Abstract. Background. Around 5–15% of patients will experience chronic postoperative pain after total knee replacement (TKR) surgery but the source of the pain is unknown. The aim of this study was to assesses patients six months after TKR using magnetic resonance imaging (MRI) of the knee, pain sensory profiles and assessments of pain catastrophizing thoughts. Methods. Forty-six patients had complete postoperative data and were included. MRI findings were scored according to the MRI Osteoarthritis Knee Score (MOAKS) recommendation for Hoffa synovitis, effusion size and bone marrow lesions. Pain sensory profiles included the assessment of pressure pain thresholds (PPTs), temporal summation of pain (TSP) and conditioned pain modulation (CPM). Pain catastrophizing was assessed using the pain catastrophizing scale (PCS). Clinical pain was evaluated using a visual analog scale (VAS, 0–10cm) and groups of moderate-to-severe (VAS>3) and non-to-mild postoperative pain (VAS≤3) were identified. Results. Patients with moderate-to-severe postoperative pain demonstrated higher grades of Hoffa synovitis (P<0.001) and effusion size (P<0.001), lower PPTs (P=0.039), higher TSP (P=0.001) and lower CPM (P=0.014) when compared to patients with non-to-mild postoperative pain. No differences were found in PCS scores. Linear regression models found TSP (P=0.013), PCS (P<0.001), Hoffa synovitis (P=0.036) and effusion size (P=0.003) as independent parameters contributing to the postoperative pain severity. Conclusion. These finding indicate that chronic postoperative after TKR is a combination of joint-related synovitis and effusion in combination with sensitization of central pain mechanisms and pain catastrophizing thoughts

The Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0) is a patient-reported disease-specific quality of life (QOL) outcome measure used to assess patients with recurrent lateral patellofemoral instability (LPI) both pre- and post-operatively. The purpose of this study was to compare the BPII 2.0 to four other relevant patient reported outcome measures (PROMs): the Tampa Scale-11 for kinesiophobia (TSK-11), the pain catastrophizing scale (PCS), a general QOL (EQ-5D-5L), and a return to sport index (ACL-RSI). This concurrent validation sought to compare and correlate the BPII 2.0 with these other measures of physical, psychological, and emotional health. The psychological and emotional status of patients can impact recovery and rehabilitation, and therefore a disease-specific PROM may be unable to consistently identify patients who would benefit from interventions encompassing a holistic and person-focused approach in addition to disease-specific treatment. One hundred and ten patients with recurrent lateral patellofemoral instability (LPI) were assessed at a tertiary orthopaedic practice between January and October 2021. Patients were consented into the study and asked to complete five questionnaires: the BPII 2.0, TSK-11, PCS, EQ-5D-5L, and the ACL-RSI at their initial orthopaedic consultation. Descriptive demographic statistics were collected for all patients. A Pearson's r correlation coefficient was employed to examine the relationships between the five PROMs. These analyses were computed using SPSS 28.0 © (IBM Corporation, 2021). One hundred and ten patients with a mean age of 25.7 (SD = 9.8) completed the five PROMs. There were 29 males (26.3%) and 81 females (73.6%) involving 50% symptomatic left knees and 50% symptomatic right knees. The mean age of the first dislocation was 15.4 years (SD = 7.3; 1-6) and the mean BMI was 26.5 (SD = 7.3; range = 12.5-52.6) The results of the Pearson's r correlation coefficient demonstrated that the BPII 2.0 was statistically significantly related to all of the assessed PROM's (p. There was significant correlation evident between the BPII 2.0 and the four other PROMs assessed in this study. The BPII 2.0 does not explicitly measure kinesiophobia or pain catastrophizing, however, the significant statistical relationship of the TSK-11 and PCS to the BPII 2.0 suggests that this information is being captured and reflected. The preliminary results of this concurrent validation suggest that the pre-operative data may offer predictive validity. Future research will explore the ability of the BPII 2.0 to predict patient quality of life following surgery

Outcomes following carpal tunnel release are generally favorable. Understanding factors that contribute to inferior outcomes may allow for strategies targeted at improving results in these patients. Our purpose was to determine if patients' underlying personality traits, specifically resiliency and catastrophization, impact their post-operative outcomes following carpal tunnel release. A prospective case series was performed. Based on our power analysis, 102 patients were recruited. Patients completed written consent, the Boston Carpal Tunnel Questionnaire (BCTQ), the Pain Catastrophizing Scale (PCS) and the Brief Resiliency Scale (BRS). A single surgeon, or his resident under supervision, then performed an open carpal release under local anaesthetic. Our primary outcome measure was a repeat BCTQ at three- and six-months. Univariate and multivariate analysis was performed to assess the correlation between PCS and BRS scores and final BCTQ scores. Forty-three and sixty-three participants completed the BCTQ at three and six months respectively. All patients showed improvement in their symptoms (p = 0.001). There was no correlation between patients PCS or BRS and the amount of improvement. There was also no correlation between PCS or BRS and the patients' raw scores at baseline or follow-up. Patients self-assessed resiliency and degree of pain catastrophization has no correlation with the amount of improvement they have three or six months post-operatively. Most patients improved following carpal tunnel release, and patients with low resiliency and high levels of pain catastrophization should expect comparable outcomes to patients without these features

Background and purpose. The Fear Avoidance Model is used to explain why some patients with acute low back pain develop chronic low back pain (CLBP). Cognitive behavioural therapy (CBT) targeting dysfunctional behavioural cognitions (pain catastrophizing and fear of movement) is recommended. Purpose: to investigate whether a two-week CBT-based pain management program results in improvement in dysfunctional behavioural cognitions and whether these improved cognitions improve functional outcomes. Methods and Results. Cohort study including 524 consecutive CLBP-patients. Main outcome: functioning (ODI). Secondary outcomes: pain severity (NRS), pain catastrophizing (PCS), fear of movement (TSK). Assessments: pre- and post-treatment, 1 and 12-months follow-up (FU). Improvement over time was analysed with repeated measures ANOVA. Path analyses were used to examine the influence of pain catastrophizing and fear of movement on functional disability and pain severity. Multiple imputation was used to complete missing data. Participants with incomplete data (12.8%) did not differ from those with complete data (n= 457). 59% were females, mean age 46 (± 9.5) years, mean CLBP-duration 12 (± 10.8) years. All outcomes significantly improved at post-treatment and a slight significant improvement between post-treatment and 12 months FU was observed. Path analyses showed a direct effect for catastrophizing on post-treatment functioning and an indirect effect for catastrophizing through fear of movement on post-treatment functioning. Comparable results with pain severity as outcome. Conclusion. A two-week pain management program improved dysfunctional behavioral cognitions and functional outcomes in patients with longstanding CLBP up to one year. Targeting both pain catastrophizing and fear of movement during the program resulted in improved outcomes. Conflicts of Interest: JK O'Dowd is director of and shareholder in RealHealth. The authors declare that this abstract has not been previously published in whole or substantial part nor has it been presented previously at a national or international meeting. Sources of Funding:. No funding obtained

The relationship between pain catastrophizing and emotional disorders including anxiety and depression in patients with hip or knee osteoarthritis undergoing total joint replacement (TJR) is an emerging area of study. The purpose of this study was to examine the association between catastrophizing, anxiety, depression and postoperative pain and functional outcomes following primary TJR. A prospective cohort study of preoperative TJR patients at one academic arthroplasty centre over a one-year period was conducted. Pain catastrophizing was assessed using the Pain Catastrophizing Scale (PCS), and anxiety/depression using the Hospital Anxiety and Depression Scale (HADS-A, HADS-D) at preoperative assessment. Postoperative outcomes at one-year included patient perceived level of hip/knee pain using a visual analogue scale (VAS), subjective perception of function using the Oxford Hip/Knee Scores, and objective function using the Knee Society Score (KSS) and Harris Hip scores (HHS). Median regression was used to assess pattern of relationship between preoperative PCS clinically relevant catastrophizing (CRC), abnormal HADS-A, abnormal HADS-D and postoperative outcomes at one-year. Median difference and 95% confidence interval (CI) were reported. T-tests were performed to determine mean differences in postoperative outcomes among patients with PCS CRC, abnormal HADS-A, and abnormal HADS-D scores versus those with normal scores at preoperative assessment. P-values less than 0.05 were considered statistically significant. The sample included 463 TJR patients (178 hips, 285 knees). Both the PCS-rumination CRC sub-domain (median difference 1, 95% CI 0.31–1.69, p=0.005) and abnormal HADS-A (median difference 1, 95% CI 0.36–1.64, p=0.002) were identified as significant predictors of one-year VAS pain. PCS-magnification CRC sub-domain was also identified as a significant predictor of KSS/HHS at one-year (median difference 1.3, 95% CI −5.23–0.11, p=0.041). Preoperative VAS pain, Oxford and HHS/KSS scores were significantly inferior in patients who had CRC PCS, abnormal HADS-A, and abnormal HADS-D scores compared to patients with normal scores. At one-year, PCS CRC patients also had significantly inferior VAS pain (p=0.001), Oxford (p < 0 .0001) and KSS/HHS (p=0.025). Abnormal HADS-A and HADS-D patients experienced significantly inferior postoperative VAS pain (HADS-A p=0.025, HADS-D p=0.030), Oxford (HADS-A p=0.001, HADS-D p=0.030), but no difference in KSS/HHS (HADS-A = 0.069, HADS-D = 0.071) compared to patients with normal PCS/HADS scores. However, patients with CRC PCS experienced significantly greater improvement in preoperative to postoperative VAS pain (p < 0 .0001), Oxford (p=0.003) and HHS/KSS (p < 0 .0001). Similarly, patients with abnormal HADS scores showed significant improvement in preoperative to one-year postoperative change scores, as compared to normal patients in VAS pain (HADS-A p=0.011, HADS-D p=0.024), KSS/HHS (HADS-A p=0.017, HADS-D p=0.031), but not Oxford (HADS-A p=0.299, HADS-D p=0.558). Patients who are anxious, depressed or who pain catastrophize have worse preoperative function and pain. Postoperatively, pain and functional outcomes are also inferior in such patients, however they do experience a significantly greater improvement in outcomes. Furthermore, it appears that rumination and anxiety traits predict pain levels postoperatively. Although these patients report higher levels of pain postoperatively, as compared to preoperative, great improvement can be expected following hip and knee TJR

Background. Emerging research has indicated that ‘significant others’ (spouses/relatives) may have important influences on continued work participation for individuals with chronic non-specific musculoskeletal pain (CMP). In order to expand on this novel area of research, data from studies conducted in The Netherlands and the UK were assimilated. Method. In both studies, worker and significant other perceptions of pain self-efficacy, perceived partner responses to pain, pain catastrophizing, and contribution to work participation were explored in relation to the worker's CMP. In the Netherlands, questionnaire data were collected from workers with CMP and their significant others (n=103), and in the UK, in-depth semi-structured interviews were conducted (n=10). Appropriate quantitative and qualitative analysis techniques were applied. Results. In the Dutch study, moderate to high levels of perceived pain self-efficacy, moderate levels of significant other solicitous and distracting responses, and low levels of significant other punishing responses and catastrophizing were reported by both significant others and workers. Significant others were viewed as crucial in helping maintain continued work participation by workers with CMP. Overall group averages indicated no significant differences, with the exception of greater pain catastrophizing reported by significant others (14.4 versus 11.1 p<0.01), although this was not deemed clinically relevant (ES=0.34). Qualitative data from the UK study supports these findings, further elaborating on the above concepts. Conclusions. This study adds further weight to the evidence which recognizes the importance of social context for successful pain management and vocational rehabilitation interventions. Conflicts of interest: No conflicts of interest. Sources of funding: Funded by Instituut Gak and the BUPA foundation

Great strides have been made in perioperative pain management after total knee arthroplasty (TKA) leading to reduced length of hospital stay, cost reduction, improved patient satisfaction, and more rapid recovery without affecting the rates of readmission after surgery. To assure a happy patient, early recognition of patients at risk for persistent postoperative pain prior to surgery is key. Patients on chronic pain medication should be evaluated by pain management specialists with the intention of reducing overall narcotic requirement prior to TKA. Patients with high anxiety levels, pain catastrophizing, and Kinesphobia are at increased risk for increased pain and poor outcomes and should be referred for cognitive behavioral therapy and coping strategies. Finally, patients with hypersensitivity syndromes localised in the soft tissue around the knee should undergo desensitization protocols prior to TKA. Patient education on the risk of increased postoperative pain is crucial to manage expectations and optimise modifiable risk factors prior to TKA. To assure a happy patient indicated for TKA, a comprehensive pain management strategy divided into pre-, intra-, and post-operative periods should be employed

Introduction. Knee arthroplasty (KA) is a highly effective surgical procedure. However, research suggests that a considerable number of patients continue to experience substantial pain and functional loss following surgical recovery. We aimed to estimate pain and function outcome trajectories for persons undergoing KA depicting the outcome, the relationship between the pain and function trajectory types, and pre-surgery predictors of trajectory type (i.e., good versus poor). Methods. Participants included 384 patients who took part in the Knee Arthroplasty Skills Training (KASTPain) clinical trial. Pain and function was assessed at 2-week pre- and 2-, 6-, and 12-month post-surgery using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Function Scales. Piecewise latent class growth models were used to estimate pain and function trajectories. Dumenci's latent kappa was used to estimate the chance-corrected agreement between pain and function trajectory types. Pre-surgery variables were used to predict trajectory types. Results. There was strong evidence for two trajectory types, labeled as good and poor, for both WOMAC pain and function scores. Model estimated rates of the poor trajectory type were 18% for both pain and function. Dumenci's latent kappa between pain and function trajectory types was 0.71 (95% CI: 0.61 – 0.80). Most pre-surgery variables were not significant predictors of the trajectory types. Conclusions. Among adults with moderate to severe pain catastrophizing undergoing KA, approximately one-fifth of patients continue to have persistent pain, poor function, or both, which is similar to the rate of poor reported outcomes in the TKA population overall. Although the poor pain and function trajectory types tend to go together within persons, a significant number of patients experience either poor pain or function but not both, suggesting heterogeneity among persons who do not fully benefit from KA. For figures, tables, or references, please contact authors directly

The purpose of this study was two-fold: 1) to examine perioperative prospective changes in pain, disability and psychosocial variables in ACL reconstructed recreational athletes over the pre-op to eight week post-op period. 2) to see what variables will predict greatest disability at eight weeks post-op. All participants were recreational athletes at the time of their injuries who had patella-autograft procedure at the the Queen Elizabeth II Health Sciences Centre. Fifty-four patients (twenty-nine males; mean age = 25.4 years, SD = 8.08). Mean education was fourteen years (SD = 2.08), 32%(17) were married, 67%(36) single, and 1% was divorced. 94%(51) of the sample was Caucasian, 3%(2) Black, and 1% Asian. One quarter reported their ACL injury was due to sport-based contact, with non-contact sporting activity reported at 76%(41). All participants completed measures of pain, depression, pain catastrophizing, state anxiety pre-op, on days one and two following surgery and again at eight weeks post-op. Disability was assessed pre-op and eight weeks post-op. Pain was varied across comparisons with preoperative pain increased twenty-four and forty-eight-hour post-op. Pain at forty-eight-hours postoperative was significantly higher than pain reported at eight-weeks post-op. Catastrophizing did not differ from the pre-op to twenty-four-hour post-op but did drop from twenty-four to forty-eight-hours and forty-eight-hours to eight-weeks post-op. Pre-op depression increased twenty-four-hour post-op, but not from twenty-four to forty-eight-hours and declined at eight-weeks. Anxiety increase pre-op to twenty-four-hours but not from twenty-four to forty-eight-hours but did drop from forty-eight-hours to eight-weeks.Disability did not change over time. Regression showed age or gender did not predict disability but forty-eight hour pain and catastrophizing did. These data indicate that pain and psychological variables change over time of ACL recovery. Results suggest that pain and distress peek during acute post-op period. As well, post-op catastrophizing predicts disability at eight weeks post-op which may indicate that catastrophizing may be related to behaviours related to slower recovery following ACL reconstructive surgery

The purpose of this study was two-fold:. to examine perioperative prospective changes in pain, disability and psychosocial variables in ACL reconstructed recreational athletes over the pre-op to eight week post-op period. to see what variables will predict greatest disability at eight weeks post-op. All participants were recreational athletes at the time of their injuries who had patella-autograft procedure at the the Queen Elizabeth II Health Sciences Centre. Fifty-four patients (twenty-nine males; mean age = 25.4 years, SD = 8.08). Mean education was fourteen years (SD = 2.08), 32%(17) were married, 67%(36) single, and 1% was divorced. 94%(51) of the sample was Caucasian, 3%(2) Black, and 1% Asian. One quarter reported their ACL injury was due to sport-based contact, with non-contact sporting activity reported at 76%(41). All participants completed measures of pain, depression, pain catastrophizing, state anxiety pre-op, on days one and two following surgery and again at eight weeks post-op. Disability was assessed pre-op and eight weeks post-op. Pain was varied across comparisons with preoperative pain increased twenty-four and forty-eight-hour post-op. Pain at forty-eight-hours postoperative was significantly higher than pain reported at eight-weeks post-op. Catastrophizing did not differ from the pre-op to twenty-four-hour post-op but did drop from twenty-four to forty-eight-hours and forty-eight-hours to eight-weeks post-op. Pre-op depression increased twenty-four-hour post-op, but not from twenty-four to forty-eight-hours and declined at eight-weeks. Anxiety increase pre-op to twenty-four-hours but not from twenty-four to forty-eight-hours but did drop from forty-eight-hours to eight-weeks.Disability did not change over time. Regression showed age or gender did not predict disability but forty-eight hour pain and catastrophizing did. These data indicate that pain and psychological variables change over time of ACL recovery. Results suggest that pain and distress peek during acute post-op period. As well, post-op catastrophizing predicts disability at eight weeks post-op which may indicate that catastrophizing may be related to behaviours related to slower recovery following ACL reconstructive surgery

Aims

Total hip arthroplasty (THA) is a common procedure to address pain and enhance function in hip disorders such as osteoarthritis. Despite its success, postoperative patient recovery exhibits considerable heterogeneity. This study aimed to investigate whether patients follow distinct pain trajectories following THA and identify the patient characteristics linked to suboptimal trajectories.

Aims

Psychological status may be an important predictor of outcome after periacetabular osteotomy (PAO). The aim of this study was to investigate the influence of psychological distress on postoperative health-related quality of life, joint function, self-assessed pain, and sports ability in patients undergoing PAO.

Purpose. Health literacy, the ability to seek, understand and utilise health information, is important for health and health-related decisions. Suboptimal health literacy is associated with poorer health outcomes in many chronic conditions although this has not been studied in chronic low back pain (CLBP). This study explored health literacy in a community cohort with and without CLBP. Methods and results. 117 adults, comprising 61 with no history of CLBP and 56 with CLBP (28 with low and high disability, respectively, determined by a median split in Oswestry scores) participated. Using a mixed methods approach, data were collected on pain severity, LBP-related disability, fear avoidance, LBP beliefs, pain catastrophizing and health literacy was measured using the Short-form Test of Functional Health Literacy in Adults (S-TOFHLA). In-depth interviews were undertaken with 36 CLBP participants to explore beliefs about LBP and experiences in seeking, understanding and using LBP information. LBP-related beliefs and behaviours, rather than pain intensity and health literacy skills, were associated with disability related to LBP. Individuals with CLBP-high disability had poorer back pain beliefs and increased fear avoidance behaviours relating to physical activity. Although S-TOFHLA scores suggested adequate health literacy across all participants and these were not related to LBP beliefs and attitudes, interviews revealed that individuals with CLBP-high disability adopted a more passive coping style and had a patho-anatomical view of their disorder compared to individuals with CLBP-low disability. Conclusion. While participants with CLBP have adequate S-TOFHLA scores, qualitative data revealed barriers in seeking, understanding and utilising LBP information

Tendon disease causes widespread morbidity ranging from mild pain to catastrophic end-stage rupture. The pathophysiology of tendon disease is not certain. An overuse exercise model was developed using rats with the aim of developing tissue with histological, biochemical and biomechanical features similar to those in human tendinosis. Results indicate that the biological response to over-exercise of the rat Achilles tendon is similar to the literature description of pathological specimens of human with disease. Biochemical and histological analysis of the rat Achilles tendons suggest that the patho-physiology is more consistent with a repair response than with a classical inflammatory response. Tendon disease causes widespread morbidity ranging from mild pain to catastrophic end-stage rupture and the pathophysiology of tendon disease is not certain. To develop an overuse exercise animal model to study the pathophysiology of Achilles tendon disease. Experimental rats were subjected to an over-exercise running regime, while control rats were maintained under normal cage activity. Achilles tendons were analyzed for histological features, glycosaminoglycan content, collagen content, collagen subtype, collagen crosslinking (hydrothermal isometric tension testing), and mechanical properties. Experimental rat Achilles tendons demonstrated: increased nuclear numbers per high-power field (527 vs. 392, p < 0.05), decreased semi-quantitative grade for collagen organization (2.9 vs. 3.7, p < 0.05) and decreased semi-quantitative grade for collagen staining (1.9 vs 3.5, p < 0.05). The total collagen content remained unchanged (84.3 vs. 89.0% p=0.38), while the glycosaminoglycan content was increased (17.5 vs. 9.0% p=0.02). Increased levels of collagen type III were not demonstrated, however. Experimental tendons were determined to have distinct differences in the collagen crosslinking patterns, with reduced total cross links and a greater population of immature, hydrolytically unstable cross links. These differences did not, however, translate into a decrease in ultimate tensile failure during mechanical testing (UTS of 77.8 vs. 88.8 N, p=0.26). The histology and biochemistry observed in the experimental rat Achilles tendons were similar to those described in the literature on human Achilles tendon disease. The rat Achilles tendon over-exercise model has demonstrated histopathology that was different from a control group and was consistent with the human literature for Achilles tendon disease. Research Grants were received from the following organizations:. Canadian Orthopaedics Foundation. American Foot and Ankle Society. Dalhousie University Department of Surgery. Nova Scotia Capitol District Health Authority Research Fund

Aims

The increase in prescription opioid misuse and dependence is now a public health crisis in the UK. It is recognized as a whole-person problem that involves both the medical and the psychosocial needs of patients. Analyzing aspects of pathophysiology, emotional health, and social wellbeing associated with persistent opioid use after injury may inform safe and effective alleviation of pain while minimizing risk of misuse or dependence. Our objectives were to investigate patient factors associated with opioid use two to four weeks and six to nine months after an upper limb fracture.

Introduction: In general a loose-balanced total knee arthroplasty (TKA) are believed to gain good postoperative range of motion (ROM), however, too much laxity is thought to be a cause for persistent pain and catastrophic long-term results. Materials and methods: We measured the antero-posterior and medio-lateral laxity to evaluate the influence of stability after cruciate-retaining TKA on ROM, pain score in Knee Society score and Functional score at 4–7 years after the operation. Twenty-one knees in 15 patients with an average age of 68 years (range, 58–78) who had a PCL retaining TKA for osteoarthrosis were examined (YS-4, 16 knees; AGC-S, 5 knees). There were 12 women and 3 men. Anteroposterior laxity was examined using a KT 2000 arthrometer at 30-degree knee flexion. Mediolateral laxity was examined at full extension with manual stress x-rays. Results: Average ROM was 112 degrees (range, 90–140 degrees), antero-posterior laxity was 9.7 mm (range, 2–27 mm) and mediolateral laxity was 10.6 degrees (range, 5–22 degrees). Knee Society pain score was 47 (range, 10–50) and Functional score was 82 (range, 40–100). No significant difference in ROM and clinical scores were noted between the lax and the stable knees. Correlations between ROM and anteroposterior or medio-lateral laxity were not significant (P = 0.55, P = 0.05, respectively; Spearman’s correlation efficient). Discussion and conclusion: A loose-balanced TKA did not gain good post-operative ROM. No parameters suggested that lax knees got better flexion angle, worse pain score and functional score than stable knees