Broken heart syndrome-like psychosomatic dysregulation in knee osteoarthritis: a bidirectional analysis of pain-stress coupling

Background: A prominent chronic musculoskeletal condition that is linked to pain, disability, and a lower quality of life is knee osteoarthritis (KOA). A biopsychosocial paradigm, which holds that psychological factors have a major impact on pain perception and functional limitation, is supported by emerging research. This model suggests a reciprocal relationship between emotional and physical health. Objective of the study was to evaluate gender-based variations across radiographic severity classes and to look into the relationship between pain intensity, functional impairment, and psychological distress in people with KOA. Methods: A cross-sectional observational study was conducted among 108 patients diagnosed with KOA. The WOMAC (modified CRD Pune version) was used to assess clinical severity, while the GAD-7 and PHQ-9 were used to assess anxiety and depressive symptoms. Pain-stress correlations were evaluated using Pearson's correlation, and male and female participants with Kellgren-Lawrence (K/L) grades II and III were compared using independent-samples t-tests. Results: Clinically significant patterns were found despite the lack of statistical significance (p>0.05). Increased psychological discomfort, especially depressive symptoms, was linked to higher WOMAC scores. In female participants, there was a somewhat favorable correlation between the severity of symptoms and depression (r=0.374, p=0.333), but anxiety exhibited mild correlations in both sexes. Pain, stiffness, function, and overall WOMAC ratings did not differ significantly based on sex across K/L grades (all p>0.05). These results point to a clinically significant connection between emotional discomfort and pain burden. Conclusions: According to the study, there might be a reciprocal relationship between psychological distress and chronic pain, supporting a biopsychosocial view of KOA. Routine rehabilitation that incorporates psychological evaluation may improve patient results and encourage more thorough, patient-centered care.