Depression, Obesity Linked with Chronic Hip Pain

Patients with chronic hip pain were significantly more likely to be older, obese, and depressed, German researchers reported.

Compared with people with no hip pain, the following were tied to an increased likelihood of chronic hip pain in the large German cohort:

• Age: odds ratio 1.08 (95% CI 1.06-1.09)
• Obesity: OR 2.55 (95% CI 1.42-4.60)
• Increased depression value: OR 8.53 (95% CI 5.09-14.28)

These associations were even stronger among individuals with disabling chronic hip pain, with increased depression values having an over 28 times higher odds for disabling chronic hip pain (OR 28.22, 95% CI 12.98-61.33) compared with those who were hip pain-free, according to Martin Schwarze, DrMed, of Heidelberg University Hospital, and colleagues.

Age was also a predictor of disabling chronic hip pain (OR 1.09, 95% CI 1.06-1.12), although obesity was no longer a significant predictor for this level of hip pain, they reported in Musculoskeletal Care.

However, gender and social status were not tied to chronic or disabling hip pain.

“Our results support the recommendation of previous researchers, that additional diagnostic studies should be performed for patients who experience chronic hip pain, particularly when there is a discrepancy between subjective pain levels and objective functional limitations,” Schwarze and colleagues stated, explaining that evaluating psychological health status in people with chronic pain can sometimes pinpoint comorbid mental factors, which can lead to a more effective treatment plan.

“The intensity of pain experienced from the hip joint, and particularly the functional limitations that ensue, are influenced not only by the pathological changes in the joint, but also by psychological cofactors such as fear, depression and catastrophizing,” they added.

The observational, cross-sectional study included data on 2,514 individuals, ages ≥14 years. Participants were administered questionnaires regarding pain, with chronic hip pain defined as pain that occurred within the past 7 days and persisted over the previous 3 months. Disabling hip pain was defined according to a separate questionnaire that assessed five functionality areas, including physical, emotion, cognitive, social, and daily activity functioning. Depressive symptoms were assessed using the Beck Depression Inventory for Primary Care questionnaire.

In the cohort, nine reported acute hip pain, 124 chronic pain, and 39 disabling chronic pain, for a total of 172 (6.9%) participants who experienced some type and severity of hip pain, the authors said.

They reported a “satisfactory” response rate of 57% in the study, but pointed out that “we could not exclude a selection bias towards participants who experience pain being consequently more motivated to complete the questionnaire.” Also, the cross-sectional design could not show causality between the assessed risk factors and hip pain.

“Our results for depressive disorder showed a stronger association with hip pain than our results for obesity,” the authors noted. They suggested that future studies should specifically look at when, and to what extent, depressive symptomatology may influence the decision to undergo primary total hip arthroplasty in this population. Future research should also look at the clinical outcomes following psychological screening among patients with hip pain.