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• Posted June 30, 2023

Fixing a Painful Joint Problem Won't Ease Mental Health Ills, Study Finds

Blaming your ailing knees for feeling down?

Unfortunately, even after physical pain eases, healing or fixing an injured joint often does not improve mental health, research shows.

A new study found that anxiety symptoms only improved when a patient had major improvements in physical function.

Depression, meanwhile, did not meaningfully improve even when the improvements to physical function were significant.

“We wanted to find out if patients have fewer symptoms of anxiety and depression as physical function improves and pain lessens,” said senior study author Dr. Abby Cheng, an assistant professor of orthopedic surgery at Washington University School of Medicine in St. Louis. “The answer is that they mostly do not.”

It's reasonable that someone might feel frustrated, anxious or depressed when they're experiencing pain.

Cheng said the findings came as a surprise even though in her practice she often sees people whose physical health has improved without dramatic gains in mental health.

“What was interesting to me was that patients' anxiety lessened somewhat in cases where patients experienced notable improvements in physical health, but depression did not improve in many such instances,” she said. “As physicians, what we really care about is how patients feel. One patient might be happy because now he or she can walk a mile, and that's good. But other patients who can walk a mile might not be happy because they no longer can run marathons, and that's not good. Patient perceptions of their well-being are what are really important, and those don't necessarily improve when pain diminishes and physical function improves.”

To study this, researchers used data from more than 11,000 patients treated in Washington University orthopedic clinics over nearly seven years.

At check-in, each patient was given a tablet and asked questions about whether their orthopedic problems were interfering with their lives.

Among the questions were these: “In the past seven days, how much did pain interfere with your ability to do household chores?” and “In the past seven days, how much did pain make it difficult to fall asleep?”

The questionnaire also asked about each person's mental health and wellness.

“Our goal is to treat a person, not just fix a hip or a knee, and physical problems are connected to mood and anxiety, even to depression,” Cheng said. “Patients have a lot going on, and it's difficult to provide good care without taking the big picture into account.”

While some other studies have found that treating specific musculoskeletal problems had led to at least some improvements in mental health symptoms, that's not what this study found, Cheng said.

“Patients may be less anxious six months after surgery, but five years down the line the story may be very different," she said. "Those symptoms of anxiety often return, although perhaps the focus of the anxiety no longer is related to the patient's hip or other orthopedic problem.”

The study, which was funded by the National Institutes of Health, were published June 28 in JAMA Network Open.

More information

The American Psychiatric Association has more on chronic pain and mental health.

SOURCE: Washington University School of Medicine in St. Louis, news release, June 28, 2023