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J Pain. 2018 Jun;19(6):690-698. doi: 10.1016/j.jpain.2018.02.006. Epub 2018 Mar 2.

Within-Person Pain Variability and Mental Health in Older Adults With Osteoarthritis: An Analysis Across 6 European Cohorts.

Author information

Department of Epidemiology and Biostatistics / Amsterdam Public Health Research Institute, Vrije Universiteit Medical Center, Amsterdam, The Netherlands. Electronic address:
Department of Epidemiology and Biostatistics / Amsterdam Public Health Research Institute, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London / Physiotherapy Department, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom.
Geestelijke Gezondheidszorg inGeest / Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital / Queen Alexandra Hospital, Cosham, Portsmouth, United Kingdom.
National Research Council, Aging Branch, Institute of Neuroscience, Padova, Italy.
Department of Preventive Medicine and Public Health, Unit of Primary Care and Family Medicine, Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
AGAPLESION Bethesda Hospital, Geriatric Research Unit / Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
The Netherlands.
United Kingdom.


Pain is a key symptom of osteoarthritis (OA) and has been linked to poor mental health. Pain fluctuates over time within individuals, but a paucity of studies have considered day-to-day fluctuations of joint pain in relation to affective symptoms in older persons with OA. This study investigated the relationship of pain severity as well as within-person pain variability with anxiety and depression symptoms in 832 older adults with OA who participated in the European Project on OSteoArthritis (EPOSA): a 6-country cohort study. Affective symptoms were examined with the Hospital Anxiety and Depression Scale, pain severity was assessed with the Western Ontario and McMaster Universities OA Index and the Australian/Canadian Hand Osteoarthritis Index, and intraindividual pain variability was measured using pain calendars assessed at baseline, 6, and 12 to 18 months. Age-stratified multiple linear regression analyses adjusted for relevant confounders showed that more pain was associated with more affective symptoms in older-old participants (74.1-85 years). Moreover, older-old participants experienced fewer symptoms of anxiety (ratio = .85, 95% confidence interval [CI], .77-.94), depression (ratio = .90, 95% CI, .82-.98), and total affective symptoms (ratio = .87, 95% CI, .79-.94) if their pain fluctuated more. No such association was evident in younger-old participants (65-74.0 years). These findings imply that stable pain levels are more detrimental to mental health than fluctuating pain levels in older persons.


This study showed that more severe and stable joint pain levels were associated with anxiety and depressive symptoms in older persons with OA. These findings emphasize the importance of measuring pain in OA at multiple time points, because joint pain fluctuations may be an indicator for the presence of affective symptoms.


Osteoarthritis; anxiety symptoms; depressive symptoms; older persons; pain variability

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