Original article
Pain Coping Skills Training for Patients With Elevated Pain Catastrophizing Who Are Scheduled for Knee Arthroplasty: A Quasi-Experimental Study

Presented to the Osteoarthritis Research Society, September 23ā€“26, 2010, Brussels, Belgium.
https://doi.org/10.1016/j.apmr.2011.01.003Get rights and content

Abstract

Riddle DL, Keefe FJ, Nay WT, McKee D, Attarian DE, Jensen MP. Pain coping skills training for patients with elevated pain catastrophizing who are scheduled for knee arthroplasty: a quasi-experimental study.

Objectives

To (1) describe a behavioral intervention designed for patients with elevated pain catastrophizing who are scheduled for knee arthroplasty, and (2) use a quasi-experimental design to evaluate the potential efficacy of the intervention on pain severity, catastrophizing cognitions, and disability.

Design

Quasi-experimental nonequivalent control group design with a 2-month follow-up.

Setting

Two university-based orthopedic surgery departments.

Participants

Adults (N=63) scheduled for knee replacement surgery who reported elevated levels of pain catastrophizing. Patients were recruited from 2 clinics and were assessed prior to surgery and 2 months after surgery.

Interventions

A group of 18 patients received a psychologist-directed pain coping skills training intervention comprising 8 sessions. The other group, a historical cohort of 45 patients, received usual care.

Main Outcome Measures

Western Ontario and McMaster Universities Arthritis Index Pain and Disability scores, as well as scores on the Pain Catastrophizing Scale.

Results

Two months after surgery, the patients who received pain coping skills training reported significantly greater reductions in pain severity and catastrophizing, and greater improvements in function as compared to the usual care cohort.

Conclusions

Pain catastrophizing is known to increase risk of poor outcome after knee arthroplasty. The findings provide preliminary evidence that the treatment may be highly efficacious for reducing pain, catastrophizing, and disability, in patients reporting elevated catastrophizing prior to knee arthroplasty. A randomized controlled trial is warranted to confirm these effects.

Section snippets

Design

This quasi-experimental (ie, nonrandomized) study compared treatment outcome between 2 independent cohorts, 1 that received the pain coping skills training and 1 that received usual care.

Pain coping skills training cohort

Participants in the pain coping skills group were consecutively recruited between April and September 2009 from 2 sites: (1) Virginia Commonwealth University Medical Center, Richmond, Virginia or (2) Duke University Medical Center, Durham, North Carolina. The patients had already consented to have knee

Results

A total of 45 patients from the usual care cohort and 18 patients from the pain coping skills cohort were included in the study (table 3). Of the 18 patients recruited for pain coping skills training, 15 completed the training. For the 3 remaining patients, 2 canceled their surgery and 1 dropped out of the study after the first training session.

Patients in the pain coping skills group demonstrated a mean improvement Ā± SD in WOMAC Pain scores of 6.9Ā±4.7 points, while patients in the usual care

Discussion

We found that improvement in self-reported function and function-related pain after pain coping skills training was substantial relative to the usual care group. The mean improvements in WOMAC Disability scores were 14.3 points greater for the pain coping skills group than the usual care group. For the WOMAC Pain scale, the mean difference between groups was 4.2 points. These mean differences are substantially larger than the minimal clinically important difference of approximately 10% of the

Conclusions

Despite the limitations in the design of our study, we found what appears to be very promising effects of pain coping skills training for knee arthroplasty patients with elevated pain catastrophizing. Mean differences in WOMAC Pain, WOMAC Function, and PCS scores between the treatment groups far exceeded clinically important differences. The findings indicate that a definitive trial of pain coping skills training for the subset of knee arthroplasty patients with elevated pain catastrophizing is

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    Supported by the National Institute of Arthritis, Musculoskeletal and Skin Diseases (grant no. 1R34AR056727-01).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

    Reprints will not be available from the author.

    Published online April 29, 2011 at www.archives-pmr.org.

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