety (four versus one site; OR 3.64, 95% CI 3.09 to 4.30). Those with clinical anxiety were less likely to undertake general fitness exercises (OR 0.60, 95% CI 0.52 to 0.70), but more likely to diet (OR 1.43, 95% CI 1.21 to 1.69), use walking aids (OR 1.53, 95% CI 1.32 to 1.77) and assistive devices (OR 1.24, 95% CI 1.04 to 1.49), and more likely to use opioids (OR 1.34, 95% CI 1.18 to1.52).


CONCLUSIONS
Anxiety is common among patients presenting to primary care with joint pain. Patients with anxiety are likely to manage their joint pain differently to those without. Case-finding to identify and treat anxiety would be appropriate in this population, with caution about opioid prescribing and consideration of exercise as an intervention.
['Barnett|Lauren A|LA|', 'Pritchard|Mark G|MG|', 'Edwards|John J|JJ|0000-0003-0432-7783', 'Afolabi|Ebenezer K|EK|', 'Jordan|Kelvin P|KP|', 'Healey|Emma L|EL|', 'Finney|Andrew G|AG|', 'Chew-Graham|Carolyn A|CA|', 'Mallen|Christian D|CD|', 'Dziedzic|Krysia S|KS|']
D000368:Aged D000369:Aged, 80 and over D001007:Anxiety D001168:Arthritis D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D059408:Pain Management D011795:Surveys and Questionnaires D006113:United Kingdom
anxiety joint pain analgesia osteoarthritis primary health care questionnaire survey