The Natural History of Knee Osteoarthritis Pain Experience and Risk Profiles

Alison H. Chang, Orit Almagor, Jungwha (Julia) Lee, Jing Song, Lutfiyya N. Muhammad, Joan S. Chmiel, Kirsten C. Moisio, Leena Sharma

Research output: Contribution to journalJournal articleResearchpeer-review

1 Citation (Scopus)


The study aimed to characterize the natural history of the pain experience, concurrently considering intermittent and constant pain over 4 years, and determine baseline factors associated with unfavorable trajectories in individuals with chronic knee pain. The Osteoarthritis Initiative (OAI) is a prospective, observational study of people with or at higher risk for knee osteoarthritis. The Intermittent and Constant Osteoarthritis Pain (ICOAP) was assessed annually at 48-to-96-month OAI visits. Twenty-eight baseline sociodemographic, knee-specific, and health-related characteristics were assessed. Group-based dual-trajectory modeling identified pain experience patterns indicated by ICOAP intermittent and constant pain scores over 4 years. Multivariable multinomial logistic regression models determined baseline factors associated with membership in each dual-trajectory group. Four longitudinal pain experience patterns were identified (n = 3,584, mean age = 64.8 [standard deviation 9.0] years, BMI = 28.6 [5.0] kg/m2; 57.9% women). Group 1 (37.7%) had minimal intermittent and no constant pain; Group 2 (35.1%) had mild intermittent and no constant pain; Group 3 (18.5%) had mild intermittent and low-grade constant pain; and Group 4 (8.7%) had moderate intermittent and constant pain. Baseline widespread pain, knee stiffness, back pain, hip pain, ankle pain, obesity, depressive symptoms, more advanced radiographic disease, and analgesic use were each associated with an increased risk of membership in less favorable Groups 2, 3, and 4. These distinct courses of pain experience may be driven by different underlying pain mechanisms. The benchmarked ICOAP scores could be used to stratify patients and tailor management. Addressing and preventing the development of modifiable risks (eg, widespread pain and knee joint stiffness) may reduce the chance of belonging to unfavorable dual-trajectory groups. Perspective: Concurrently tracking intermittent versus constant pain experience, group-based dual-trajectory modeling identified 4 distinct pain experience patterns over 4 years. The benchmarked ICOAP scores in these dual trajectories could aid in stratifying patients for tailored management strategies and intensity of care.

Original languageEnglish
JournalJournal of Pain
Issue number12
Pages (from-to)2175-2185
Number of pages11
Publication statusPublished - Dec 2023
Externally publishedYes

Bibliographical note

Copyright © 2023 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.


  • dual trajectory
  • intermittent and constant osteoarthritis pain
  • Knee osteoarthritis
  • natural history
  • pain


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