The pain was the main driver of seeking medical care in an Arthritis Care & Research study of patients with osteoarthritis. In addition to pain, insomnia and depression increased health care use

In the study of 2976 patients, half of the participants presented with at least one of the three symptoms (pain, insomnia, depression), and approximately 34% and 29% suffered from insomnia or depression, respectively, in addition to moderate to severe pain.

The combined effects of pain + insomnia, and pain + depression were additive and increasingly diverse types of health care use, and these effects increased greatly with increasing insomnia and depression severity after controlling for pain. The findings indicate the important role that concurrent symptomatic conditions may play in increasing the use of health care services.

Results

About 34% and 29% of participants presented at least sub?clinical insomnia and at least sub?clinical depression symptoms, respectively, in addition to moderate to severe pain.

The pain had the largest independent effects on increasing all types of HCU, followed by depression (moderate effects) on increased office visits, LOS, outpatient and inpatient costs, and insomnia (mild effects) on decreased LOS.

No synergistic effects were found on HCU among the three symptoms. Combined effects of pain + insomnia, and pain + depression were significant for all types of HCU and increased greatly with increasing insomnia and depression severity except for hip/knee replacement.

"Pain, insomnia, and depression are common in older adults with osteoarthritis. Unfortunately, they commonly occur together," said lead author Dr. Minhui Liu, of Johns Hopkins University School of Nursing.

"To our knowledge, our study is the first to examine their effects on diverse health care use. We are glad to find that although their effects on health care use are substantial, their combined effects are not greater than the sum of their individual effects, which is good for patients."