385: THE ASSOCIATION OF MOVEMENT-EVOKED PAIN WITH COGNITIVE / EMOTIONAL FACTORS: A CROSS-SECTIONAL STUDY

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Physiotherapy (e.g. exercise, rehab), Quantitative Sensory testing (static and dynamic, e.g., HPT, PPT, CPM, TSP, offset analgesia)

Background and Aims: Movement-evoked pain (MEP) is a key feature of knee osteoarthritis (KOA) that often results in limited physical activity and reduced quality of life. Despite its clinical relevance, MEP is a relatively new construct, resulting in sparse and heterogenous knowledge in assessing the influence of individual psychological factors on MEP intensity. An individual’s pattern of physical (in)activity may be affected by MEP, along with associated thoughts and feelings of their painful movements. However, this relationship remains under-researched. Therefore, the aim of this study is to determine (a) the association and explained variances of situational catastrophizing, knee confidence, and fear of movement with MEP and (b) whether associations differ based on the perceived threat of the task.

Methods: This cross-sectional study included people with diagnosed KOA or fulfilling KOA NICE Criteria and activity-related knee pain ≥3/10 most days of the past month. Exclusion criteria: inflammatory arthritis, recovering from a lower-limb injury or total knee replacement, inability to complete physical performance tests (PPT), provide consent, understand English. Participants completed 3 PPTs (30-second sit-to-stand test, 9-step stair climb, and 6-minute walk test) and rated their peak MEP (0-100) following each task. Before PPTs, participants ranked them from most to least threatening regarding the expected knee pain and completed the Brief Fear of Movement Scale for Osteoarthritis (BFMSO) and a question on knee confidence. After PPTs participants completed the Situational Catastrophizing Questionnaire (SCQ). A hierarchical linear regression model for each PPT assessed the association and explained variance of all factors with MEP. Variables were entered in blocks and models were adjusted for age, sex, BMI and pain at rest (0-100).

Results: Data from 81 participants (64% female) with a mean age of 67.5 years (SD: 8.4) were included in the analysis. The adjusted r-squared value for the sit-to-stand, stair climb, and 6-minute walk models including BFMSO, knee confidence, and SCQ were 0.37 (F(7,73) = 7.85, RMSE = 17.66), 0.56 (F(7,73) = 15.38, RMSE = 13.92) and 0.48 (F(7,73) = 11.66, RMSE = 17.00), respectively. BFMSO and knee confidence scores were not significantly associated with MEP in any models. SCQ was significant in all models with a beta value of 2.95 (95% CI = 1.37, 4.53) for the sit-to-stand model, 2.73 (95% CI = 1.25, 4.22) for the stair climb model, and 3.10 (95% CI = 1.62, 4.57) for the 6-minute walk model. The addition of perceived threat ranking to each model did not improve model fit, nor its explained variance (adjusted r-squared: sit-to-stand=0.36, stair climb=0.55, 6-minute walk=0.47).

Conclusions: The findings of this study provide the first momentary cognitive pain appraisals for MEP in people with KOA explaining ~50% of the variance in stair climb and 6-minute walk tests. Although the effects of situational catastrophizing were not clinically significant, our results suggest that momentary negative pain appraisals may play a role in shaping pain responses compared to broader constructs such as fear of movement and knee confidence providing an opportunity for clinicians to the address the cognitions in the SCQ items. These results combined with the small evidence base warrant further study to more fully understand the impact of cognitive appraisals on MEP.

References: Fullwood, D., et al., Toward Understanding Movement-evoked Pain (MEP) and its Measurement: A Scoping Review. Clin J Pain, 2021. 37(1): p. 61-78.

Leemans, L., et al., It Hurts to Move! Intervention Effects and Assessment Methods for Movement-Evoked Pain in Patients With Musculoskeletal Pain: A Systematic Review with Meta-analysis. J Orthop Sports Phys Ther, 2022. 52(6): p. 345-374.

​National Clinical Guideline, C., National Institute for Health and Clinical Excellence: Guidance, in Osteoarthritis: Care and Management in Adults. 2014, National Institute for Health and Care Excellence (UK). Copyright © National Clinical Guideline Centre, 2014.: London.

Presenting Author: Lisa Carlesso
Submitting Author: Lisa Carlesso

Senior Author: Lisa Carlesso

IASP 2026 Global Year theme of Neuropathic Pain: No

• Eden Daniel: MSc - McMaster University
• Luciana Macedo: PhD - McMaster University
• Ayse Kuspinar: PhD - McMaster University