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Temporal association of pain catastrophizing and pain severity across the perioperative period: a cross-lagged panel analyses following total knee arthroplasty.

OBJECTIVE
While numerous studies show that preoperative pain catastrophizing is a risk factor for pain following total knee arthroplasty (TKA), little is known regarding the temporal course of the association between perioperative pain catastrophizing and pain severity. The present study investigated temporal changes and their dynamic associations between pain catastrophizing and pain severity before and after TKA.


DESIGN
A secondary data analysis of a larger observational parent study featuring prospective repeated measurement over 12 months.


SETTING
Dual-site academic hospital.


SUBJECTS
245 individuals who underwent TKA.


METHODS
Participants completed pain catastrophizing and pain severity questionnaires at baseline, 6-weeks, and 3-, 6-, and 12-months post-TKA. Cross-lagged panel analysis was conducted using structural equation modeling including age, sex, race, baseline anxiety and depressive symptoms as covariates.


RESULTS
Reduction in pain catastrophizing from baseline to 6-week post-TKA was associated with lower pain severity at 3-month post-TKA (standardized β = .14; SE = .07, p = .046), while reduction in pain severity at 6-week post-TKA was not associated with pain catastrophizing at 3-month post-TKA (p = .905). In the chronic post-surgical period (>3 months), pain catastrophizing at 6-month post-TKA predicted pain severity at 12 months post-TKA (β = .23, p = .009)] while controlling for auto-correlation and covariates, but not vice versa.


CONCLUSIONS
We provide evidence that changes in pain catastrophizing from baseline to 6-week post-TKA are associated with subsequent pain severity. Future studies are warranted to determine whether targeting pain catastrophizing during the perioperative period may improve clinical outcomes for individuals undergoing TKA.