Long-Term Pain Following Joint Arthroplasty Affected by Emotional Distress

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.

Reference

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