Pain Management Strategies in Patients with Knee Osteoarthritis and Hypertension: Use, and Differences in Pain and Arthritis Pain Self-Efficacy

Background: Chronic pain caused by knee osteoarthritis has a negative impact on patients’ quality of life. The prevalence of hypertension is high among patients with knee osteoarthritis, and usage of pain medications can increase patients’ blood pressure. Purpose: 1) Describe characteristics of pain and non pharmacological pain management strategies used by participants with knee osteoarthritis and hypertension in daily life; 2) Categorize pain management strategies and assess frequency and patterns of strategies patients used; and 3) Examine the effectiveness of pain management strategies on pain, and their relationship with pain self-efficacy. Method: This secondary analysis of data from a randomized controlled trial used qualitative and quantitative methods to address the aims. Seventy individuals from the 6-month intervention arm were included in this study. Qualitative data for Aims 1 and 2 were collected by semi-structured interview. Quantitative data for Aim 3 included participants’ knee pain, bodily pain, and pain self-efficacy, measured by Western Ontario and McMaster Universities Osteoarthritis Index, Short Form-36v2 Bodily Pain subscale, and Arthritis Pain Self-efficacy subscale, respectively, at baseline, immediate post-intervention, and 6 months post-intervention. Constant comparative and content analyses were used in Aims 1 and 2, respectively, to describe and summarize pain and pain management strategies that participants used. Linear mixed modeling was used in Aim 3 to assess differences in pain and pain self-efficacy for pain management strategies over time. Results: On average, participants employed five pain management strategies. The most commonly used strategies were practicing physical self-care activities, performing psychological self-care activities, being active, changing position, and avoiding overuse. Pain management strategies were categorized into treatment strategies only and both preventative and treatment strategies. Participants who only used treatment strategies reported significantly lower bodily pain (b=-7.94, p=.017) compared with participants who used both preventative and treatment strategies. A mediating effect of self-efficacy on the association between pain management strategies and pain was not found. Conclusion: Participants used multiple pain management strategies to control pain, and treatment strategies were favored, which health care providers can recommend to patients. Health care providers can suggest preventative strategies that are evidenced-based and that patients find effective to control their pain