The role of presurgical expectancies in predicting pain and function one year following total knee arthroplasty

Abstract

The present study examined the prospective value of response expectancies (ie, pain, sleep) and behavioral outcome expectancies (ie, return to function) in the prediction of pain severity and functional limitations 12 months after total knee arthroplasty (TKA). The study sample consisted of 120 individuals (73 women, 47 men) with osteoarthritis of the knee who were scheduled for TKA. Measures of expectancies, pain severity, pain catastrophizing, pain-related fears of movement, and depression were completed prior to surgery. Participants also completed measures of pain severity and functional limitations 12 months following surgery. Analyses revealed that behavioral outcome expectancies were stronger predictors of follow-up pain and functional limitations than response expectancies. Consistent with previous research, analyses also revealed that pain catastrophizing, pain-related fear of movement, and depression predicted follow-up pain and function. In a multivariate analysis, only pain catastrophizing contributed significant unique variance to the prediction of follow-up pain and function. Behavioral outcome expectancies partially mediated the relation between catastrophizing and follow-up pain and function. The relation between catastrophizing and follow-up pain severity and functional limitations remained significant even when controlling for behavioral outcome expectancies. The results suggest that interventions designed to specifically target behavioral outcome expectancies and catastrophizing might improve post-surgical outcomes.

Gabapentin reduces preoperative anxiety and pain catastrophizing in highly anxious patients prior to major surgery: a blinded randomized placebo-controlled trial

“…35 Furthermore, increased pain catastrophizing predicted increased pain and poor function one year following total knee arthroplasty. 36 Our data are the first to suggest that gabapentin may play a role in the reduction of pain catastrophizing and help reduce the negative effect caused by such thinking. Future studies might investigate pharmacological interventions aimed at decreasing pain catastrophizing to determine whether patients realize improvements in post-surgical pain and conceivably postoperative patient function.…”

Do Psychological Factors Predict Poor Outcome in Patients Undergoing TKA? A Systematic Review

“…Lingard and Riddle [34] estimated the effect to be 3 to 5 points lower on the 20-point pain component of the WOMAC, indicating worse pain in the group of patients with lower mental health scores. Two studies [39,47] that examined the correlation between patient pain after TKA and the Pain Catastrophizing Scale found a statistically significant relationship. Riddle et al [39] found that a Pain Catastrophizing Scale score of 16 or greater predicted less than 50% improvement in WOMAC pain score (odds ratio [OR], 2.67; 95% CI, 1.2 À 6.1; p = 0.02).…”

“…The remaining six studies did not examine these states specifically but showed that lower preoperative mental health scores had similar postoperative associations [8,9,13,27,46,47,50]. Pain scores in the patient population with anxiety, depression, or lower mental health scores were elevated at baseline and at all assessment points [13,27,28,34,37,47,50] for up to 2 years in one study [34 ]. Lingard and Riddle [34] estimated the effect to be 3 to 5 points lower on the 20-point pain component of the WOMAC, indicating worse pain in the group of patients with lower mental health scores.…”

“…The studies were conducted in seven countries: 10 in the USA [3,5,8,9,13,14,24,34,39,46]; four in the UK [27,34,44,50]; four in Canada; [18,26,34,47]; and one each in Australia [34], Spain [15], Greece [37], and Korea [28]. Most studies (17) were conducted in metropolitan populations; one study was a multinational cohort study conducted in 13 centers in four countries (UK, USA, Australia, and Canada) [34].…”

“…Two other studies [8,9] used the State Trait Anxiety Index and the Beck Depression Index. Two studies used the Pain Catastrophizing Scale [39,47]. Other psychological assessment tools included the Self-Efficacy Scale [50], Purpose In Life [46], Patient Health Questionnaire [13], Hospital Anxiety and Depression scale [5], and the Centre for Epidemiological Studies Depression scale [37].…”