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

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Abstract

Background

Pain 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.

Methods

In 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.

Results

Mean (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).

Conclusions

No 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.

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Most cited references 46

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Theoretical perspectives on the relation between catastrophizing and pain.

Michael Sullivan, Beverly Thorn, Jennifer Haythornthwaite … (2001)

The tendency to "catastrophize" during painful stimulation contributes to more intense pain experience and increased emotional distress. Catastrophizing has been broadly conceived as an exaggerated negative "mental set" brought to bear during painful experiences. Although findings have been consistent in showing a relation between catastrophizing and pain, research in this area has proceeded in the relative absence of a guiding theoretical framework. This article reviews the literature on the relation between catastrophizing and pain and examines the relative strengths and limitations of different theoretical models that could be advanced to account for the pattern of available findings. The article evaluates the explanatory power of a schema activation model, an appraisal model, an attention model, and a communal coping model of pain perception. It is suggested that catastrophizing might best be viewed from the perspective of hierarchical levels of analysis, where social factors and social goals may play a role in the development and maintenance of catastrophizing, whereas appraisal-related processes may point to the mechanisms that link catastrophizing to pain experience. Directions for future research are suggested.

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The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales.

P N Baker, J van der Meulen, J. Lewsey … (2007)

A postal questionnaire was sent to 10,000 patients more than one year after their total knee replacement (TKR). They were assessed using the Oxford knee score and were asked whether they were satisfied, unsure or unsatisfied with their TKR. The response rate was 87.4% (8231 of 9417 eligible questionnaires) and a total of 81.8% (6625 of 8095) of patients were satisfied. Multivariable regression modelling showed that patients with higher scores relating to the pain and function elements of the Oxford knee score had a lower level of satisfaction (p < 0.001), and that ongoing pain was a stronger predictor of this. Female gender and a primary diagnosis of osteoarthritis were found to be predictors of lower levels of patient satisfaction. Differences in the rate of satisfaction were also observed in relation to age, the American Society of Anesthesiologists grade and the type of prosthesis. This study has provided data on the Oxford knee score and the expected levels of satisfaction at one year after TKR. The results should act as a benchmark of practice in the United Kingdom and provide a baseline for peer comparison between institutions.

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Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants.

Sarah Hewlett, Paul Dieppe, Vikki Wylde … (2011)

Persistent postsurgical pain is a prevalent but underacknowledged condition. The aim of this study was to assess the prevalence, sensory qualities, and postoperative determinants of persistent pain at 3 to 4years after total knee replacement (TKR) and total hip replacement (THR). Patients completed a questionnaire with included the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) Pain Scale, PainDetect Questionnaire, Short-Form McGill Pain Questionnaire, and questions about general health and socioeconomic status. A total of 632 TKR patients and 662 THR patients completed a questionnaire (response rate of 73%); 44% of TKR patients and 27% of THR patients reported experiencing persistent postsurgical pain of any severity, with 15% of TKR patients and 6% of THR patients reporting severe-extreme persistent pain. The persistent pain was most commonly described as aching, tender, and tiring, and only 6% of TKR patients and 1% of THR patients reported pain that was neuropathic in nature. Major depression and the number of pain problems elsewhere were found to be significant and independent postoperative determinants of persistent postsurgical pain. In conclusion, this study found that persistent postsurgical pain is common after joint replacement, although much of the pain is mild, infrequent, or an improvement on preoperative pain. The association between the number of pain problems elsewhere and the severity of persistent postsurgical pain suggests that patients with persistent postsurgical pain may have an underlying vulnerability to pain. A small percentage of patients have severe persistent pain after joint replacement, and this is associated with depression and the number of pain problems elsewhere. Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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Author and article information

Contributors

Lise Husby Høvik: + 47 72 57 56 08 , + 47 72 82 67 14 , lise.hovik@stolav.no

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Journal ID (iso-abbrev): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date (Electronic): 17 May 2016

Publication date PMC-release: 17 May 2016

Publication date Collection: 2016

Volume: 17

Electronic Location Identifier: 214

Affiliations

[ ]Clinic of Anaesthesia and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Postboks 3250, N-7006 Trondheim, Norway

[ ]Orthopaedic Research Center, Orthopaedic Department, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

[ ]Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

[ ]Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

[ ]Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

[ ]National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

[ ]Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

Article

Publisher ID: 1073

DOI: 10.1186/s12891-016-1073-0

PMC ID: 4869354

PubMed ID: 27188877

SO-VID: 1cfc5d1a-8924-4e8e-914c-4c24b978c6c2

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 11 December 2015

Date accepted : 11 May 2016

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: total knee arthroplasty,pain catastrophizing,pain,fast-track surgery

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ScienceOpen disciplines: Orthopedics

Keywords: total knee arthroplasty, pain catastrophizing, pain, fast-track surgery

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

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Most cited references 46

Theoretical perspectives on the relation between catastrophizing and pain.

The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales.

Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants.

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