Can pain catastrophizing be changed in surgical patients? A scoping review

Abstract

Background: Catastrophizing, a coping style characterized by an exaggerated negative affect when experiencing or anticipating pain, is an important factor that adversely affects surgical outcomes. Various interventions have been attempted with the goal of reducing catastrophizing and, by extension, improving treatment outcomes. We performed a systematic review to determine whether catastrophizing can be altered in surgical patients and to present evidence for interventions aimed at reducing catastrophizing in this population. Methods: Using a scoping design, we performed a systematic search of MEDLINE and Embase. Studies reporting original research measuring catastrophizing, before and after an intervention, on the Pain Catastrophizing Scale (PCS) or Coping Strategies Questionnaire (CSQ) were selected. Studies were assessed for quality, the nature of the intervention and the magnitude of the effect observed. Results: We identified 47 studies that measured the change in catastrophizing score following a broad range of interventions in surgical patients, including surgery, patient education, physiotherapy, cognitive behavioural therapy, psychologist-directed therapy, nursing-directed therapy and pharmacological treatments. The mean change in catastrophizing score as assessed with the PCS ranged from 0 to –19, and that with the CSQ, from +0.07 to –13. Clinically important changes in catastrophizing were observed in 7 studies (15%). Conclusion: Catastrophizing was observed to be modifiable with an intervention in a variety of surgical patient populations. Some interventions produced greater reductions than others, which will help direct future research in the improvement of surgical outcomes.

Preoperative cognitive–behavioral therapy for reducing pain catastrophizing and improving pain outcomes after total knee replacement: a randomized clinical trial

“…The changes in PCS scores following CBT were selected within the range 0 to −19 consistent with of interventions for changing PCS scores in surgical patients. 9 The primary outcome for phase 2 was the difference in the proportion of subjects that achieved a 3-month decrease in WOMAC pain subscale >4. The primary outcome was compared between groups using the proportions test and the relative risk of an increase in the proportion of patients with…”

“…In a systematic review of studies examining interventions to reduce catastrophizing, Gibson and Sabo found that CBT interventions reduced PCS scores from 0 to −19. 9 The effects were assessed across multiple study types and was not adjusted for confounding variables. They also reported that the mean clinically important reduction in the PCS score was −9.1.…”

“…8 Cognitive-behavioral therapy (CBT) may be a potential method of reducing pain catastrophizing and may be an effective intervention for reducing postsurgical pain. [9][10][11] CBT is an established modality for treating chronic pain; however, no randomized studies have evaluated the effectiveness of different regimes of CBT prior to surgery on the measurement of pain catastrophizing, nor the effect of reducing catastrophizing preoperatively on clinical pain outcomes following TKA. 11 Our first aim was to determine the relative effectiveness of CBT delivered via 4-week or 8-week telehealth, or four in person CBT sessions with no-CBT controls in patients exhibiting high catastrophizing preoperatively.…”

The influence of pain catastrophizing and central sensitization on the reported pain after hip arthroscopy

“…In patients undergoing total knee arthroplasty, the level of pain catastrophizing is associated with higher postoperative pain, lower quality of life and lower patient reported outcomes after surgery [ 4 , 14 , 25 ]. Pain catastrophizing can be modified and is under influence of several factors, such as surgery, physical therapy, cognitive behavioral therapy and pharmacotherapy [ 11 ]. Surgical treatment itself can be a reason for a decrease in pain catastrophizing but it is important to realize that there is a group of patients that might benefit from pre-operative counseling, physiotherapy or even pharmacotherapy [ 11 ].…”

“…Pain catastrophizing can be modified and is under influence of several factors, such as surgery, physical therapy, cognitive behavioral therapy and pharmacotherapy [ 11 ]. Surgical treatment itself can be a reason for a decrease in pain catastrophizing but it is important to realize that there is a group of patients that might benefit from pre-operative counseling, physiotherapy or even pharmacotherapy [ 11 ]. There is literature that shows a significant decrease in pain catastrophizing after a cognitive behavioral therapy program prior to orthopedic surgery [ 7 ].…”