Preoperative Cognitive Therapy for Improving Health Outcomes After TKA in High-risk Catastrophizing Subjects

Rush University Medical Center160 enrolled

Overview

The investigators propose a randomized controlled trial to evaluate the effects of treatment intended to reduce pain catastrophizing among patients reporting high pain catastrophizing prior to total knee replacement(TKR), total hip replacement(THR), or shoulder surgery in an effort to thereby reduce the incidence of persistent post-surgical pain (PPP) and enhance physical function at 3-months post-surgery. Preemptive treatment aimed at a known predictor of PPP following total knee replacement is highly innovative and have potentially high impact for public health. Cognitive therapy is a well-tolerated modality among chronic pain patients with few if any side effects. Cognitive therapy (CT) represents an inexpensive method that could greatly reduce suffering and costly post-surgical pain management for high risk TKR patients.

Aim 1 is to determine which CT protocol is most effective in reducing Pain Catastrophizing Scale (PCS) and Coping Strategies Questionnaire Catastrophizing Subscale (CSQ-CAT) scores in high-risk TKR candidates. CT will consist of four-to-eight weekly 1-hr individual cognitive therapy sessions prior to surgery. Aim 2 is to compare the most efficient treatment from Aim 1 with a control group to evaluate pain relief at 3 months.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Enrollment

160

Conditions

Catastrophization

Eligibility

Sex: ALLMin age: 18 YearsMax age: 85 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: 1. undergoing standard primary TKR; THR or Shoulder Surgery 2. 18- 85 yrs of age; 3. Surgical joint is the primary source of patient's pain; 4. Patient agrees to preoperative visits and treatment, follow-up visits and treatment, and to comply with the assessment tests; 5. Patient consents to standard anesthetic and analgesic protocol, with medical care as deemed necessary by the anesthesiologist, and has no contraindications. 6. Patient has been diagnosed with osteoarthritis. Exclusion Criteria: 1. Currently using antidepressant medication or undergoing cognitive therapy; 2. chronic opioid use ≥ 10 mg/day of morphine equivalents within one wk prior to the surgery, and duration of use \> 4 wks; 3. history of opioid abuse; 4. inability to understand and communicate with the investigators to complete the study related questionnaires 5. patient is planning to undergo another elective joint procedure during the 6-mo period of participation; 6. any co-morbidity which results in severe systemic disease limiting function {as defined by the American Society of Anesthesiology (ASA) physical status classification \> 3}.

Outcomes

Primary Outcomes

(Aim 1) Pain Catastrophizing Scale (PCS)

Pain Catastrophizing Scale - Min=0, Max=52, Higher score = more catastrophizing so lower scores are preferable.

Time frame: 4 or 8 weeks after start of treatment

(Aim 2) Proportion of patients with pain relief

Proportion of patients w a 3 month decrease in WOMAC pain subscale \<= 4. (WOMAC Osteoarthritis Index)

Time frame: 3 month

Secondary Outcomes

Patient Health Questionnaire (PHQ-8)

Patient Health Questionnaire (PHQ-8): The eight-item Patient Health Questionnaire depression scale (PHQ-8) is established as a valid diagnostic and severity measure for depressive disorders

Time frame: 4 and 8 weeks after start of treatment

Generalized anxiety disorder (GAD-7)

Generalized anxiety disorder (GAD-7): The seven-item Generalized Anxiety Disorder Scale (GAD-7) is a practical self-report anxiety questionnaire.