The impact of pain on quality of life in patients with osteoarthritis: a cross-sectional study from Palestine

Shalhoub et al. BMC Musculoskeletal Disorders (2022) 23:248 https://doi.org/10.1186/s12891-022-05207-x Open Access RESEARCH The impact of pain on quality of life in patients with osteoarthritis: a cross-sectional study from Palestine Mojahed Shalhoub1, Mohammad Anaya1, Soud Deek1, Anwar H. Zaben2, Mazen A. Abdalla1,2, Mohammad M. Jaber1,2, Amer A. Koni3,4 and Sa’ed H. Zyoud4,5,6* Abstract Background: Osteoarthritis is one of the most common musculoskeletal problems. Pain is the most common complaint and the most significant cause of decreased health-related quality of life (HRQOL) among osteoarthritic patients. The objectives of this study were to assess the impact of pain on quality of life among patients with osteoarthritis and to assess the association of sociodemographic and clinical factors with HRQOL. Methods: Using a cross-sectional study design, we collected data from osteoarthritis patients in orthopedic outpatient clinics from four hospitals in the Palestine-West bank between November 2020 and March 2021. We used the Brief Pain Inventory (BPI) scale to assess pain and the Quality of Life scale five dimensions (EQ-5D) with the visual analog scale of the European Quality of Life (EQ-VAS) to assess HRQOL. Results: In our study, 196 patients composed the final sample, with an average of 60.12 ± 13.63 years. The medians for the EQ-5D score and EQ-VAS score were 0.72 (0.508–0.796) and 70 (55–85), respectively. The pain severity score was found to have a significant negative association with both the EQ-5D and EQ-VAS scores with r of − 0.620, p <  0.001, and − 0.554, p <  0.001, respectively. Similar associations were found between pain interference score and both EQ-5D (r = − 0.822, p <  0.001) and EQ-VAS scores (r = − 0.609, p <  0.001). Multiple regression analysis showed that participants with higher educational level (p = 0.028), less diseased joints (p = 0.01), shorter duration of disease (p = 0.04), and lesser pain severity and interference scores (both with p < 0.001) had significantly higher HRQOL scores. Conclusions: We found that many variables have a significant negative impact on HRQOL among patients with osteoarthritis. Our finding provides a well-founded database to use by clinicians and healthcare professionals who work with patients with osteoarthritis, as well as educational and academic institutions. Keywords: Osteoarthritis, Quality of life, Pain, Brief pain inventory, EQ-5D, EQ-VAS, Palestine Background Osteoarthritis (OA) is an age-related disease characterized pathologically by areas of focal damage and loss of articular cartilage in synovial joints [1], is one of the most *Correspondence: 4 Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus 44839, Palestine Full list of author information is available at the end of the article frequent chronic diseases that can lead to loss of quality of life and increased prevalence and incidence due to increased life expectancy [1]. Worldwide, osteoarthritis affects approximately 7% of the population [2]. The primary clinical symptom of osteoarthritis is pain, which can be intermittent or constant [3]. Pain is the symptom that forces patients to seek medical advice and contributes the most to functional limitations and reduced quality of life [3]. Specifically, the impact of OA on the quality © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Shalhoub et al. BMC Musculoskeletal Disorders (2022) 23:248 of life was found to be significantly associated with the sites of pain and sex [4]. However, pain is not the only symptom of osteoarthritis. Patients may also suffer from joint stiffness, especially in the morning [5], and joint cracking during movement [6]. Osteoarthritis can be diagnosed by taking a complete comprehensive history and physical examination [7]. The diagnosis may or may not require radiographic findings, considering that some patients may initially be asymptomatic [7]. Osteoarthritis is classified into two main types based on previous abnormalities in the affected joint. The first type is primary osteoarthritis, which occurs in joints without a previous abnormality and an inciting trauma or agent. The second type is secondary osteoarthritis, which is more common than the primary type. It is usually due to a previous joint abnormality, such as trauma, rheumatoid arthritis, avascular necrosis, hemoglobinopathy, Paget disease, Ehlers-Danlos syndrome, or Marfan syndrome [8, 9]. There are many risk factors for osteoarthritis, some of which are modifiable, and some are nonmodifiable. The most important modifiable factors are obesity, occupational status, comorbidities, and physical activity that can be managed to improve joint function. Nonmodifiable risk factors include age and genetic or hereditary mutations that increase the susceptibility to osteoarthritis [10, 11]. In Europe, it was reported that a large percentage of OA patients (59.6%) complained of moderate to severe pain and had a significant impact on several aspects of health [12]. It was also documented that patients with moderate to severe pain due to OA had a high impact on the quality of life, even using medications [12]. In addition, the OA population had lower social relationships, psychological well-being, and independent living than individuals without OA [13]. That necessitates appropriate intervention to enhance their HRQOL [13]. Due to the impact of osteoarthritis on quality of life, many therapies are used to improve symptoms in these patients, although no treatment delays or prevents osteoarthritis or provides longterm relief of symptoms [14]. In general, OA treatment options depend on the severity and duration of patient symptoms. They include non-pharmacological (i.e., physical therapy), pharmacological (i.e., acetaminophen and non-steroidal anti-inflammatory drugs), complementary (i.e., yoga and acupuncture), and surgical op (...truncated)