In the follow-up study, which also tapped data from HOSTAS, the researchers chose to examine the data from another angle, looking at 356 patients more individually. To do so, they utilized the Australian/ Canadian hand osteoarthritis index (AUSCAN) pain subscale, initially and for four years annually. They categorized patients with deteriorated pain, stable pain or improved pain using patient reports via the Minimal Clinically Important Improvement (MCII) measure.1
Pain Course
At an individual level, pain course seemed variable. Four years after the initial assessment, pain had worsened in 30% of patients, but had remained stable for 32% and had improved in 38%. Using the patient acceptable symptom state (PASS) patient-reported outcome, which describes the highest level of symptoms at which patients regard the symptom as acceptable, 44% met PASS levels at baseline and 49% at follow-up.1 Dr. van der Meulen notes that overall pain scores were consistent with what had previously been found in the literature.
Illness Perceptions & Coping Styles
The investigators used the Illness Perception Questionnaire (IPQ), which measures eight different domains in which patients may perceive their disease and their level of control over it.10 They found that patients with less perceived understanding of the disease (the illness coherence category of the IPQ) were more likely to experience improvements in their pain. Patients with a higher perception of negative disease consequences from hand OA (via the IPQ) were less likely to experience improvement in their pain over the period.1
Although the general literature on patient education suggests increased health literacy may be associated with less pain intensity, it’s possible in this case that some patients had a darker view of their prognosis than is fully warranted, influencing their pain course through a sort of nocebo effect.11
“The expectations people have of their disease may influence how they experience it,” explains Dr. van der Meulen. “I think that’s where the importance of proper patient education comes in. If you always tell patients that their pain is only going to get worse, you may bias them toward a more negative experience of their symptoms.”
The investigators also used the Coping with Rheumatic Stressors (CORS) questionnaire, a tool developed for use in rheumatic diseases that categorizes eight different coping styles—different ways to think about and manage the impact of the disease. They identified one particular coping style that was more likely to be associated with pain worsening over a four-year period.1
