Skip to main content
SpringerLink
Log in

Pain and disability in osteoarthritis: A review of biobehavioral mechanisms

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Pain and disability are cardinal symptoms in osteoarthritis. The literature is reviewed in order to identify causes of these symptoms at the articular, kinesiological, and psychological level. It is concluded that pain and disability are associated with degeneration of cartilage and bone (articular level), with muscle weakness and limitations in joint motion (kinesiological level), and with anxiety, coping style, attentional focus on symptoms, and possibly depression (psychological level). Biobehavioral mechanisms of pain and disability which explain the observed associations are described and the empirical evidence for these mechanisms is evaluated. Methodological and conceptual deficiencies in the research reviewed are pointed out and suggestions for further research are given.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Acheson, R. M., and Ginsburg, G. N. (1973). New Haven survey of joint diseases. XVI. Impairment, disability and arthritis.Br. J. Prev. Soc. Med. 27: 168–176.

    PubMed  Google Scholar 

  • Acheson, R. M., Chan, Y. K., and Clemett, A. R. (1970). New Haven survey of joint diseases. XII. Distribution and symptoms of osteoarthrosis in the hands with reference to handedness.Ann. Rheum. Dis. 29: 275–286.

    PubMed  Google Scholar 

  • Badley, E. M., Wagstaff, S., and Wood, Ph. H. N. (1984). Measures of functional ability (disability) in arthritis in relation to impairment of range of joint movement.Ann. Rheum. Dis. 43: 563–569.

    PubMed  Google Scholar 

  • Baron, M., Dutil, E., Berkson, L., Lander, Ph., and Becker, R. (1987). Handfunction in the elderly: Relation to osteoarthritis.Arth. Rheum. 14: 815–819.

    Google Scholar 

  • Barksy, A. J., and Klerman, G. L. (1983). Overview: Hypochondriasis, bodily complaints and somatic styles.Am. J. Psychiat. 140: 273–283.

    PubMed  Google Scholar 

  • Beals, C., Lampman, R. M., Banwell, B. F., Braunstein, E. M., Albers, J. W., and Castor, C. W. (1985). Measurement of exercise tolerance in patients with rheumatoid arthritis or osteoarthritis.J. Rheumatol. 12: 458–461.

    PubMed  Google Scholar 

  • Brandt, K. D. (1985a). Degenerative joint disease and other primary diseases in cartilage. In Kelley, W. N., Harris, E. D., Rudy, S., and Sledge, C. B. (eds.),Textbook of Rheumatology, 2nd ed., Saunders, Philadelphia, pp. 1417–1431.

    Google Scholar 

  • Brandt, K. D. (1985b). Osteoarthritis: Clinical patterns and pathology. In Kelley, W. N., Harris, E. D., Ruddy, S., and Sledge, C. B. (eds.),Textbook of Rheumatology, 2nd ed., Saunders, Philadelphia, pp. 1432–1447.

    Google Scholar 

  • Cobb, S., Merchant, W. R., and Rubin, T. (1957). The relationship of symptoms to osteoarthritis.J. Chron. Dis. 5: 197–204.

    PubMed  Google Scholar 

  • Davis, M. A. (1981). Sex differences in reporting osteoarthritic symptoms: A sociomedical approach.J. Health Soc. Behav. 22: 298–310.

    PubMed  Google Scholar 

  • Dolce, J. J., and Raczynski, J. M. (1985). Neuromuscular activity and electromyography in painful backs: Psychological and biomechanical models in assessment and treatment.Psychol. Bull. 97: 502–520.

    PubMed  Google Scholar 

  • Ekdahl, C., Andersson, S., and Svensson, B. (1989). Muscle function of the lower extremities in rheumatoid arthritis and osteoarthritis.J. Clin. Epidemiol. 42: 947–954.

    PubMed  Google Scholar 

  • Felson, D. T., Maimark, A., Anderson, J., Kazis, L., Castelli, W., and Meenan, R. F. (1987). The prevalence of knee osteoarthritis in the elderly.Arth. Rheum. 30: 914–918.

    Google Scholar 

  • Feuerstein, M., Papciak, A. S., and Hoon, P. E. (1987). Behavioral mechanisms of chronic low back pain.Clin Psychol. Rev. 7: 243–273.

    Google Scholar 

  • Flor, H., and Turk, D. C. (1984). Etiological theories and treatments for chronic back pain. I. Somatic models and interventions.Pain 19: 105–121.

    PubMed  Google Scholar 

  • Forman, M. D., Malamet, R., and Kaplan, D. (1983). A survey of osteoarthritis of the knee in the elderly.J. Rheumatol. 10: 282–287.

    PubMed  Google Scholar 

  • Gresham, G. E., and Rathey, U. K. (1975). Osteoarthritis in knees of aged persons: relationship between roentgenographic and clinical manifestations.JAMA 233: 168–170.

    PubMed  Google Scholar 

  • Guccione, A. A., Felson, D. T., and Anderson, J. J. (1990). Defining arthritis and measuring functional status in elders: Methodological issues in the study of disease and physical disability.Am. J. Public Health 80: 945–949.

    PubMed  Google Scholar 

  • Keefe, F. J., and Gill, K. M. (1986). Behavioral concepts in the analysis of chronic pain syndromes.J. Consult. Clin. Psychol. 54: 776–783.

    PubMed  Google Scholar 

  • Keefe, F. J., Caldwell, D. S., Queen, K. T., Gil, K. M., Martinez, S., Crisson, J. E., Ogden, W., and Nunley, J. (1987a). Pain coping strategies in osteoarthritis patients.J. Consult. Clin. Psychol. 55: 208–212.

    PubMed  Google Scholar 

  • Keefe, F. J., Caldwell, D. S., Queen, K., Gil, K. M., Martinez, S., Crisson, J. E., Ogden, W., and Nunley, J. (1987b). Osteoarthritic knee pain: A behavioral analysis.Pain 28: 309–321.

    PubMed  Google Scholar 

  • Kellgren, J. H. (1983). Pain in osteoarthritis.J. Rheum. (Suppl. 9) 10: 108–109.

    Google Scholar 

  • Kellgren, J. H., and Lawrence, J. S. (1952). Rheumatism in miners. Part II: X-ray study.Br. J. Industr. Med. 9: 197–207.

    Google Scholar 

  • Kellgren, J. H., and Lawrence, J. S. (1957). Radiological assessment of osteoarthrosis.Ann. Rheum. Dis. 16: 494–502.

    PubMed  Google Scholar 

  • Kellgren, J. H., and Lawrence, J. S. (1963).Atlas of Standard Radiographs, prepared by Department of Rheumatology and Medical Illustrations, University of Manchester, Blackwell, Oxford.

    Google Scholar 

  • Kirwan, J. R., and Silman, A. J. (1987). Epidemiological, sociological and environmental aspects of rheumatoid arthritis and osteoarthritis.Baillieres Clin. Rheumatal. 1: 467–489.

    Google Scholar 

  • Lankhorst, G. J., Van de Stadt, R. J., Van der Korst, J. K., Hinlopen-Bonrath, E., Griffioen, F. M. M., and De Boer, W. (1982). Relationship of isometric knee extension torque and functional variables in osteoarthritis of the knee.Scand. J. Rehab. Med. 14: 7–20.

    Google Scholar 

  • Lankhorst, G. J., Van de Stadt, R. J., and Van der Korst, J. K. (1985). The relationships of functional capacity, pain and isometric and isokinetic torque in osteoarthritis of the knee.Scand. J. Rehab. Med. 17: 167–172.

    Google Scholar 

  • Lawrence, J. S., Bremmer, J. M., and Bier, F. (1966). Osteoarthritis: Prevalence in the population and relationship between symptoms and x-ray changes.Ann. Rheum. Dis. 25: 1–24.

    PubMed  Google Scholar 

  • Lichtenberg, P. A., and Skehan, M. W., and Swensen, C. H. (1984). The role of personality, recent life stress and arthritic severity in predicting pain.J. Psychosom. Res. 28: 231–236.

    PubMed  Google Scholar 

  • Lorig, K., Konkol, L., and Gonzalez, V. (1987). Arthritis patient education: A review of the literature.Pat. Educ. Couns. 10: 207–252.

    Google Scholar 

  • Lunghi, M. E., Miller, P. McC, and McQuillan, W. M. (1978). Psychological factors in osteoarthritis of the hip.J. Psychosom. Res. 22: 57–63.

    PubMed  Google Scholar 

  • Massardo, L., Watt, I., Cushnaghan, J., and Dieppe, P. (1989). Osteoarthritis of the knee joint: An eight year prospective study.Ann. Rheum. Dis. 48: 893–897.

    PubMed  Google Scholar 

  • McCaul, K. D., and Malott, J. M. (1984). Distraction and coping with pain.Psychol. Bull. 95: 516–533.

    PubMed  Google Scholar 

  • Miller, R., Kettelkamp, D., Laubenthal, K. N., Karagiorgos, A., and Smidt, G. L. (1973). Quantitative correlations in degenerative arthritis of the knee.J. Bone Joint Surg. 55: 956–962.

    PubMed  Google Scholar 

  • Minor, M. A., Hewett, J. E., Webel, R. R., Dreisinger, T. E., and Kay, D. R. (1988). Exercise tolerance and disease related measures in patients with rheumatoid arthritis and osteoarthritis.J. Rheumatol. 15: 905–911.

    PubMed  Google Scholar 

  • Moskowitz, R. W. (1985). Clinical and laboratory findings in osteoarthritis. In McCarthy, P. J. (ed.),Arthritis and Allied Conditions, 10th ed., Lea and Febiger, Philadelphia, pp. 1408–1431.

    Google Scholar 

  • Nordesjö, L. O., Nordgren, B., Wigren, A., and Kolstad, K. (1983). Isometric strength and endurance in patients with severe rheumatoid arthritis or osteoarthritis in the knee joints.Scand. J. Rheumatol. 12: 152–156.

    PubMed  Google Scholar 

  • Patrick, M., Aldridge, S., Hamilton, E., Manhire, A., and Doherty, M. (1989). A controlled study of hand function in nodal and erosive osteoarthritis.Ann. Rheum. Dis. 48: 978–982.

    PubMed  Google Scholar 

  • Peck, J. R., Smith, T. W., Ward, J. R., and Milano, R. (1989). Disability and depression in rheumatoid arthritis.Arth. Rheum. 32: 1100–1106.

    Google Scholar 

  • Pennebaker, J. W. (1982).The Psychology of Physical Symptoms, Springer, New York.

    Google Scholar 

  • Philips, H. C. (1987). Avoidance behavior and its role in sustaining chronic pain.Behav. Res. Ther. 25: 273–279.

    Article  PubMed  Google Scholar 

  • Pincus, T., Callahan, L. F., Bradley, L. A., Vaughn, W. K., and Wolfe, F. (1986). Elevated MMPI scores for hypochondriasis, depression and hysteria in patients with rheumatoid arthritis reflect disease rather than psychological status.Arth. Rheum. 29: 1456–1466.

    Google Scholar 

  • Pincus, T., Mitchell, J. M., and Burkhauser, R. V. (1989). Substantial work disability and earnings losses in individuals less than age 65 with osteoarthritis: Comparisons with rheumatoid arthritis.J. Clin. Epidemiol. 42: 449–457.

    PubMed  Google Scholar 

  • Revenson, T. A., and Felton, B. J. (1989). Disability and coping as predictors of psychological adjustment to rheumatoid arthritis.J. Consult. Clin. Psychol. 57: 344–348.

    PubMed  Google Scholar 

  • Steinbrocker, O., Traegger, C., and Batterman, R. (1948). Therapeutic criteria in rheumatoid arthritis.JAMA 140: 659–662.

    Google Scholar 

  • Stokes, M., and Young. A. (1984). The contribution of reflect inhibition to arthrogenous muscle weakness.Clin. Sci. 67: 7–14.

    PubMed  Google Scholar 

  • Summers, M. N., Haley, W. E., Reveille, J. D., and Alarcon, G. S. (1988). Radiographic assessment and psychologic variables as predictors of pain and functional impairment in osteoarthritis of the knee or hip.Arth. Rheum. 31: 204–209.

    Google Scholar 

  • Threlkeld, A. J., and Currier, D. P. (1988). Osteoarthritis: Effects on synovial joint tissues.Phys. Ther. 68: 364–370.

    PubMed  Google Scholar 

  • Turk, D. C., and Flor, H. (1984). Etiological theories and treatments for chronic back pain. II. Psychological models and interventions.Pain 19: 209–233.

    PubMed  Google Scholar 

  • Watson, D., and Pennebaker, J. W. (1989). Health complaints, stress and distress: Exploring the central role of negative affectivity.Psychol. Rev. 96: 234–254.

    PubMed  Google Scholar 

  • Yelin, E., Lubeck, D., Holman, H., and Epstein, W. (1987). The impact of rheumatoid arthritis and osteoarthritis: The activities of patients with rheumatoid arthritis compared to controls.J. Rheumatol. 14: 710–717.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Netherlands Institute of Primary Health Care, P.O. Box 1568, 3500, BN Utrecht, The Netherlands

    Joost Dekker

  2. Faculty of Human Movement Sciences, Free University, Amsterdam, The Netherlands

    Bob Boot & Luc H. V. van der Woude

  3. Department of Rheumatology, University of Utrecht, Utrecht, The Netherlands

    J. W. J. Bijlsma

Authors
  1. Joost Dekker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bob Boot
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luc H. V. van der Woude
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. W. J. Bijlsma
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dekker, J., Boot, B., van der Woude, L.H.V. et al. Pain and disability in osteoarthritis: A review of biobehavioral mechanisms. J Behav Med 15, 189–214 (1992). https://doi.org/10.1007/BF00848325

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00848325

Key words

Search

Navigation