Cognitive-behavioral therapy had a positive initial effect on PTG pain catastrophizing


February 15, 2022

2 minute read



Mero B, et al. Paper 72. Presented at: Orthopedic Research Society Annual Meeting. February 4-8, 2022; Tampa, Florida.

Disclosures: Mero does not report any relevant financial information.

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TAMPA, Fla. — Compared to usual orthopedic care, cognitive behavioral therapy after 1 month decreased catastrophic pain in patients undergoing total knee replacement surgery, according to results presented here.

However, 3 months after the cognitive-behavioral therapy (CBT) intervention, patients’ pain catastrophizing scores (PCS) were not significantly different than they were after 1 month, research from the University of Illinois at Chicago.

Benjamin Mero, BS, a second-year medical student, presented the results at the annual meeting of the Orthopedic Research Society.

Mero and colleagues conducted a systematic review and analyzed randomized controlled studies to investigate treatments for catastrophic pain in TKA.

“Our research demonstrates that CBT is an effective short-term treatment for catastrophic pain in patients undergoing total knee replacement surgery in the perioperative period,” he said. noted.

Researchers sought to examine the effect of CBT in patients undergoing TKA, as findings on the effectiveness of catastrophic pain treatments are mixed in the literature. Also, sample sizes in studies that evaluated CBT for patients undergoing TKA are small, Mero said.

For the meta-analysis, the researchers searched the PubMed, Medline, and Cochrane Library databases for randomized controlled trials involving CBT in patients undergoing TKA. Among 284 results, they identified seven trials (658 patients) conducted from 1 January 2011 to 31 July 2021, which met the inclusion conditions of having search terms such as ‘pain’, ‘catastrophic pain’ and ‘PTG “. After excluding one trial which, according to the abstract, had “a quasi-experimental control group”, the remaining six trials all described the CBT method used and included pain catastrophizing scores (PCS) and functional scores.

“CBT in this context refers to the thought process related to pain, with sessions with a therapist,” Mero said.

The researchers then extracted demographic data, PCS scores preoperatively and at 1 month and 3 months postoperatively, as well as secondary functional outcomes between 2 and 6 months postoperatively, which included the company score of the knee, Oxford knee score, knee range of motion and WOMAC scale scores. They also extracted the mean difference (MD) from a random-effects model in PCS scores for the study population.

Results after 1 month of CBT intervention showed that the random-effects model MD for PCS scores was -4.85, “showing improvement in PCS scores after CBT,” according to the abstract.

“At 1 month postoperative, our data show that CBT appears to improve PCS scores with an average difference of approximately 5 points compared to routine orthopedic care. At 3 months, the data show that there was no significant difference between CBT and routine orthopedic care. Ultimately, no difference was found between CBT and routine orthopedic care in functional outcomes at the postoperative interval of 2 to 6 months,” a Mero said.

Among the limitations of the study were the small number of studies included in the analysis and the fact that they were all level 2 studies, he said.

Mero said, “Another limitation is the lack of studies evaluating the effectiveness of CBT over a longer interval.”


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