Asokumar Buvanendran 1 , Amanda C Sremac 1 , Patricia A Merriman 1 , Craig J Della Valle 2 , John W Burns 3 , Robert J McCarthy 4 Show Affiliations »
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INTRODUCTION: Cognitive-behavioral therapy (CBT ) can reduce preoperative pain catastrophizing and may improve postsurgical pain outcomes . We hypothesized that CBT would reduce pain catastrophizing more than no-CBT controls and result in improved pain outcomes . METHODS: The study was a randomized controlled trial of patients undergoing elective total knee arthroplasty between January 2013 and March 2020 . In phase 1, the change in pain catastrophizing scores (PCS ) among 4-week or 8-week telehealth, 4-week in person and no-CBT sessions was compared in 80 patients with a PCS >16. In phase 2, the proportion of subjects that achieved a 3-month decrease in Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain subscale >4 following 4-week telehealth CBT with no-CBT controls were compared in 80 subjects. RESULTS: In phase 1, 4-week telehealth CBT had the highest completion rate 17/20 (85%), demonstrated an adjusted median reduction in PCS of -9 (95% CI -1 to -14, p<0.01) compared with no-CBT and was non-inferior to 8-week telehealth CBT at a margin of 2 (p=0.02). In phase 2, 29 of 35 (83%) in the 4-week telehealth CBT and 26 of 33 (79%) subjects in the no-CBT demonstrated a decrease in the WOMAC pain subscale >4 at 3 months, difference 4% (95% CI -18% to 26%, p=0.48), despite a median decrease in the PCS for the 4-week CBT and no-CBT group of -6 (-10 to -2, p=0.02). CONCLUSIONS: Our findings demonstrate that CBT interventions delivered prior to surgery in person or via telehealth can reduced PCS scores ; however, this reduction did not lead to improved 3-month pain outcomes . TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT01772329, registration date 21 January 2013). © American Society of Regional Anesthesia & Pain Medicine 2021. No commercial re-use. See rights and permissions. Published by BMJ.
RCT Entities: Population
Interventions
Outcomes
INTRODUCTION: Cognitive-behavioral therapy (CBT) can reduce preoperative pain catastrophizing and may improve postsurgical pain outcomes. We hypothesized that CBT would reduce pain catastrophizing more than no-CBT controls and result in improved pain outcomes. METHODS: The study was a randomized controlled trial of patients undergoing elective total knee arthroplasty between January 2013 and March 2020. In phase 1, the change in pain catastrophizing scores (PCS) among 4-week or 8-week telehealth, 4-week in person and no-CBT sessions was compared in 80 patients with a PCS >16. In phase 2, the proportion of subjects that achieved a 3-month decrease in Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain subscale >4 following 4-week telehealth CBT with no-CBT controls were compared in 80 subjects. RESULTS: In phase 1, 4-week telehealth CBT had the highest completion rate 17/20 (85%), demonstrated an adjusted median reduction in PCS of -9 (95% CI -1 to -14, p<0.01) compared with no-CBT and was non-inferior to 8-week telehealth CBT at a margin of 2 (p=0.02). In phase 2, 29 of 35 (83%) in the 4-week telehealth CBT and 26 of 33 (79%) subjects in the no-CBT demonstrated a decrease in the WOMAC pain subscale >4 at 3 months, difference 4% (95% CI -18% to 26%, p=0.48), despite a median decrease in the PCS for the 4-week CBT and no-CBT group of -6 (-10 to -2, p=0.02). CONCLUSIONS: Our findings demonstrate that CBT interventions delivered prior to surgery in person or via telehealth can reduced PCS scores; however, this reduction did not lead to improved 3-month pain outcomes. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT01772329, registration date 21 January 2013). © American Society of Regional Anesthesia & Pain Medicine 2021. No commercial re-use. See rights and permissions. Published by BMJ.
Entities: Disease
Species
Keywords:
acute pain; chronic pain; treatment outcome
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Year: 2021
PMID： 33452201 DOI： 10.1136/rapm-2020-102258
Source DB: PubMed Journal: Reg Anesth Pain Med ISSN： 1098-7339 Impact factor: 6.288