Abstract
BackgroundApproximately 20% of patients report persistent and disabling pain following total knee arthroplasty (TKA) despite an apparently normally functioning prosthesis. One potential risk factor for unexplained persistent pain is high levels of pain catastrophizing. We designed a three-arm trial to determine if a pain coping skills training program, delivered prior to TKA, effectively reduces function-limiting pain following the procedure in patients with high levels of pain catastrophizing.Methods/designThe trial will be conducted at four University-based sites in the US. A sample of 402 patients with high levels of pain catastrophizing will be randomly assigned to either a pain coping skills training arm, an arthritis education control arm or usual care. Pain coping skills will be delivered by physical therapists trained and supervised by clinical psychologist experts. Arthritis education will be delivered by nurses trained in the delivery of arthritis-related content. The primary outcome will be change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain scale score 12 months following surgery. A variety of secondary clinical and economic outcomes also will be evaluated.DiscussionThe trial will be conducted at four University-based sites in the US. A sample of 402 patients with high levels of pain catastrophizing will be randomly assigned to either a pain coping skills training arm, an arthritis education control arm or usual care. Pain coping skills will be delivered by physical therapists trained and supervised by clinical psychologist experts. Arthritis education will be delivered by nurses trained in the delivery of arthritis-related content. The primary outcome will be change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain scale score 12 months following surgery. A variety of secondary clinical and economic outcomes also will be evaluated.Trial RegistrationNCT01620983
Highlights
20% of patients report persistent and disabling pain following total knee arthroplasty (TKA) despite an apparently normally functioning prosthesis
Pain coping skills will be delivered by physical therapists trained and supervised by clinical psychologist experts
Our study will be the first to examine the efficacy of a pain coping skills training intervention delivered by physical therapists to patients at risk for poor outcome following orthopaedic surgery
Summary
20% of patients report persistent and disabling pain following total knee arthroplasty (TKA) despite an apparently normally functioning prosthesis. We designed a three-arm trial to determine if a pain coping skills training program, delivered prior to TKA, effectively reduces function-limiting pain following the procedure in patients with high levels of pain catastrophizing. Pain is the predominant complaint of patients seeking total knee arthroplasty (TKA) [1,2,3], a common and generally effective procedure for patients with advanced knee arthritis [1]. Failure of the prosthesis is typically a late complication occurring years following the surgery and accounts for approximately 5% of poor outcomes [7]. The large majority of “poor” outcomes following knee arthroplasty are attributed to disabling pain and impaired function that is not related to early complications or prosthetic loosening. Improvements in pain or function scores have consistently been on the order of 40% to 60% relative to baseline, from 6 months to 2 years postoperatively [8,9,10,11,12,13,14,15,16]
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