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

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.

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Association between socioeconomic status and pain, function and pain catastrophizing at presentation for total knee arthroplasty

BMC Musculoskeletal Disorders ◽

10.1186/s12891-015-0475-8 ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 41

Author(s):

Candace H Feldman ◽

Yan Dong ◽

Jeffrey N Katz ◽

Laurel A Donnell-Fink ◽

Elena Losina

Keyword(s):

Socioeconomic Status ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Pain Catastrophizing ◽

Total Knee

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Does Preoperative Pain Catastrophizing Influence Objectively Measured Physical Activity Before and After Total Knee Arthroplasty: A Prospective Cohort Study

Journal for the Measurement of Physical Behaviour ◽

10.1123/jmpb.2020-0024 ◽

2020 ◽

pp. 1-7

Author(s):

Sara Birch ◽

Torben Bæk Hansen ◽

Maiken Stilling ◽

Inger Mechlenburg

Keyword(s):

Physical Activity ◽

Total Knee Arthroplasty ◽

Knee Osteoarthritis ◽

Muscle Mass ◽

Knee Arthroplasty ◽

Pain Catastrophizing ◽

Knee Function ◽

Preoperative Pain ◽

Before And After ◽

Total Knee

Background: Pain catastrophizing is associated with pain both before and after a total knee arthroplasty (TKA). However, it remains uncertain whether pain catastrophizing affects physical activity (PA). The aim was to examine the influence of pain catastrophizing on the PA profile, knee function, and muscle mass before and after a TKA. Methods: The authors included 58 patients with knee osteoarthritis scheduled for TKA. Twenty-nine patients had a score >22 on the Pain Catastrophizing Scale (PCS), and 29 patients had a score <11. PA was measured with a triaxial accelerometer preoperative, 3 months, and 12 months after TKA. Other outcome measures consisted of the Knee Osteoarthritis Outcome Score and dual-energy X-ray absorptiometry scans. Results: The authors found no difference in PA between patients with a better/low or a worse/high score on the PCS, and none of the groups increased their mean number of steps/day from preoperative to 12 months postoperative. Patients with better/low PCS scores had higher/better preoperative scores on the Knee Osteoarthritis Outcome Score subscales (symptoms, pain, and activity of daily living), and they walked longer in the 6-min walk test. Further, they had lower body mass index, lower percent fat mass, and higher percent muscle mass than patients with worse/high PCS scores both before and after a TKA. Conclusion: Preoperative pain catastrophizing did not influence PA before or after a TKA. Although the patients improved substantially in self-reported knee function, their PA did not increase. This may be important to consider when the clinicians are informing the patients about the expected benefits from the operation.

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Quantifying Achievable Levels of Improvement in Knee Joint Biomechanics During Gait After Total Knee Arthroplasty Relative to Osteoarthritis Severity

Journal of Applied Biomechanics ◽

10.1123/jab.2020-0051 ◽

2020 ◽

pp. 1-9

Author(s):

Jereme B. Outerleys ◽

Michael J. Dunbar ◽

Glen Richardson ◽

Cheryl L. Hubley-Kozey ◽

Janie L. Astephen Wilson

Keyword(s):

Total Knee Arthroplasty ◽

Knee Joint ◽

Knee Arthroplasty ◽

Frontal Plane ◽

Knee Adduction Moment ◽

Patient Specific ◽

Knee Biomechanics ◽

Knee Oa ◽

Joint Biomechanics ◽

Total Knee

Total knee arthroplasty (TKA) surgery improves knee joint kinematics and kinetics during gait for most patients, but a lack of evidence exists for the level and incidence of improvement that is achieved. The objective of this study was to quantify patient-specific improvements in knee biomechanics relative to osteoarthritis (OA) severity levels. Seventy-two patients underwent 3-dimensional (3D) gait analysis before and 1 year after TKA surgery, as well as 72 asymptomatic adults and 72 with moderate knee OA. A combination of principal component analysis and discriminant analyses were used to categorize knee joint biomechanics for patients before and after surgery relative to asymptomatic, moderate, and severe OA. Post-TKA, 63% were categorized with knee biomechanics consistent with moderate OA, 29% with severe OA, and 8% asymptomatic. The magnitude and pattern of the knee adduction moment and angle (frontal plane features) were the most significant contributors in discriminating between pre-TKA and post-TKA knee biomechanics. Standard of care TKA improves knee biomechanics during gait to levels most consistent with moderate knee OA and predominately targets frontal plane features. These results provide evidence for the level of improvement in knee biomechanics that can be expected following surgery and highlight the biomechanics most targeted by surgery.

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

BMC Musculoskeletal Disorders ◽

10.1186/s12891-016-1073-0 ◽

2016 ◽

Vol 17 (1) ◽

Cited By ~ 22

Author(s):

Lise Husby Høvik ◽

Siri Bjørgen Winther ◽

Olav A. Foss ◽

Kari Hanne Gjeilo

Keyword(s):

Total Knee Arthroplasty ◽

Cohort Study ◽

Postoperative Pain ◽

Knee Arthroplasty ◽

Prospective Cohort ◽

Pain Catastrophizing ◽

Preoperative Pain ◽

Total Knee ◽

One Year

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Negative Affect, Type D Personality, Quality of Life, and Dysfunctional Outcomes of Total Knee Arthroplasty

Pain Research and Management ◽

10.1155/2019/6393101 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Matthias Vogel ◽

Christian Riediger ◽

Martin Krippl ◽

Jörg Frommer ◽

Christoph Lohmann ◽

...

Keyword(s):

Quality Of Life ◽

Total Knee Arthroplasty ◽

Negative Affect ◽

Knee Arthroplasty ◽

Pain Catastrophizing ◽

Fear Avoidance ◽

Type D ◽

Total Knee

Background. Type D personality (TDP) is a sign of tapered stress and compromises treatment outcomes including those of hip arthroplasty. The common dissatisfaction with total knee arthroplasty (TKA) is predicted by fear avoidance, pain catastrophizing and emotional lability, with poor quality of life (QoL) reflecting these strains. This study is the first to investigate the influence of TDP on TKA assuming (1) negative affect (NA) to be linked to fear avoidance and to increased dissatisfaction with TKA and (2) the expression of NA and social inhibition (SI) to not be stable over time. Method. We studied 79 participants using the brief symptom inventory-18, the pain-catastrophizing scale, the Tampa scale of kinesiophobia, the SF-36, and the WOMAC preoperatively and 12 months postoperatively. T-test and regression were used to compare the variables of interest between groups built based upon outcome severity. Result. NA at follow-up predicted knee pain (p=0.02) and knee function (p<0.01) at follow-up. Contrarily, increased expressions of NA/SI at follow-up were predicted by NA (p=0.04) and rumination (p=0.05) at the baseline. Conclusion. The present results suggest the postoperative increase of NA to be linked to dysfunctional outcomes of TKA due to an interaction with pain catastrophizing. Baseline self-rated physical health did not connect to the dissatisfaction with TKA 1-year postoperatively.

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Variability in Recommendations for Total Knee Arthroplasty Among Rheumatologists and Orthopedic Surgeons

The Journal of Rheumatology ◽

10.3899/jrheum.130762 ◽

2013 ◽

Vol 41 (1) ◽

pp. 47-52 ◽

Cited By ~ 12

Author(s):

Liana Fraenkel ◽

Lisa Suter ◽

Lawrence Weis ◽

Gillian A. Hawker

Keyword(s):

Total Knee Arthroplasty ◽

Knee Pain ◽

Knee Arthroplasty ◽

Employment Status ◽

Functional Limitations ◽

Knee Oa ◽

Orthopedic Surgeons ◽

Physician Characteristics ◽

Academic Settings ◽

Total Knee

Objective.The most rapidly growing population of patients undergoing total knee arthroplasty (TKA) is under the age of 65. The objective of our study was to gain insight into the factors influencing physicians’ recommendations for persons in this age group with moderate osteoarthritis (OA).Methods.Rheumatologists and orthopedic surgeons attending national meetings were asked to complete a survey including a standardized scenario of a 62-year-old person with knee OA who has moderate knee pain limiting strenuous activity despite medical management. We used an experimental 2 × 2 × 2 design to examine the effects of sex, employment status, and severity of radiographic OA on physicians’ recommendations. Each physician was asked to rate a single scenario.Results.The percentage of physicians recommending TKA varied from 30% to 55% for scenarios describing a patient with mild radiographic OA, and from 39% to 71% for scenarios describing a patient with moderate radiographic OA. Surgeons were less likely to recommend TKA for women compared to men of the same age, employment status, symptom severity, and functional status, and radiographs. Rheumatologists practicing in academic settings were more likely to recommend TKA compared to those practicing in nonacademic settings, and American surgeons were more likely to recommend TKA compared to their European counterparts.Conclusion.Orthopedic surgeons and rheumatologists vary significantly in their recommendations for patients with moderate knee pain and functional limitations. Both patient and physician characteristics influence physicians’ recommendations, and rheumatologists and orthopedic surgeons display different patterns of decision making.

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Analgesic Effect of Perioperative Escitalopram in High Pain Catastrophizing Patients after Total Knee Arthroplasty

Anesthesiology ◽

10.1097/aln.0000000000000597 ◽

2015 ◽

Vol 122 (4) ◽

pp. 884-894 ◽

Cited By ~ 25

Author(s):

Troels H. Lunn ◽

Vibe G. Frokjaer ◽

Torben B. Hansen ◽

Per W. Kristensen ◽

Thomas Lind ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Placebo Group ◽

Side Effects ◽

Knee Arthroplasty ◽

Serotonin Reuptake ◽

Selective Serotonin Reuptake Inhibitors ◽

Pain Treatment ◽

Pain Catastrophizing ◽

Selective Serotonin ◽

Total Knee

Abstract Background: Sufficient pain treatment remains a challenge after total knee arthroplasty (TKA), especially in high pain catastrophizing patients. Serotonergic signaling may be involved in pain processing, but the effect of selective serotonin reuptake inhibitors on well-defined postoperative pain has not previously been investigated. The authors hypothesized that perioperative escitalopram would reduce pain after TKA in high pain catastrophizing patients. Methods: A total of 120 pain catastrophizing patients (selected using the pain catastrophizing scale as preoperative screening tool) scheduled for TKA were randomized in a double-blind manner to either 10 mg escitalopram or placebo daily from preanesthesia to postoperative day 6 in addition to a standardized analgesic regime. The primary outcome was pain upon ambulation 24 h after surgery. Secondary outcomes were overall pain during well-defined mobilizations and at rest from 2 to 48 h and from days 2 to 6, morphine equivalents, anxiety, depression, and side effects. Results: Pain upon ambulation (mean [95% CI]) 24 h after surgery in the escitalopram versus placebo group was 58 (53 to 64) versus 64 (58 to 69), the mean difference being −5 (−13 to 3), P = 0.20. Overall pain upon ambulation and at rest from days 2 to 6 was lower in the escitalopram versus placebo group, as was depression score at day 6 (all P ≤ 0.01 in analyses uncorrected for multiple tests). Side effects were nonsignificant except for reduced tendency to sweat and prolonged sleep in the escitalopram group. No other between-group differences were observed. Conclusions: Escitalopram did not reduce pain upon ambulation 24 h after TKA in high pain catastrophizing patients. Future studies on optimal timing, dose, and duration of selective serotonin reuptake inhibitor treatment might be warranted.

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