Conference Papers

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Is there a relationship between the intermittent and constant osteoarthritis pain score (ICOAP) and pain flares in knee osteoarthritis?.
(W.B. Saunders-Elsevier, 2016) Atukorala, I.; Pathmeswaran, A.; Makovey, J.; Metcalf, B.; March, L.; Bennell, K.L.; Chang, T.; Zhang, Y.; Hunter, D.J.
PURPOSE: The Intermittent and Constant Osteoarthritis Pain Score (ICOAP) is a recently validated multidimensional osteoarthritis pain measure. This 11-item tool takes into account both the constant (6 items) and intermittent (5 items) pain of knee osteoarthritis (KOA) within 7 days summated to a single score. These items are scored from 0 (no pain) to 4 (extremely severe pain). The intent of this project was to assess the association and utility of ICOAP and its subscales in predicting pain flares in KOA identified by a 0-10 point numerical rating scale (NRS). METHODS: Study participants were selected from a 3-month web-based longitudinal follow up study developed to identify risk factors for KOA pain flares. Participants were requested to complete the ICOAP questionnaire at days 0, 30, 60 and 90 (control period assessment points) and at time points whenever they experienced knee pain flare (case period assessment points) during the follow up period. A KOA pain flare was defined as current pain with a greater than 2 point increase (on a 0-10point NRS) from the mildest KOA pain intensity reported at day 0. The ICOAP score at point of a KOA pain flare was used to identify whether ICOAP was associated with occurrence of a pain flare. Conditional logistic regression was used to identify the odds of association with pain flare by the individual subscales and total ICOAP. Receiver Operating Characteristic Curves (ROC curves) were used to assess the utility of the ICOAP and its subscales (immediately preceding the flare) in predicting pain flares using the pain flares identified by the numeric rating scale as the gold standard. The ICOAP value for the first flare during the follow up period was used to predict pain. RESULTS: 213 persons (61%females) with multiple KOA pain flares were selected. Their mean age was 62.1 years (SD 8.5). The mean body mass index was 29.8 kg/m2 (SD 6.5). There were 652 flares documented with 1232 control periods over a 3- month period. 325 flares had a documented ICOAP within the preceding 30 days. The time gap between control period and flare period assessment points differed between subjects with the mean time gap being 18.5 days (SD 9.3). The mean number of flares per person per month was 1.97 (SD 2.65). None of the patients had a pain flare at baseline ICOAP total, constant and intermittent subscales had a significant association with pain flare (Table 1). However, the ICOAP scores (total, constant and intermittent) did not usefully predict pain flares and demonstrated an area under the ROC curves of 0.69 (95% confidence interval (CI)0.67-0.72), 0.69 (95% CI 0.67-0.72), 0.67 (95% CI 0.64-0.69) for total ICOAP score, constant pain and intermittent pain subscales respectively. CONCLUSIONS: The total ICOAP score (as well as the Constant and Intermittent subscales) recorded at point of flare was associated with KOA pain flares identified by the NRS. However, the ICOAP and its subscales did not usefully predict a pain flare. The lack of difference between the constant and intermittent ICOAP score can be attributed to correlation of items in the two subscales. The lack of complete correlation between the ICOAP values and pain flare assessed by the NRS is possibly due to the multidimensional nature of the ICOAP in contrast to the uni-dimensional nature of NRS. (Table Presented).
Do traditional risk factors for knee osteoarthritis predict pain flares in knee osteoarthritis?.
(BMJ Publishing, 2016) Atukorala, I.; Pathmeswaran, A.; Chang, T.; Zhang, Y.; Hunter, D.J.
BACKGROUND: Knee pain is the main cause of disability and reduced function in knee osteoarthritis (KOA). Though knee pain in osteoarthritis was previously perceived as a chronic condition it is now established that KOA pain fluctuates. There is emerging evidence that time variant risk factors-such as knee injury, buckling and mood- are associated with knee pain flares. But, it is not known whether conventional risk factors associated with KOA - age, gender, body mass index-are associated with pain flares in KOA. OBJECTIVES: This study examines whether conventional time invariant risk factors for KOA and baseline pain felt by the patient are associated with KOA pain flares. METHODS: Study participants were selected from a 3-month web-based longitudinal follow up study developed to identify risk factors for KOA pain flares. Participants were requested to complete online questionnaire at days 0, 30, 60 and 90 (control period assessment points) and at time points whenever they experienced knee pain flare (case period assessment points) during the follow up period. A KOA pain flare was defined as current pain with a greater than 2 point increase (on a 0-10 point numeric rating scale) from the mildest KOA pain intensity reported at day 0. The association of pain flares with traditional risk factors for knee osteoarthritis -gender, weight, height, body mass index- was assessed by negative binomial regression. The duration of knee osteoarthritis, baseline pain intensity (lowest pain and highest pain scores at baseline) were similarly evaluated. The best explanatory variable was decided by forward selection. RESULTS: 345 persons (61.2% females) with multiple KOA pain flares were selected. Their mean age was 62.1years (SD +/-8.2). The mean body mass index was 29.8kg/m2 (SD +/-6.5). The participants rated their baseline pain (on a numeric rating scale) as being 4.41 (SD+/- 2.02) and their worst pain as being 7.91 (SD +/-1.74). An average of 1.92 (SD 2.59) flares were documented during the 3-month period. The levels of baseline pain - usual and worst pain felt at baseline- were the only parameters significantly associated with KOA pain flares (Table 1). CONCLUSIONS: The baseline pain scores were the strongest predictors of pain flares of knee osteoarthritis. The traditional risk factors associated with knee osteoarthritis did not usefully predict pain flares. The traditional time invariant risk factors may not be associated with short term variability in pain though they are associated with long term outcomes of knee osteoarthritis. It is postulated that as knee pain is already present, time invariant risk factors that contributed to the original symptom causation are not associated with pain flare. (Table Presented).

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