Changes in Anxiety and Depression Are Mediated by Changes in Pain Severity in Patients Undergoing Lower-Extremity Total Joint Arthroplasty

Hassett, Afton L.; Marshall, Elizabeth; Bailey, Angela M.; Moser, Stephanie; Clauw, Daniel J.; Hooten, W. Michael; Urquhart, Andrew G.; Brummett, Chad M.

doi:10.1097/aap.0000000000000682

Cited by 56 publications

(36 citation statements)

References 28 publications

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“…In a systematic review, post-operative pain was reported in 9% of patients after THA in the follow-up [31]. Improvements in pain and physical function after lower extremity total joint arthroplasty were associated with improvement in depression and anxiety symptoms [32]. After having had an acute pain experience, some patients are unable to resume their daily levels of activity and tend to regard pain as a threat [33].…”

Section: Discussionmentioning

confidence: 99%

Excellent Functional Outcome and Quality of Life after Primary Cementless Total Hip Arthroplasty (THA) Using an Enhanced Recovery Setup

Leiß

Götz

Maderbacher

et al. 2021

JCM

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Background: Total hip arthroplasty combined with the concept of enhanced recovery is of continued worldwide interest, as it is reported to improve early functional outcome and treatment quality without increasing complications. The aim of the study was to investigate functional outcome and quality of life 4 weeks and 12 months after cementless total hip arthroplasty in combination with an enhanced recovery concept. Methods: A total of 109 patients underwent primary cementless Total Hip Arthroplasty (THA) in an enhanced recovery concept and were retrospectively analyzed. After 4 weeks and 12 months, clinical examination was analyzed regarding function, pain and satisfaction; results were evaluated using Harris Hip score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EQ-5D-5L, EQ-VAS and subjective patient-related outcome measures (PROMs). Preoperatively, HADS (Hospital Anxiety and Depression Scale) was collected. A correlation analysis of age, American Society of Anesthesiologists (ASA), HADS and comorbidities (diabetes mellitus, art. hypertension, cardiovascular disease) with WOMAC, Harris Hip score (HHS) and EQ-5D was performed. Results: Patients showed a significant improvement in Harris Hip score 4 weeks and 12 months postoperatively (p < 0.001). WOMAC total score, subscale pain, subscale stiffness and subscale function improved significantly from preoperative to 12 months postoperative (p < 0.001). EQ-5D showed a significant improvement preoperative to postoperative (p < 0.001). The influence of anxiety or depression (HADS-A or HADS-D) on functional outcome could not be determined. There was a high patient satisfaction postoperatively, and almost 100% of patients would choose enhanced recovery surgery again. Conclusion: Cementless THA with the concept of enhanced recovery improves early clinical function and quality of life. PROMs showed a continuous improvement over a follow-up of 12 months after surgery. PROMs can help patients and surgeons to modify expectations and improve patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Excellent Functional Outcome and Quality of Life after Primary Cementless Total Hip Arthroplasty (THA) Using an Enhanced Recovery Setup

Leiß

Götz

Maderbacher

et al. 2021

JCM

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“…Chronic pain after TKA can affect all dimensions of health-related quality of life, and has been found to be associated with functional limitations, depression, anxiety, poorer general health, sleep problems and long-term opioid use. 28 - 32 Older people with chronic pain after joint arthroplasty can experience interference with relationships and become socially isolated, which is a risk factor for other problems and can limit their capacity to bring about change or to seek help for their pain. 31 , 33 , 34 Some people experience considerable pain-related distress, and this is often highest in those who experience no change or deterioration in pain symptoms following surgery.…”

Section: Personal and Economic Impactmentioning

confidence: 99%

Chronic pain after total knee arthroplasty

Wylde¹,

et al. 2018

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Despite a good outcome for many patients, approximately 20% of patients experience chronic pain after total knee arthroplasty (TKA).Chronic pain after TKA can affect all dimensions of health-related quality of life, and is associated with functional limitations, pain-related distress, depression, poorer general health and social isolation.In both clinical and research settings, the approach to assessing chronic pain after TKA needs to be in-depth and multidimensional to understand the characteristics and impact of this pain. Assessment of this pain has been inadequate in the past, but there are encouraging trends for increased use of validated patient-reported outcome measures.Risk factors for chronic pain after TKA can be considered as those present before surgery, intraoperatively or in the acute postoperative period. Knowledge of risk factors is important to guide the development of interventions and to help to target care. Evaluations of preoperative interventions which optimize pain management and general health around the time of surgery are needed.The causes of chronic pain after TKA are not yet fully understood, although research interest is growing and it is evident that this pain has a multifactorial aetiology, with a wide range of possible biological, surgical and psychosocial factors that can influence pain outcomes.Treatment of chronic pain after TKA is challenging, and evaluation of combined treatments and individually targeted treatments matched to patient characteristics is advocated. To ensure that optimal care is provided to patients, the clinical- and cost-effectiveness of multidisciplinary and individualized interventions should be evaluated.Cite this article: EFORT Open Rev 2018;3:461-470. DOI: 10.1302/2058-5241.3.180004

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“…However, it is difficult to establish a clear relationship between any one of these variables. Prospectively collected data following total knee and hip arthroplasty found that improvements in pain and physical function were associated with improvements in anxiety and depression 6 months after surgery, and the change in overall body pain mediated these changes in affect 35. Unfortunately, our study was underpowered to detect mediating factors such as overall body pain that may play a role.…”

Section: Discussionmentioning

confidence: 86%

Medial branch radiofrequency ablation outcomes in patients with centralized pain

Morffi

Larach

Moser

et al. 2019

Reg Anesth Pain Med

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Background and objectivesWe hypothesized that patients with characteristics of centralized pain (fibromyalgia (FM)-like phenotype) would be less likely to respond to radiofrequency ablation (RFA), which may explain some of the failures of this peripherally directed therapy.MethodsWe conducted a prospective, observational study of patients undergoing RFA using a number of validated self-report measures of pain, mood and function. The 2011 Fibromyalgia Survey Criteria were used to assess for symptoms of centralized pain and was the primary predictor of interest. We constructed multivariable linear regression models to evaluate covariates independently associated with change in pain 3 months after RFA.Results141 patients scheduled for medial branch blocks were enrolled in the study; 55 underwent RFA (51 with complete 3 months’ follow-up). Patients with higher FM scores had less improvement in overall body pain; however, this was not statistically significant (adjusted mean change in pain FM+0.41, FM−1.11, p=0.396). In a secondary analysis, the FM score was not associated with change in back pain (p=0.720), with both groups improving equally. This cohort also reported significant improvement in anxiety, physical function, catastrophizing, and sleep disturbance at 3 months after RFA.ConclusionsAlthough patients with high baseline centralized pain exhibited less improvement in overall pain, this trend was not statistically significant, possibly due to insufficient power. The same trend was not seen with change in spine pain with both groups improving equally. Centralized pain patients may have less improvement in overall pain but may have equal improvement in their site-specific pain levels after localized interventions.

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Changes in Anxiety and Depression Are Mediated by Changes in Pain Severity in Patients Undergoing Lower-Extremity Total Joint Arthroplasty

Cited by 56 publications

References 28 publications

Excellent Functional Outcome and Quality of Life after Primary Cementless Total Hip Arthroplasty (THA) Using an Enhanced Recovery Setup

Excellent Functional Outcome and Quality of Life after Primary Cementless Total Hip Arthroplasty (THA) Using an Enhanced Recovery Setup

Chronic pain after total knee arthroplasty

Medial branch radiofrequency ablation outcomes in patients with centralized pain

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