Preoperative Catastrophizing != Postoperative Pain

Preoperative pain catastrophizing and postoperative pain after total knee arthroplasty: a prospective cohort study with one year follow-up – free full-text /PMC4869354/ – BMC Musculoskelet Disord. – May 2016

Conclusions: No 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.

This paper shows us that “catastrophizing” is actually distress from the severity of pain. 

Background

Total nnee arthroplasty (TKA) is considered a painful procedure, and pain after hospital discharge is an ongoing challenge despite multimodal approaches to pain management

Successful rehabilitation after TKA depends on patients’ recovery efforts and ability to cope with pain.

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.

Recent studies evaluating the predictors of persistent pain after TKA have suggested that some psychological variables might predispose individuals to a negative pain-related outcome after surgery

Anxiety and depression have been frequently evaluated, and the role of pain catastrophizing is increasingly being considered.

They just can’t stop trying to blame our pain on our distress over being in pain.

Preoperative pain catastrophizing has been a strong predictor of postoperative pain in several studies of knee replacement surgery.

However, other studies find weak or no association and a recent systematic review found that only a few studies have followed patients beyond three months

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.

Second, we wanted to investigate a possible shift in postoperative pain catastrophizing.

Discussion

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.

We found no support for such an association.

The preoperative catastrophizing had no significant influence on postoperative pain at any of the follow-up assessments.

High scores of preoperative catastrophizing in our study may be explained by imminent surgery, considering that catastrophizing is related to the tendency to exaggerate the possibility of a catastrophic result as well as the level of preoperative pain.

Joint replacement is considered a highly effective treatment for reducing pain in patients diagnosed with osteoarthritis

When pain intensity declined, so did the levels of catastrophizing.

This is proof that catastrophizing is related to the level of pain a person is experiencing. 

Categorizing our distress from constant pain as catastrophizing seems ridiculous to those of us with real pain.

Reducing pain catastrophizing is highlighted as a key factor in determining successful rehabilitation for pain-related conditions and

reduction of catastrophizing is associated with clinical improvement of pain

You could also say “reduction of pain is associated with clinical improvement of catastrophizing.”

Cure the pain, cure the catastrophizing.

Catastrophizing shows some degree of stability over time in the absence of interventions but can be context dependent and determined by situational factors.

…like the situation of having constant pain that stops you from doing your job and being able to earn money.

The consequence of pain-related psychosocial risk factors such as pain catastrophizing, seems to be reduced activity or participation in daily activities.

“Reduced activity or participation in daily activities” is not a result of catastrophizing, but rather a result of having chronic pain. 

Providing assurance that the pain condition does not contain a serious health risk has shown to have an effect on physical activity.

Information and education allow patients to re-evaluate the threat they associate with their condition

A higher level of preoperative pain was associated with higher postoperative pain in our study.

Most studies of catastrophizing and opioid use conveniently ignore the pre-existing pain underlying these “problems”.

These findings are in accordance with previous published research across different surgical fields.

Preoperative pain is a well-known predictor of acute and persistent postoperative pain, according to several studies.

If it’s known that “preoperative pain is a well-known predictor of acute and persistent postoperative pain,”, then why all the insistence on catastrophizing as the cause of postoperative pain?

We found no association between preoperative catastrophizing and persistent postoperative pain in TKA patients up to one year after surgery.

Further, the large reduction in pain catastrophizing scores from baseline to follow-up, both at eight weeks and one year, challenges the evidence concerning stability of pain catastrophizing over time.

Other thoughts?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.