Brief Mindfulness-Based Cognitive Behavioral Therapy is Associated with Faster Recovery in Patients Undergoing Total Knee Arthroplasty: A Pilot Clinical Trial

Abstract

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

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“…Based on their ability to heighten healing processes, whether they can assist in efforts to improve cartilage regeneration efforts or minimize inflammation that can worsen structural damage should be examined. In the interim it appears adding a mindfulness-based intervention to neuromuscular exercises and others appears to reduce pain intensity and improve function, balance and quality of life in adults with knee osteoarthritis [55], in addition to speeding up recovery post knee joint replacement therapy [58].…”

Let’s Get Physical! A Comprehensive Review of Pre- and Post-Surgical Interventions Targeting Physical Activity to Improve Pain and Functional Outcomes in Spine Surgery Patients

“…Finally, it is recommended that future studies test interventions focusing on other relevant behavioral and cognitive targets in addition to physical activity (e.g., social support, pain catastrophizing, pain self-efficacy) to effectively enhance recovery and long-term outcomes after spine surgery. For example, recent studies have suggested that reductions in catastrophizing and fear of movement mediate the beneficial effects of CBT on improving pain and function after a variety of surgeries, including knee surgery [ 67 ] and spine surgery [ 68 ]. Interventions targeted at such crucial psychosocial process variables and delivered in “high-risk” samples of patients (e.g., those who are sedentary or high in catastrophizing and fear of movement) may optimize the beneficial outcomes of such treatment approaches.…”

Osteoarthritis and Depression Update: 2023-Can the Stress and Coping Model Help?

“…Ultimately this should be identified and treated because even if replacement surgery is forthcoming a high number of cases continue to feel dissatisfied. In addition to careful evaluation of depression subtypes [49], to improve six month outcomes, those with excess preoperative pain profiles, as well as opioid users [39,50] who are depressed and those with low self efficacy scores that align with opioid use or dysfunctional cognitions should be preferentially targeted [51][52][53].…”