Pain catastrophising is a psychological condition whereby patients irrationally believe their pain will be worse than what they are likely to experience.

Patients who catastrophise tend to become excessively worried about pain. They tend to have more investigations, more treatment, and be slower with rehabilitation, thus leading to poorer return to work outcomes.

This study from the United States explored pain coping strategies for people undergoing a knee replacement. 

Patients scheduled to undergo knee replacement surgery were assessed for pain catastrophising. 18 patients identified as catastrophising their pain received pain coping skills training through a psychologist. The training was undertaken over eight sessions.

These patients were compared to a group of 45 similar patients who had not had pain coping training. The researchers studied pain and disability scores, as well as pain catastrophising two months after surgery. 

Those who had received pain coping skills training reported significantly greater reduction in pain severity and catastrophising, and had improved outcomes compared to those who did not have the training. 

While the researchers suggest that a larger study should be completed, they argue that their study provides good preliminary evidence that educating patients with high levels of catastrophising can make a major difference in patient outcomes.

The research findings are not just relevant to knee replacement surgery and should be applicable to a broad range of conditions that are treated either with or without an operation.

Authors

Riddle DL, Keefe FJ, Nay WT, McKee D, Attarian DE & Jensen MP.

Institution

Department of Physical Therapy and Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA.

Title

Pain coping skills training for patients with elevated pain catastrophizing who are scheduled for knee arthroplasty: a quasi-experimental study.

Source

Arch Phys Med Rehabil. 2011 Jun;92(6):859-65. Epub 2011 Apr 29.

Abstract

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.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/21530943