Preoperative pain catastrophizing and postoperative pain after total knee arthroplasty: a prospective cohort study with one year follow-up

Abstract

BackgroundPain relief is likely to be the most important long-term outcome for patients undergoing total knee arthroplasty (TKA). However, research indicates that persistent pain (> 3 months) is a considerable problem, affecting up to 34 % of patients. Pain catastrophizing might contribute to acute and persistent pain experienced after surgery. The primary aim of the present study was to examine the association between preoperative pain catastrophizing and postoperative pain in patients undergoing TKA up to one year after surgery. Second, we wanted to investigate a possible shift in postoperative catastrophizing.MethodsIn this prospective cohort study, 71 TKA patients were included consecutively between January and June 2013. Pain was assessed with the Brief Pain Inventory (BPI) and the item “average pain” was used as the main outcome. Pain catastrophizing was measured by the Pain Catastrophizing Scale (PCS). Questionnaires were completed prior to surgery (baseline) and at two days, two weeks, eight weeks and one year postoperatively.ResultsMean (SD) preoperative pain score was 5.4 (2.2), reduced to 2.9 (2.3) after eight weeks and 2.4 (2.4) after one year (p < 0.001). The overall median preoperative PCS score was 17.0 (7.8–28.3). The overall model estimated PCS mean score was 7.6 at eight weeks and 6.5 at one year follow-up. The results at eight weeks and one year follow-up were both significantly lower than the preoperative value (p < 0.001). The preoperative PCS score was not associated with the postoperative pain score (p = 0.942), while preoperative pain was a significant covariate in the mixed linear model (p < 0.001).ConclusionsNo associations were found between preoperative pain catastrophizing and pain eight weeks or one year after surgery. The decrease in PCS-scores challenges evidence regarding the stability of pain catastrophizing. However, larger studies of psychological risk factors for pain after TKA are warranted.

Psychological interventions that target sleep reduce pain catastrophizing in knee osteoarthritis

“…Our sample exhibited low levels of pain-catastrophizing at baseline (Mean PCS=15.01) similarly to those reported in other studies of KOA patients [17; 18], but lower than baseline PCS scores reported in intervention studies in other chronic pain conditions [5; 22; 28]. This could have caused a floor effect, and possibly larger effects might be observed in patients with greater pain-catastrophizing.…”

“…One such target is pain-catastrophizing, a cognitive and emotional coping style which is considered one of the most salient psychological factors contributing to heightened acute and chronic pain [36; 46]. In KOA, catastrophizing is associated with pain and disability [44] and is a risk factor for continuation of chronic pain following total knee arthroplasty [3; 18; 54]. …”

“…However, these studies have not investigated daily or nocturnal pain-catastrophizing. An additional gap in the literature remains in regards to the effect of behavioral sleep interventions on the pain-catastrophizing of patients with KOA, who tend to have lower levels of pain-catastrophizing [17; 18]. …”

Surgeon identification of pain catastrophizing versus the Pain Catastrophizing Scale in orthopedic patients after routine surgical consultation

“…Some studies have suggested that female patients have higher levels of catastrophizing than male patients, 2 but others have not corroborated this. 14,15 This may be a function of variation in sample composition. Jacobsen and colleagues 16 proposed that younger patients manifest higher levels of pain catastrophizing than older patients and suggested that this may be due to less experience coping with painful events.…”

Comparison Between Closed Suction Drainage and No Drainage Following Total Knee Arthroplasty in a Tertiary Care Setting in Pakistan

“…Total knee arthroplasty, a common orthopedic reconstructive procedure, has helped many to overcome the disability and pain from osteoarthritis of the knee [1]. Despite the gratifying results, a major complication of hemorrhage is inevitable to prevent but can be controlled [2].…”