Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Pain Med. 2021 Aug 6;22(8):1727-1734. doi: 10.1093/pm/pnab035.
Although numerous studies show that preoperative pain catastrophizing is a risk factor for pain after total knee arthroplasty (TKA), little is known about the temporal course of the association between perioperative pain catastrophizing and pain severity. The present study investigated temporal changes and their dynamic associations between pain catastrophizing and pain severity before and after TKA.
A secondary data analysis of a larger observational parent study featuring prospective repeated measurement over 12 months.
Dual-site academic hospital.
A total of 245 individuals who underwent TKA.
Participants completed pain catastrophizing and pain severity questionnaires at baseline, 6 weeks, and 3, 6, and 12 months after TKA. Cross-lagged panel analysis was conducted with structural equation modeling including age, sex, race, baseline anxiety, and depressive symptoms as covariates.
Reduction in pain catastrophizing from baseline to 6 weeks after TKA was associated with lower pain severity at 3 months after TKA (standardized β = 0.14; SE = 0.07, P = 0.046), while reduction in pain severity at 6 weeks after TKA was not associated with pain catastrophizing at 3 months after TKA (P = 0.905). In the chronic postsurgical period (>3 months), pain catastrophizing at 6 months after TKA predicted pain severity at 12 months after TKA (β = 0.23, P = 0.009) with controlling for auto-correlation and covariates, but not vice versa.
We provide evidence that changes in pain catastrophizing from baseline to 6 weeks after TKA are associated with subsequent pain severity. Future studies are warranted to determine whether targeting pain catastrophizing during the perioperative period may improve clinical outcomes for individuals undergoing TKA.
尽管大量研究表明术前疼痛灾难化是全膝关节置换术后疼痛的一个风险因素，但对于围手术期疼痛灾难化与疼痛严重程度之间的关联的时间进程知之甚少。本研究调查了 TKA 前后疼痛灾难化与疼痛严重程度之间的时间变化及其动态关联。
对一项更大的观察性前瞻性重复测量的母研究进行二次数据分析，随访时间为 12 个月。
双站点学术医院。
共 245 名接受 TKA 的患者。
参与者在基线、6 周以及 TKA 后 3、6 和 12 个月时完成疼痛灾难化和疼痛严重程度问卷。使用结构方程模型进行交叉滞后面板分析，包括年龄、性别、种族、基线焦虑和抑郁症状作为协变量。
从基线到 TKA 后 6 周时疼痛灾难化的降低与 TKA 后 3 个月时的疼痛严重程度降低相关（标准化β=0.14；SE=0.07，P=0.046），而 TKA 后 6 周时疼痛严重程度的降低与 TKA 后 3 个月时的疼痛灾难化无关（P=0.905）。在慢性手术后阶段（>3 个月），TKA 后 6 个月时的疼痛灾难化预测 TKA 后 12 个月时的疼痛严重程度（β=0.23，P=0.009），同时控制了自相关和协变量，但反之则不然。
我们提供了证据表明 TKA 后从基线到 6 周时疼痛灾难化的变化与随后的疼痛严重程度相关。未来的研究需要确定在围手术期靶向疼痛灾难化是否可以改善接受 TKA 的患者的临床结果。
