Abstract
Objectives
To investigate pain catastrophizing presentations up to 6 months postoperatively and
subsequent changes in pain intensity and physical function.
Design
Prospective observational multisite study.
Setting
Two tertiary care facilities between 2016 and 2019.
Participants
: Adult patients (N=348) undergoing a mastectomy, thoracic surgery, total knee or
hip arthroplasty, spinal fusion, or major abdominal surgery.
Interventions
Not applicable.
Main Outcome Measures
Pain Catastrophizing Scale scores, Defense and Veterans Pain Rating Scale, average
pain intensity, and Patient Reported Outcomes Measurement Information System (PROMIS)
physical function.
Results
Four pain catastrophizing trajectories were identified in 348 surgical patients during
the 6 months of postoperative recovery: stable, remitting, worsening, and unremitting.
Linear mixed-effects models found that the unremitting trajectory was associated with
higher pain intensity over time. The average pain intensity of participants in the
remitting trajectory was estimated to decrease at a faster rate over the 6 months
after surgery than pain of other trajectories, despite participants reporting high
preoperative Pain Catastrophizing Scale and pain scores. Worsening and unremitting
trajectories were associated with reduced physical function. Preoperative average
pain intensity scores were not associated with postoperative physical function scores,
nor were participants’ preoperative physical function scores associated with average
pain intensity scores postoperatively. Prolonged hospitalization, smoking, and preoperative
opioid prescriptions were associated with the unremitting trajectory.
Conclusions
Findings suggest that preoperative pain catastrophizing scores alone may not be adequate
for estimating long-term patient-reported outcomes during postoperative rehabilitation.
Pain catastrophizing has a dynamic presentation and is associated with changes in
pain intensity and physical function up to 6 months postoperatively. Routine assessments
can inform the delivery of early interventions to surgical patients at risk of experiencing
a pain catastrophizing trajectory associated with suboptimal outcomes during rehabilitation.
Keywords
List of abbreviations:
CI (confidence interval), DVPRS (Defense and Veterans Pain Rating Scale), PCS (Pain Catastrophizing Scale), PROMIS (Patient Reported Outcomes Measurement Information System)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 20, 2020
Footnotes
Clinical Trial Registration No.: NCT03081299.
Disclosures: Michael L. Kent received an investigator-initiated grant from Pacira Pharmaceuticals Inc. during the conduct of the study. There was no involvement in the design; collection, analysis, and interpretation of the data; writing of the report; or the decision to submit for publication. The other authors have nothing to disclose.
The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of Veterans Affairs, Uniformed Services University, the Department of the Army/Navy/Air Force, Department of Defense, the United States Government, or the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.
Identification
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© 2020 by the American Congress of Rehabilitation Medicine
