Long-Term Pain Following Joint Arthroplasty Affected by Emotional Distress

Knee replacement surgery 2 days post op. on a 72 year old senior woman. Doctor is changing the bandages
Long-term pain trajectories following joint arthroplasty are affected by emotional distress and cognitive flexibility.

For patients who undergo joint arthroplasty, long-term pain was associated with emotional distress and cognitive flexibility, according to results of a longitudinal prospective study published in Pain Practice.

Patients (N=210) undergoing total knee arthroplasty (TKA), partial knee arthroplasty (PKA) or total hip arthroplasty (THA) at a single center in Italy were recruited for this study. Participants were assessed by a battery of pain and neuropsychological testing including the Trail Making Test (TMT) prior to surgery. All patients were given standardized pain management including oral morphine sulfate 5 or10 mg as a pain management rescue. After surgery, patients maintained a pain diary.

Participants were 34.8% men, aged median 65 (interquartile range [IQR], 13) years, 41.9% had PKA, 31.0% TKA, and 27.1% THA.

At month 1, pain intensity was predicted by higher emotional distress (b, 0.783; t, 2.214; P =.028), explaining 15.7% of the variance (F[6,138], 7.265; P <.001) and pain interference was predicted by emotional distress (b, 1.272; t, 3.349; P <.001) and TMT scores (b, 0.014; t, 2.059; P =.04), explaining 22.2% of the variance (F[6,138], 7.415; P <.001).

At 3 months, pain intensity was predicted by central sensitization (b, 0.934; t, 3.130; P =.004), explaining 15.1% of the variance (F[5,139], 4.347; P =.001) and pain interference by central sensitization (b, 0.733; t, 2.089; P =.038) and emotional distress (b, 1.034; t, 2.483; P =.014), explaining 24.6% of the variance (F[8,136], 8.119; P <.001).

At 12 months, pain intensity and interference were predicted by central sensitization (b, 0.837; t, 2.943; P =.004) and (b, 0.755; t, 2.783; P =.006), explaining 9.8% (F[7,135], 2.099; P =.048) and 9.1% (F[7,135], 2.272; P =.04) of the variance, respectively.

This study was limited by combining 3 surgical procedures, especially as procedure was significant in the final model of pain trajectories (THA vs TKA; b, -1.278; standard error [SE], 0.282; P <.001).

These data indicated that long-term pain trajectories following joint arthroplasty were affected by the patient’s emotional distress and cognitive flexibility.


Giusti EM, Lacerenza M, Gabrielli S, et al. Psychological factors and trajectories of post-surgical pain: a longitudinal prospective study. Pain Pract. Published online September 9, 2021. doi:10.1111/papr.13074