Background & Aims

Persistent post-surgical pain is a common problem that occurs in a significant number of patients post-surgery, contributing to a notable decline in their quality of life and functioning. TKA has the highest rate of PPSP at 6 months (49%) when compared to a variety of surgeries. Pain that persists beyond the expected period of healing serves little or no useful purpose and can be devastating to one’s sense of well-being. Disabling pain and reduced function have a dramatic impact on quality of life and productivity, including negative effects on mood, daily activities, sleep, cognitive functions, and social life. In recent years, attention has increasingly focused on identifying potentially modifiable predictors of pain and pain disability, with the aim of facilitating early intervention and improving pain management outcomes. Research indicates that psychological distress prior to surgery puts patients at elevated risk for chronic pain following surgery.  Furthermore, the way one responds to pain (i.e., pain coping) has important consequences on functioning and quality of life. Unfortunately, psychological factors are often overlooked in the management of pre-and post-operative pain. Recognizing and addressing these factors are critical steps towards enhancing perioperative pain management strategies.

The aim of this study was to examine the relations between pain severity, psychological distress (depression, anxiety, and stress), pain-related coping, and pain-related disability/functioning in Veterans undergoing TKA.

Methods

Veterans (n= 498) in the present study were recruited for a clinical trial examining the comparative efficacy of two brief interventions for Veterans undergoing TKA.  Included in the present study’s sample were the 498 Veterans who completed baseline self-report measures of pain severity (Brief Pain Inventory (BPI)), pain related disability/functioning (BPI & Knee Injury and Osteoarthritis Outcome Score (KOOS)), psychological distress (Depression Anxiety Stress Scale (DASS)) and coping (Chronic Pain Acceptance Questionnaire (CPAQ) and Pain Catastrophizing Scale (PCS)). To address the study aims of this cross-sectional study, we examined zero-order correlations among study variables.

Results

Veterans were predominantly males (88%), and between 40 and 93 years of age (mean age ≈ 66.6 years old).  Approximately 25% of the sample was African American and 8% Hispanic.  Higher levels of depression, anxiety, and stress were moderately yet significantly correlated with pain related disability/functioning (rs range from .26 – .37). Of note, greater pain severity was related to greater pain related disability/functioning and pain catastrophizing (rs range from .28 – .48).

Further, higher pain catastrophizing, pain non-acceptance and decreased engagement in valued- life activities was strongly related to psychological variables (anxiety & depression) (rs range from .30 – .59). And importantly, the way one copes with pain further relates to the degree of pain related disability & functioning.  (rs range from .26 – .47).

Conclusions

These findings suggest that mental health and coping factors are important constructs in the experience of pain and pain-related functioning.

As such, future research should explore the impact of targeting psychological distress & coping on pain and pain functioning.

This study findings could shift the paradigm from managing acute postoperative pain to preventing chronic pain in at-risk patients through a psychological intervention. It potentially marks a departure from the conventional pharmacological approach to postoperative pain, embracing an interdisciplinary strategy that addresses the psychology of pain in clinical practice.

References

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  1. Patton CM, Hung M, Lawrence BD, Patel AA, Woodbury AM, Brodke DS, et al. Psychological distress in a Department of Veterans Affairs spine patient population. The Spine Journal: Official Journal of the North American Spine Society. 2012;12(9):798-803.

 

  1. Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology. 2000;93(4):1123-33.

 

  1. Rakel BA, Blodgett NP, Bridget Zimmerman M, Logsden-Sackett N, Clark C, Noiseux N, et al. Predictors of postoperative movement and resting pain following total knee replacement. Pain. 2012;153(11):2192-203.

Presenting Author

Merlyn Rodrigues

Poster Authors

Merlyn Rodrigues

MA

Baylor College of Medicine

Lead Author

E-mail

Bridget Zimmerman

PhD

University of Iowa, Iowa City, IA

Lead Author

Raquel Gonzalez

BA

Baylor College of Medicine, Houston, TX

Lead Author

Breeana White

BS

Baylor College of Medicine, Houston, TX

Lead Author

Jennie Embree

MS

University of Iowa, Iowa City, IA

Lead Author

Barbara Rakel

PhD

University of Iowa, Iowa City, IA

Lead Author

Lilian Dindo

PhD

Baylor College of Medicine, Houston, TX

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Post-surgical/Post-traumatic Chronic Pain