Assessing chronic joint pain: lessons from a focus group study

Abstract

Objective: To explore the pain experience of persons with chronic pain of the hip or knee in the context of self-assessment instruments commonly used to assess pain severity in individuals with osteoarthritis.

Methods: Participants who reported that they currently had either hip or knee pain were recruited from the UK Somerset and Avon Survey of Health. A total of 28 participants (14 men and 14 women, ages 57-89 years) took part in 6 focus groups stratified according to pain site and severity. Using the "questerviews" technique, participants described and discussed their experience of joint pain in the context of standard self-assessment questionnaires: the Hip Disability and Osteoarthritis Outcome Score and the Knee Injury and Osteoarthritis Outcome Score. The focus groups were audio recorded and transcribed. Data were analyzed by identifying emergent codes that were grouped and compared, resulting in the identification of key categories.

Results: Both knee pain and hip pain participants expressed similar pain experiences. Four key categories were identified, all of which impacted upon participants' responses to the standardized questionnaires: pain is intermittent and variable, pain elsewhere in the body influences the experience of joint pain, pain is inextricable from function, and adaptation and avoidance strategies modify the experience of pain.

Conclusion: The assessment or measurement of pain should take into account the importance of pain experience as well as severity through use of patient narrative accounts.