Liu M, et al. - Researchers investigated whether pain with concurrent insomnia and depression symptoms influence the use of health care services in older adults with osteoarthritis (OA). Among patients with a primary diagnosis of OA from Group Health Cooperative (GHC) (n=2,976), at minimum subclinical insomnia and at minimum subclinical depression symptoms, in addition to moderate-to-severe pain, were reported in approximately 34% and 29% of patients, respectively. In patients with OA, the pain was identified as the main driver for health care use. Increase in various types of health care use was reported in relation to insomnia plus depression combined with pain. With increasing severity of insomnia and depression, a large increase in these combined effects was seen. These findings suggest that concurrent symptomatic conditions may play an important role in increasing the use of health care services.