TY - JOUR T1 - Preoperative cognitive–behavioral therapy for reducing pain catastrophizing and improving pain outcomes after total knee replacement: a randomized clinical trial JF - Regional Anesthesia & Pain Medicine JO - Reg Anesth Pain Med SP - 313 LP - 321 DO - 10.1136/rapm-2020-102258 VL - 46 IS - 4 AU - Asokumar Buvanendran AU - Amanda C Sremac AU - Patricia A Merriman AU - Craig J Della Valle AU - John W Burns AU - Robert J McCarthy Y1 - 2021/04/01 UR - http://rapm.bmj.com/content/46/4/313.abstract N2 - Introduction Cognitive–behavioral therapy (CBT) can reduce preoperative pain catastrophizing and may improve postsurgical pain outcomes. We hypothesized that CBT would reduce pain catastrophizing more than no-CBT controls and result in improved pain outcomes.Methods The study was a randomized controlled trial of patients undergoing elective total knee arthroplasty between January 2013 and March 2020. In phase 1, the change in pain catastrophizing scores (PCS) among 4-week or 8-week telehealth, 4-week in person and no-CBT sessions was compared in 80 patients with a PCS >16. In phase 2, the proportion of subjects that achieved a 3-month decrease in Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain subscale >4 following 4-week telehealth CBT with no-CBT controls were compared in 80 subjects.Results In phase 1, 4-week telehealth CBT had the highest completion rate 17/20 (85%), demonstrated an adjusted median reduction in PCS of −9 (95% CI −1 to −14, p<0.01) compared with no-CBT and was non-inferior to 8-week telehealth CBT at a margin of 2 (p=0.02). In phase 2, 29 of 35 (83%) in the 4-week telehealth CBT and 26 of 33 (79%) subjects in the no-CBT demonstrated a decrease in the WOMAC pain subscale >4 at 3 months, difference 4% (95% CI −18% to 26%, p=0.48), despite a median decrease in the PCS for the 4-week CBT and no-CBT group of −6 (−10 to −2, p=0.02).Conclusions Our findings demonstrate that CBT interventions delivered prior to surgery in person or via telehealth can reduced PCS scores; however, this reduction did not lead to improved 3-month pain outcomes.Trial registration number ClinicalTrials.gov (NCT 01772329, registration date 21 January 2013).Data are available upon reasonable request. Deidentified participant data may be available from RJM (ORCID id:0000-0002-0966-5311), the corresponding author, on request and execution of a data use agreement. ER -