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Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review

Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review

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Title: Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review
Author: Burns, Lindsay, C.
Ritvo, Sarah, E.
Ferguson, Meaghan, K.
Clarke, Hance
Seltzer, Ze'ev
Katz, Joel
Abstract: Background: Total knee arthroplasty (TKA) is a common and costly surgical procedure. Despite high success rates, many TKA patients develop chronic pain in the months and years following surgery, constituting a public health burden. Pain catastrophizing is a construct that reflects anxious preoccupation with pain, inability to inhibit pain-related fears, amplification of the significance of pain vis-à-vis health implications, and a sense of helplessness regarding pain. Recent research suggests that it may be an important risk factor for untoward TKA outcomes. To clarify this impact, we systematically reviewed the literature to date on pain catastrophizing as a prospective predictor of chronic pain following TKA.
Methods: We searched MEDLINE, EMBASE, and PsycINFO databases to identify articles related to pain catastrophizing, TKA, risk models, and chronic pain. We reviewed titles and abstracts to identify original research articles that met our specified inclusion criteria. Included articles were then rated for methodological quality. including methodological quality. Due to heterogeneity in follow-up, analyses, and outcomes reported across studies, a quantitative meta-analysis could not be performed.
Results: We identified six prospective longitudinal studies with small-to-mid-sized samples that met the inclusion criteria. Despite considerable variability in reported pain outcomes, pain catastrophizing was identified as a significant predictor of chronic pain persisting $3 months following TKA in five of the studies assessed. Limitations of studies included lack of large-scale data, absence of standardized pain measurements, inadequate multivariate adjustment, such as failure to control for analgesic use and other relevant covariates, and failure to report non-significant parameter estimates.
Conclusion: This study provides moderate-level evidence for pain catastrophizing as an independent predictor of chronic pain post-TKA. Directions for future research include larger, well-controlled studies with standard pain outcomes, identification of clinically-relevant catastrophizing cut-offs that predict pain outcomes, investigation of other psychosocial risk factors, and assessment of interventions aimed to reduce pain catastrophizing on chronic pain outcomes following TKA surgery.
Sponsor: Lindsay C Burns is supported by a Canadian Institutes of Health Research (CIHR) Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award. Hance Clarke is supported by a Merit Award (Department of Anaesthesia, University of Toronto) and the CIHR STAGE Training Program in Genetic Epidemiology. Joel Katz is supported by a CIHR Canada Research Chair in Health Psychology at York University.
Subject: pain catastrophizing, total knee arthroplasty, total knee replacement, knee arthroplasty, risk factors, chronic pain
Type: Article
Rights: http://www.dovepress.com/pain-catastrophizing-as-a-risk-factor-for-chronic-pain-after-total-kne-peer-reviewed-article-JPR
URI: http://hdl.handle.net/10315/28521
Published: Dove Medical Press Limited
Citation: Burns, L.C., Ritvo, S.E., Ferguson, M.K., Clarke, H., & Seltzer, Z., Katz, J. (2015). Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: A systematic review. Journal of Pain Research, 8, 21-32. http://dx.doi.org/10.2147/JPR.S64730
ISSN: 1178-7090
Date: 05/01/2015

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