Presented at the 2012 AAPM Annual Meeting « Back

Pain Catastrophizing, but not Widespread Pain, Is Associated with Poor Pain Outcomes After Knee Replacement: An Analysis from the Multicenter Osteoarthritis Study (MOST)

Jasvinder A. Singh, MD MPH, jasvinder.md@gmail.com¹, Cora (Beth) E. Lewis, MD¹, Ke Wang, MSc², David Felson, MD², Mike Nevitt, MD³, James Torner, MD⁴, Laurence A. Bradley, PhD¹, Tuhina Neogi, MD MPH², (1) University of Alabama at Birmingham, Birmingham, Alabama, (2) Boston University, Boston, Massachusetts, (3) UCSF, San Francisco, California, (4) University of Iowa, Iowa City, Iowa

Background/Objective: We examined whether pain catastrophizing and widespread pain are associated with poor pain outcomes post-knee replacement (KR). Methods: We used data from Multicenter Osteoarthritis Study (MOST), a longitudinal cohort study of persons with or at high risk of knee OA. In patients who underwent KR, we assessed poor pain outcomes: (1) moderate-severe knee pain post-KR (maximal score of at least moderate pain on at least one of the 5 Western Ontario McMaster Osteoarthritis index (WOMAC) pain questions); and (2) poor pain responder (failure to achieve clinically meaningful change in knee pain i.e., decrease of ≥5.6/20 on WOMAC pain in replaced knee after KR). Primary predictor variables of interest were widespread pain and pain catastrophizing, assessed by the Coping Strategies Questionnaire. Multivariable-adjusted regression analyses adjusted for age, sex, BMI, ethnicity, clinic, contralateral knee OA or KR, comorbidity, lower back pain and pre-KR WOMAC pain. Results: During follow-up, 297 subjects had 391 eligible new KRs. 34% patients had moderate-severe knee pain post-KR and 31% patients were poor pain responders. In multivariable-adjusted analyses, pain catastrophizing was associated with significantly higher odds of moderate-severe pain outcome (odds ratio (0R), 2.3; 95% CI:1.3, 3.9; p = 0.0025), and poor pain responder status post-KR (OR, 2.8; 95% CI:1.5, 5.1; p = 0.0008). Widespread pain was not significantly associated with either outcome with OR of 1.2 (95% CI:0.7, 2.1; p = 0.49) and 1.1 (0.6, 2.0; p = 0.71), respectively. Conclusions: This is the first evidence in a well-characterized longitudinal osteoarthritis cohort that pain catastrophizing is associated with worse pain outcomes post-KR.

Funding: NIA