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

Lise Husby Høvik,Kari Hanne Gjeilo,Siri Bjørgen Winther,Olav A Foss

doi:10.1186/s12891-016-1073-0

Abstract

BackgroundPain 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.MethodsIn 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.ResultsMean (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).ConclusionsNo 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.

Highlights

Pain relief is likely to be the most important long-term outcome for patients undergoing total knee arthroplasty (TKA)
The primary aim of this study was to explore the association between preoperative pain catastrophizing and postoperative pain up to one year after surgery in patients undergoing primary TKA
The primary aim of this study was to examine whether the levels of preoperative pain catastrophizing were associated with pain up to one year after TKA

Summary

Introduction

Pain relief is likely to be the most important long-term outcome for patients undergoing total knee arthroplasty (TKA). 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. Total knee arthroplasty (TKA) improves function and reduces pain for the majority of patients, and pain relief is likely to be the most important long-term outcome [1]. Physical activities targeted towards regaining muscle strength are important to reduce the risk of postoperative complications such as prolonged stiffness, persistent pain and diminished function [14,15,16]

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