The prognostic value of pain catastrophizing in health-related quality of life judgments after Total knee arthroplasty

Abstract

BackgroundTotal knee arthroplasty (TKA) is a highly effective procedure that yields reductions in pain and disability associated with end stage osteoarthritis (OA) of the knee. Quality of life instruments are frequently used to gauge the outcomes of total knee arthroplasty (TKA). However, research suggests that post-TKA reductions in symptom severity may not be the sole predictors of quality of life post-TKA. The primary objective of the present study was to examine the prognostic value of catastrophic thinking in health-related quality of life (HRQoL) judgments in patients with severe OA after TKA.MethodsIn this study we used a prospective cohort design to examine the value of pain catastrophizing in predicting HRQoL 1 year after TKA. Participants with advanced OA of the knee who were scheduled for TKA were recruited at one of three hospitals in Canada. The study sample consisted of 116 individuals (71 women, 45 men) who completed study questionnaires at their pre-surgical evaluation and 1 year after surgery. Hierarchical regression analysis was used to assess the unique contribution of pre-surgical pain catastrophizing to the prediction of post-surgical HRQoL judgments.ResultsThe results of the hierarchical regression equation revealed that the overall model was significant, F (9,106) = 8.3, p < 001, and accounted for 36.4% of the variance in the prediction of post-surgical physical component score of HRQoL. Pain catastrophizing was entered in the last step of the equation and contributed significant unique variance (β = −.35, p < .001) to the prediction of post-surgical physical component score of HRQoL above and beyond the variance accounted for by demographic variables, co-morbid health conditions, baseline HRQoL, and post-surgical reductions in pain, joint stiffness and physical disability.ConclusionsThe current findings highlight the importance of pre-surgical catastrophic cognitions in influencing HRQoL judgments after TKA. The findings suggest that psychosocial interventions designed to reduce pain catastrophizing before TKA might contribute to better quality of life outcomes following surgery.

High Pain Catastrophizing Scale predicts lower patient-reported outcome measures in the foot and ankle patient

“…Overall, our results correlate with a previous study from Dunn et al [17] that identified catastrophization, anxiety and depression as important players in modulating postoperative pain. Our results point in the same direction as Yakobov et al [23] who noted that pain catastrophization correlated significantly to the postoperative Health-Related Quality of Life (HRQoL) over other variables (demographic variables, co-morbid health conditions, baseline HRQoL, and postoperative reductions in pain, joint stiffness and physical disability). A similar trend was observed by Wright et al [24] supporting that catastrophizers (PCS > 30) would be more likely to have a longer length of stay after total joint surgery.…”

The Mesolimbic Dopamine System in Chronic Pain and Associated Affective Comorbidities

“…The amygdala also appears to modulate affective abnormalities associated with chronic pain, such as catastrophizing, through exaggerated and abnormal functional connectivity with the central executive network (88). This is important because catastrophizing can further exacerbate chronic pain conditions and increase the likelihood of poor clinical outcomes (89,90). Similar to the observations in patients with chronic pain, studies have found that using oral morphine for 1 month leads to persistent decreases in amygdala gray matter volume (91).…”

Determination of the Relationship Between Surgical Fear Levels and Postoperative Pain Levels in Patients Undergoing Total Knee Prosthesis Surgery

“…Literatürdeki çalışmalar incelendiğinde, diz protezi uygulanan hastaların ağrı puan ortalamalarının 2-4 arasında değiştiği gözlenmektedir. 10,17 Bu araştırmada, hastaların eğitim durumuna göre ağrı puan ortalamaları arasındaki fark istatistiksel olarak anlamlı bulundu (p<0,05). Eğitim düzeyi sadece okuryazar olanların ağrı puan ortalamasının, diğer gruplara oranla anlamlı derecede yüksek olduğu belirlendi (Tablo 4).…”

“…2 Cerrahi girişim uygulanan hastalarda olduğu gibi, total diz protezi (TDP) uygulanacak hastalarda da komplikasyon gelişme riski, fonksiyonlarını kaybetme düşüncesi, ameliyat sonrası ağrı, öz bakım yetersizliği, düşme endişesi ile ölüm düşüncesi gibi nedenlerle kaygı ve korku duydukları belirtilmektedir. [8][9][10] TDP; ağrıyı gidermek, hareketliliği ve stabiliteyi sağlamak, deformiteyi düzeltmek, eklem çizgisinin korunması, bağ dengesinin sağlanması, komşu eklemlerde ağrılı sekonder etkilerin önlenmesi ve giderilmesi amacıyla uygulanan cerrahi girişim-lerden biridir. 11 Osteoartritli hastalarda şiddetli ağrı varlığı, TDP uygulanması için bir endikasyon olarak belirtilmektedir, ancak TDP ameliyatları yüksek derecede ağrıya neden olan ameliyatlardan biridir.…”