Cognitive Behavioral Therapy for Postoperative TKA Pain

Cognitive behavioral therapy (CBT) is known to be beneficial for treating pain and joint function in osteoarthritis (OA) of the knee, but it is uncertain whether it is a viable treatment for pain severity following total knee arthroplasty (TKA). A study evaluated the impact of a CBT program on pain, knee function, quality of life, and pain catastrophizing in postoperative TKA patients. The researchers found that while a CBT program improved some outcomes compared with usual care, it did not have an effect on others.

A total of 100 knee OA patients undergoing TKA were randomized to either a CBT or usual care group. Outcomes included pre- and postoperative visual analog scale (VAS), Pain Catastrophizing Scale (PCS), Oxford Knee Score (OKS), knee range of motion (ROM), EuroQol Five-Dimensional (EQ-5D), and Hospital for Special Surgery (HSS) Knee Rating Scale.

Pain during activity was lower in the CBT group from the fifth day (P=0.003) to the third month (P=0.019) postoperatively. At one year, the mean VAS score during activity did not largely differ between the CBT and usual care groups (0.8 vs. 0.9). The CBT group had lower PCS scores at one (P=0.014) and three (P=0.027) months postoperatively. Pain during rest, knee ROM, EQ-5D, OKS, and HSS did not largely differ between the groups.