Psychology or Radiographic Evidence? Surprising New Pain Study

Pain is hot these days…and anything we can determine that informs our understanding of the relationship between pain and musculoskeletal health is welcome.

New work from the University of Texas Southwestern Medical Center (UT Southwestern), “Do psychological factors or radiographic severity play a role in the age of onset in symptomatic developmental dysplasia of hip and femoroacetabular impingement syndrome?” appears in BMC Musculoskeletal Disorders.

Joel Wells M.D., M.P.H., assistant professor in the department of orthopedic surgery at UT Southwestern, and co-author described where this study fits in the continuum of care for total arthroplasty patients to OTW. “I see all ages, patients from 12 to 90. And patients present so differently, even though they have similar pathology. Not to mention, it has been shown in hip preservation that often times patients that presented later or older may not have the same results after a hip preservation procedure. Therefore, I sought to determine if other aspects of a patient, not just their hip severity, correlated with age of onset of symptoms.”

So, to try to tease out answers to this complicated question, Wells and his co-authors collected demographic, clinical, and radiographic data on 56 patients with developmental dysplasia of the hip and 84 patients with femoroacetabular impingement syndrome. Each patient was diagnosed by the team based on radiographic findings and clinical history. The researchers then determined the age of onset by subtracting each patient’s reported duration of symptoms from each patient’s age at presentation. The team also assessed each patients pain catastrophizing (PCS) and depression using a pain catastrophizing scale and the hospital anxiety and depression scale (HADS), respectively.

Dr. Wells summarized his study findings to OTW, “Although a patient’s pain catastrophizing did not correlate with age of onset of symptoms, radiographic severity and limitations in functional outcome did. This is important to understand, that even though patients may experience pain differently, and cope with pain differently, ultimately radiographic severity of disease did correlate with the age of symptom onset.”

“It is important to understand more than just a patient’s hip, we are treating complex patients that experience pain differently. Yet, radiographic severity, an objective not subjective measure, ultimately leads all patients to eventually have symptoms no matter how they experience or deal with pain.”

“The ultimate goal of this work was to find factors that lead to either a late or early age of onset. It is important to catch patients with hip dysplasia and femoroacetabular impingement as soon as possible, in order to help prevent or delay a disease…hip arthritis. If we want to cure a disease such as hip arthritis, it is important to understand all factors that cause patients to present with symptoms.”