Objective To assess whether brief mindfulness-based cognitive behavioral therapy (MBCBT) could enhance the benefits of total knee arthroplasty (TKA) in improving pain and pain-related disability. Specifically, to determine (1) whether patients who received MBCBT differed from matched controls who received treatment as usual (TAU) on post-surgical pain outcomes, and (2) whether changes in pain catastrophizing, depression, and/or anxiety explained the potential effects of MBCBT on pain outcomes. Design Pilot clinical trial. Subjects Sample of 44 patients undergoing TKA. Patients who completed a brief MBCBT intervention (n = 22) were compared with age-, race-, and sex-matched controls who received TAU (n = 22). Methods The MBCBT intervention included 4, 60-minute sessions delivered by a pain psychologist in-person and via telephone during the perioperative period. Participants were assessed at baseline, 6 weeks, 3 months, and 6 months post-surgery. Results Compared to matched controls, patients who received MBCBT had lower pain severity and pain interference at 6-week post-surgery. Group differences in outcomes were mediated by changes in pain catastrophizing, but not by changes in depression or anxiety. The MBCBT group had similar reductions in pain severity and interference as the control group at 3- and 6-month post-surgery. Conclusions This work offers evidence for a safe and flexibly delivered nonpharmacological treatment (MBCBT) to promote faster recovery from TKA and identifies change in pain catastrophizing as a mechanism by which this intervention may lead to enhanced pain-related outcomes. Clinical Trial Registration ClinicalTrials.gov (NCT04328701) https://clinicaltrials.gov/ct2/show/NCT04328701?term=NCT04328701&draw=2&rank=1
Background and Objectives Knee osteoarthritis is one of the primary causes of chronic pain among older adults and because of the aging population, the number of total knee arthroplasties (TKAs) performed is exponentially increasing. While pain reduction is a goal of TKA, movement-evoked pain is rarely assessed pre- and post-TKA. We characterized the distributions of change in pain, function, and situational catastrophizing in patients from pre-surgery to 3 months post-surgery and explored associations among these pre-post changes. Research Design and Methods This prospective study longitudinally assessed movement-evoked pain, function, and situational catastrophizing in patients with knee osteoarthritis (N=92) using in-person performance-based tests (6-minute walk test [6MWT], stair-climb test [SCT]) prior to and 3-months after TKA. Patients also completed the Western Ontario McMaster Universities Scales (WOMAC) pain and function subscales, and Pain Catastrophizing Scale (PCS), pre-surgery and 3- and 6-months post-surgery. Results Movement-evoked pain and function on performance tests significantly improved from pre- to post-TKA. Improved SCT function was associated with reduced SCT pain and catastrophizing. Similarly, reduced pain during the SCT was associated with reduced catastrophizing during the SCT. However, 6MWT function was not associated with 6MWT pain or catastrophizing; yet reduced pain during the 6MWT was associated with reduced catastrophizing during the 6MWT. Reduced movement-evoked pain during both performance tests was consistently associated with improved WOMAC function and pain, whereas improved function on performance tests was inconsistently associated with WOMAC function and pain. Notably, greater movement-evoked pain on both performance tests at 3-months post-TKA was associated with worse WOMAC function and pain at 6 months, whereas better function on performance tests at 3-months was associated with better WOMAC function, but not related to WOMAC pain at 6 months. Discussion and Implications Findings highlight the importance of situation-specific and in-vivo assessments of pain and catastrophizing during physical activity.
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