title: Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review.
abstract: BACKGROUND
  Total knee arthroplasty (TKA) is a common and costly surgical procedure. Despite high success rates, many TKA patients develop chronic pain in the months and years following surgery, constituting a public health burden. Pain catastrophizing is a construct that reflects anxious preoccupation with pain, inability to inhibit pain-related fears, amplification of the significance of pain vis-à-vis health implications, and a sense of helplessness regarding pain. Recent research suggests that it may be an important risk factor for untoward TKA outcomes. To clarify this impact, we systematically reviewed the literature to date on pain catastrophizing as a prospective predictor of chronic pain following TKA.
  
  
  METHODS
  We searched MEDLINE, EMBASE, and PsycINFO databases to identify articles related to pain catastrophizing, TKA, risk models, and chronic pain. We reviewed titles and abstracts to identify original research articles that met our specified inclusion criteria. Included articles were then rated for methodological quality. including methodological quality. Due to heterogeneity in follow-up, analyses, and outcomes reported across studies, a quantitative meta-analysis could not be performed.
  
  
  RESULTS
  We identified six prospective longitudinal studies with small-to-mid-sized samples that met the inclusion criteria. Despite considerable variability in reported pain outcomes, pain catastrophizing was identified as a significant predictor of chronic pain persisting ≥3 months following TKA in five of the studies assessed. Limitations of studies included lack of large-scale data, absence of standardized pain measurements, inadequate multivariate adjustment, such as failure to control for analgesic use and other relevant covariates, and failure to report non-significant parameter estimates.
  
  
  CONCLUSIONS
  This study provides moderate-level evidence for pain catastrophizing as an independent predictor of chronic pain post-TKA. Directions for future research include larger, well-controlled studies with standard pain outcomes, identification of clinically-relevant catastrophizing cut-offs that predict pain outcomes, investigation of other psychosocial risk factors, and assessment of interventions aimed to reduce pain catastrophizing on chronic pain outcomes following TKA surgery.
authors.affiliation: Department of Psychology, York University, Toronto, ON, Canada ; Arthritis Research Centre of Canada, Vancouver, BC, Canada ; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Lindsay C
authors.initials: LC
authors.lastname: Burns
authors.affiliation: Department of Psychology, York University, Toronto, ON, Canada.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Ritvo
authors.affiliation: Department of Psychology, York University, Toronto, ON, Canada.
authors.forename: Meaghan K
authors.initials: MK
authors.lastname: Ferguson
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada ; Department of Anesthesia, University of Toronto, Toronto, ON, Canada ; Centre for the Study of Pain, Faculties of Dentistry and Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Hance
authors.initials: H
authors.lastname: Clarke
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada ; Centre for the Study of Pain, Faculties of Dentistry and Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Ze'ev
authors.initials: Z
authors.lastname: Seltzer
authors.affiliation: Department of Psychology, York University, Toronto, ON, Canada ; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada ; Department of Anesthesia, University of Toronto, Toronto, ON, Canada ; Centre for the Study of Pain, Faculties of Dentistry and Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Joel
authors.initials: J
authors.lastname: Katz
keywords: chronic pain; knee arthroplasty; pain catastrophizing; risk factors; total knee arthroplasty; total knee replacement