Dissociation and Pain-Catastrophizing: Absorptive Detachment as a Higher-Order Factor in Control of Pain-Related Fearful Anticipations Prior to Total Knee Arthroplasty (TKA).

Matthias Vogel,Sebastian Illiger,Jörg Frommer,Martin Krippl,Christian Riediger,Lydia Frenzel,Christoph Lohmann

doi:10.3390/jcm8050697

Matthias Vogel, Sebastian Illiger + Show 5 more

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https://doi.org/10.3390/jcm8050697

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Abstract

Total Knee Arthroplasty (TKA) is the ultima-ratio therapy for knee-osteoarthritis (OA), which is a paradigmatic condition of chronic pain. A hierarchical organization may explain the reported covariation of pain-catastrophizing (PC) and dissociation, which is a trauma-related psychopathology. This study tests the hypotheses of an overlap and hierarchical organization of the two constructs, PC and dissociation, respectively, using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Childhood Trauma Screener (CTS), a shortened version of the Dissociative Experiences Scale (FDS-20), the Brief Symptom Inventory (BSI-18), the Pain-Catastrophizing Scale (PCS), and the Tampa Scale of Kinesiophobia (TSK) in 93 participants with knee-OA and TKA. Non-parametric correlation, linear regression, and an exploratory factor analysis comprising the PCS and the FDS-20 in aggregate were run. The three factors: (1) PC factor, (2) absorptive detachment, and (3) conversion altogether explained 60% of the variance of the two scales. Dissociative factors were related to childhood trauma, and the PC-factor to knee-pain. The latter was predicted by absorptive detachment, i.e., disrupted perception interfering with the integration of trauma-related experiences possibly including invasive surgery. Absorptive detachment represents negative affectivity and is in control of pain-related anxieties (including PC). The clinical associations of trauma, psychopathology, and maladaptation after TKA may be reflections of this latent hierarchical organization of trauma-related dissociation and PC.

Highlights

IntroductionKleiman et al [6] corroborated the hierarchical model by means of a factor analytic study examining the factor structure of measures of negative affect and content-related anxieties, including PC in aggregate
This study tests the hypotheses of an overlap and hierarchical organization of the two constructs, PC and dissociation, respectively, using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Childhood Trauma Screener (CTS), a shortened version of the Dissociative Experiences Scale (FDS-20), the Brief Symptom Inventory (BSI-18), the Pain-Catastrophizing Scale (PCS), and the Tampa Scale of Kinesiophobia (TSK) in 93 participants with knee-OA and Total Knee Arthroplasty (TKA)
The present study explored the relationships between childhood trauma, PC, and dissociation in patients with end-stage knee osteoarthritis scheduled for TKA, based on the assumption of (1) a phenomenological overlap and clinical interaction [29], and (2) a hierarchical organization [3] between dissociation and PC [33]

Summary

Introduction

Kleiman et al [6] corroborated the hierarchical model by means of a factor analytic study examining the factor structure of measures of negative affect and content-related anxieties, including PC in aggregate Those authors extracted one common factor termed sensitivity to pain traumatization, which represents a pain-related stress reaction of a posttraumatic character (e.g., intrusive thoughts, avoidance, and arousal). Similar to the factor analytic studies in personality disorder research, those studies indicate the possibility of explaining the covariation among the observed pain-related variables through the use of latent constructs, brought to light by factor analysis [12], with regards to research on chronic pain and its nested psychological correlates The knowledge of such systematic interactions between PC, which is an important predictor of postoperative pain [13], and posttraumatic symptomatology likely offers hints on adequate psychotherapeutic strategies, as well. Dissociative symptoms, if proven to contribute to chronic pain, would call for a trauma-specific therapy in this context

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