Study on the Current Status and Influencing Factors of Pain Beliefs in Elderly Patients with Knee Osteoarthritis Receiving Non-surgical Treatment:A Cross-Sectional Study

Abstract Objective This study aims to understand the current status of pain beliefs among elderly patients with knee osteoarthritis (KOA) undergoing nonsurgical treatment and to analyze the main associated factors. Methods This was a cross-sectional study. By means of convenience sampling, 265 patients who visited the orthopedics and pain clinics of a tertiary hospital from September 2025 to March 2026 were selected as the research subjects. A survey was conducted using the following instruments: a General Information Questionnaire, the Pain Beliefs and Perceptions Inventory (PBPI), the Visual Analogue Scale (VAS), the Shortened Chinese Version of the Family Resilience Assessment Scale (FRAS-C), the Short Form 36 Health Survey Questionnaire (SF-36), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results The total PBPI score among elderly KOA patients receiving nonsurgical treatment was (-0.08 ± 8.24), ranging from − 32 to 32, with lower scores indicating less negative pain beliefs (i.e., stronger positive beliefs). The scores of each dimension were: pain mystery (2.25 ± 2.85), self-blame (0.50 ± 2.40), belief that pain will continue (-2.48 ± 2.26), and belief that pain cannot be relieved (-0.35 ± 2.76). The total SF-36 score was 57.59 ± 16.30 (transformed norm-based scoring), the FRAS-C total score was 95.50 ± 9.99, and the WOMAC total score was 30.43 ± 14.96. Pain intensity (VAS score), marital status, family resilience, quality of life, and the WOMAC index were identified as significant associated factors for pain beliefs (P < 0.05). Specifically, higher pain intensity (β = 0.083, 95% CI: 0.01 to 3.67), being divorced or widowed (β = 0.101, 95% CI: 0.57 to 3.98), and higher WOMAC scores (β = 0.162, 95% CI: 0.03 to 0.15) were associated with more negative pain beliefs, whereas higher family resilience (β = -0.352, 95% CI: -0.37 to -0.21) and better quality of life (β = -0.406, 95% CI: -0.31 to -0.17) were associated with less negative pain beliefs. Conclusion Pain beliefs in this patient population are at a neutral level with considerable individual variation. Clinical healthcare professionals should pay attention to the status of pain beliefs and develop personalized intervention strategies for at-risk patients based on the identified associated factors.