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The pain that accompanies joint disease is responsible, more than any other medical condition, for the disability that accompanies aging. The National Arthritis Data Workgroup, organized by the National Institutes of Health, estimates a prevalence of self-reported arthritis in people over age 65 to be about 50%. Arthritis limits activity in 11.6% of people over age 65.42 While the prevalence and incidence of joint disease do increase with age, this is not merely a disease of the old nor is it an inevitable consequence of aging. Arthritis and musculoskeletal disorders are one of the leading causes of disability in people ages 16-72. Sixty percent of people with arthritis are of working age. Arthritis cost the US economy 65 billion dollars in medical costs and lost wages in 1992.78 Arthritis is second only to heart disease as a cause of work disability.
Osteoarthritis is a disorder of synovial joints that results in destruction of articular cartilage, increased formation of subchondral bone, and formation of new bone at joint margins. Since abnormalities are not restricted to one type of tissue in OA, it has been suggested that "joint failure" can be used to describe the pathogenesis, similar to kidney failure or heart failure that may result from many different primary tissue disorders. Although a common synonym for OA is degenerative joint disease, this term is not completely correct, since it is now known that, at least in the initial stages of the disorder, a misguided effort by the chondrocytes to regenerate cartilage is responsible for many of the clinical features of this condition.
PAIN PERCEPTION AND ASSESSMENT: GENERAL CONSIDERATIONS
Pain is a subjective experience, and it cannot be directly measured or observed. Moreover, not only is the severity of disease not a reliable marker for pain severity, but pain severity is influenced by much more than the physical process. Thoughts and emotions contribute to that central descending control of peripheral nociception. An individual's level of stress, anxiety, and depression and the coping skills he or she has to adapt to life circumstances have great impact on pain perception, and treating those factors directly improves outcomes in chronic pain syndromes. Treatment of depression and mood disturbances is an important strategy in managing chronic pain from a variety...