Knee osteoarthritis pain worsens depression | Depression worsens knee osteoarthritis pain

There is a lot of research being published on the effects of depression on knee pain. In much of the research, investigators say that doctors are not in tune with these problems in their patients and their scoring systems for documenting depression may not be accurate. The one common thread that appears in many of the studies is that the knee pain patient suffering from depression needs to be offered treatments that give them hope and have a good personal support system.

A study lead by the University of Southern California looked further into behavioral modification in knee and hip osteoarthritis patients with depression. In the very simplest terms, behavioral modification in patients with depression is training in how to replace pessimistic/catastrophizing thoughts, with thoughts that are more optimistic.

The researchers noted that based on existing literature, demographic (age, sex, race/ethnicity, and education) and clinical variables (disease severity, body mass index, patient treatment expectations, depression, and patient pain coping style) were specified as targets for potential moderators.

Trial outcome variables (the factors that would influence all the patients regardless of age or weight for example, included pain, fatigue, self-efficacy (a belief in one’s own ability to succeed), quality of life, catastrophizing, and use of pain medication.

The researchers identified the 5 key factors that would influence successful or non-successful treatment outcomes in patients with osteoarthritis:

  1. The ability to cope with pain
  2. The patient expectation for treatment response
  3. radiographically assessed disease severity (The researchers looked at the MRIs of knee and hip osteoarthritis to determine severity of the disease)
  4. age, and
  5. education.

Surprisingly they found that levels of depression at baseline were not associated with treatment response. So if a patient had less severe depression or more severe depression, their test outcome would be the same.

What is one to make of this research?

“It is becoming increasingly evident that structural changes alone do not account for all musculoskeletal pain”

Let’s go further into the complex MRI discussion.

Doctors from the Benha University School of Medicine in Egypt wrote in the European journal of rheumatology of how depression may make knee pain significantly worse than it should be, at least significantly worse than an MRI suggests.

In the research we cited above, the MRI suggested that the patient’s pain should be worse, in this research the MRI is suggesting that the patient’s pain should be less. The patients in the above study had worse MRI and less pain, the patients as we will see in this study, had “better” MRIs and more pain. This is of course the inherent problem of MRIs, they do not always tell the true story.

These are the learning points from the Egyptian research:

At the University of Maryland, doctors examined depressive symptoms clearly associated with increases in pain and functional limitations in knee osteoarthritis patients. Publishing in the journal Clinical rheumatology, this research construct was to determine if depression severity accelerated problems of knee osteoarthritis and document it by radiographic and clinical assessments. They could not find evidence  that depressive symptoms have a detectable effect on changes in radiographic disease severity in knee osteoarthritis.

Are doctors asking patients the right questions to get the best determination of the patient’s depression challenges

Writing in the medical journal Disability and rehabilitation, researchers in the United Kingdom are suggesting that people with chronic knee pain and hip osteoarthritis may benefit from “Acceptance commitment therapy,” a form of psychotherapy and behavioral modification. They hope this treatment would be especially hopeful in people who have significant pain. Such as those in the above study whose MRIs suggested that they should not have the severe pain they are suffering from.

As a side note, the researchers also questioned whether accepted depression and physiological scoring systems, such as the Rasch-transformed and standard scales were accurate in assessing these patients.3 In other words, were doctors asking patients the right questions to get the best determination of the patient’s depressive challenges?

In another study, the same group of researchers writing in the medical journal Disability and rehabilitation examined the type of questionnaires that should be offered to patients with knee osteoarthritis to determine levels of hopelessness and depression.

Here is what they wrote:



In the above studies from 2016 and 2017, doctors tried to come up with plans treating a symptom of knee pain, that is depression.

In 2009, our team published in the Journal of Prolotherapy our findings on healing knee pain. This is what we wrote:

This observational study was the first to show Prolotherapy helps not only the physical components of unresolved knee complaints such as pain, stiffness, range of motion and crunching sensations, but also helps numerous quality of life functions including walking ability, sleep, athletic ability, activities of daily living, and feelings of depression and anxiety.

This study also showed that 15 months after their last Prolotherapy session, the vast majority of improvements continued.

In this study population, Prolotherapy reduced the patients’ subjective overall disability, medication usage, other pain therapy treatments needed, as well as depressed and anxious feelings.

Prolotherapy improved the patients walking and exercise ability, sleep, activities of daily living, and work situation. For the vast majority of the patients, Prolotherapy had a long lasting effect and changed their lives for the better.

You can read that complete study here Prolotherapy research for unresolved knee pain.

Are you a candidate for our non-surgical treatments? Ask our specialists:

Contact us now!

1 Broderick JE, Keefe FJ, Schneider S, Junghaenel DU, Bruckenthal P, Schwartz JE, Kaell AT, Caldwell DS, McKee D, Gould E.  Cognitive behavioral therapy for chronic pain is effective, but for whom?. Pain. 2016 Sep 1;157(9):2115-23.

2 El Monaem SM, Hashaad NI, Ibrahim NH. Correlations between ultrasonographic findings, clinical scores, and depression in patients with knee osteoarthritis. European Journal of Rheumatology. 2017 Sep;4(3):205.

3 Clarke SP, Poulis N, Moreton BJ, Walsh DA, Lincoln NB. Evaluation of a group acceptance commitment therapy intervention for people with knee or hip osteoarthritis: a pilot randomized controlled trial. Disability and rehabilitation. 2017 Mar 27;39(7):663-70.

4 Lincoln N, Moreton B, Turner K, Walsh D. The measurement of psychological constructs in people with osteoarthritis of the knee: a psychometric evaluation. Disabil Rehabil. 2017 Feb;39(4):372-384. doi: 10.3109/09638288.2016.1146356. Epub 2016 Mar 17. [Pubmed]

5. Rathbun AM, Yau MS, Shardell M, Stuart EA, Hochberg MC. Depressive symptoms and structural disease progression in knee osteoarthritis: data from the Osteoarthritis Initiative. Clin Rheumatol. 2017 Jan;36(1):155-163. doi: 10.1007/s10067-016-3495-3. Epub 2016 Dec 12. [Pubmed]

4 Patel S, Heine PJ, Ellard DR, Underwood M. Group exercise and self-management for older adults with osteoarthritis: a feasibility study. Prim Health Care Res Dev. 2016 May;17(3):252-64. doi: 10.1017/S1463423615000389. [Pubmed]


Make an Appointment |

Subscribe to E-Newsletter
Find out if you are a good candidate
First Name:
Last Name:

Enter code:

for your symptoms

Prolotherapy, an alternative to surgery

Were you recommended SURGERY?
Get a 2nd opinion now!

★ ★ ★ ★ ★We pride ourselves on 5-Star Patient Service!Come see why patients travel from all
over the world to visit our clinics.
Current Patients
Become a New Patient

Chicagoland Office
715 Lake St., Suite 600
Oak Park, IL 60301
(708) 393-8266 Phone
(855) 779-1950 Fax
Southwest Florida Office
9738 Commerce Center Ct.
Fort Myers, FL 33908
(239) 308-4701 Phone
(855) 779-1950 Fax Fort Myers, FL Office
We are an out-of-network provider.
© 2018 | All Rights Reserved | Disclaimer
National Prolotherapy Centers specializing in Comprehensive Prolotherapy,
Stem Cell Therapy, and Platelet Rich Plasma.

Meet our Prolotherapy Doctors and check out our Prolotherapy research.