The association between pain catastrophizing, physical function and pain in a cohort of patients undergoing knee arthroplasty

Sara Birch,Inger Mechlenburg,Torben Bæk Hansen,Maiken Stilling

doi:10.1186/s12891-019-2787-6

Sara Birch, Inger Mechlenburg + Show 2 more

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https://doi.org/10.1186/s12891-019-2787-6

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Abstract

BackgroundPain catastrophizing contributes to acute and long-term pain after knee arthroplasty (KA), but the association between pain catastrophizing and physical function is not clear.We examined the association between preoperative pain catastrophizing and physical function one year after surgery, as well as differences in physical function, pain and general health in two groups of patients with high and low preoperative pain catastrophizing score.MethodsWe included 615 patients scheduled for KA between March 2011 and December 2013. Patients completed The Pain Catastrophizing Scale (PCS) prior to surgery. The Oxford Knee Score (OKS), Short Form-36 (SF-36) and the EuroQol-5D (EQ-5D) were completed prior to surgery, and 4 and 12 months after the surgery.ResultsOf the 615 patients, 442 underwent total knee arthroplasty (TKA) and 173 unicompartmental knee arthroplasty (UKA). Mean age was 67.3 (SD: 9.7) and 53.2% were females. Patients with PCS > 21 had statistically significantly larger improvement in mean OKS for both TKA and UKA than patients with PCS < 11; 3.2 (95% CI: 1.0, 5.4) and 5.4 (95% CI: 2.2, 8.6), respectively. Furthermore, patients with preoperative PCS > 21 had statistically significantly lower OKS, SF-36 and EQ-5D and higher pain score than patients with PCS < 11 both preoperatively and 4 and 12 months postoperatively.ConclusionsPatients with high levels of preoperative pain catastrophizing have lower physical function, more pain and poorer general health both before and after KA than patients without elevated pain catastrophizing.

Highlights

For persons with end-stage knee osteoarthritis, knee arthroplasty (KA) is common treatment for pain and disability when non-surgical management is no longer effective
We found no differences between the two groups in Pain Catastrophizing Scale (PCS) (p = 0.61) or Oxford Knee Score (OKS) (p = 0.16) (These analyses only included the patients who answered the questionnaire)
The primary end-point in this study was 12 months after the operation so this has no consequence for the primary results. Despite these limitations, our study shows that preoperative catastrophic thinking in relation to pain may be a risk factor for postoperative pain 12 months after KA

Summary

Introduction

For persons with end-stage knee osteoarthritis, knee arthroplasty (KA) is common treatment for pain and disability when non-surgical management is no longer effective. The procedure is safe and highly successful, patients’ satisfaction rate following TKA is only around 80% [4]. This has led several investigators to evaluate. Several risk factors for poor outcome after KA are found These factors can be divided into physical and psychological predictors. The former include young age, female gender, obesity, severe preoperative knee pain and other painful joints [5,6,7,8]. Pain catastrophizing contributes to acute and long-term pain after knee arthroplasty (KA), but the association between pain catastrophizing and physical function is not clear. We examined the association between preoperative pain catastrophizing and physical function one year after surgery, as well as differences in physical function, pain and general health in two groups of patients with high and low preoperative pain catastrophizing score

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