Are Catastrophizing thoughts sending you to knee replacement you probably do not need?

Category: Blog

Sometimes we self-fulfill our own prophesies. Someone with knee pain can turn that pain into catastrophizing thoughts of “what ifs.” What if I need knee replacement? Researchers are showing that your thoughts may be the cause of worsening knee pain and ultimately an unneeded knee replacement.

A June 2018 study (1) from doctors in the United Kingdom sought to understand the factors that would cause someone with knee pain to have full body or “central pain augmentation” from their knee pain. What does this mean? It means that the knee pain was so severe to the patient that it was hurting other parts of their body and racking them with whole body pain.

The investigators identified eight self-reported common factors among the patients of their study:

  • anxiety,
  • depression,
  • catastrophizing,
  • neuropathic-like pain,
  • fatigue,
  • sleep disturbance,
  • pain distribution, and
  • cognitive impact were identified as likely indices of central pain mechanisms.

The investigators found that where these factors existed, patients would have pain throughout their body with their knee being the common point of pain origin.

Does this mean if you have shoulder pain and knee pain, the pain in your shoulder is coming from your knee? It is possible according to the research.

When pain is all encompassing a positive mental outlook may make treatment more successful

A study from a combined research team from the University of Southern California and Duke University suggests that if you have knee pain related to osteoarthritis and you have high to medium expectations that your treatment will work (this is any treatment) you will have better results. In contrast, patients with interpersonal problems associated with pain coping did not benefit much from the treatment.(2)

There has been a number of studies released recently which sought to make knee pain treatment more successful by examining the patient’s mental health before the treatments.

Knee replacement surgery made things worse for patients with anxiety and depression

Much of this research is being conducted to help sought out knee replacement patients who may not benefit from the procedure because of depressive cycles or anxiety disorders. This is suggested in research from the University of Iowa that says that in patients recommended to knee replacement, both pain intensity and pain-related distress demonstrated significant relationships with anxiety, depression, and catastrophizing. The investigators suggest  brief psychological interventions for pre-surgical knee replacement patients to help makes the surgery more successful.(3)

In a study from the University of Oslo (4) researchers found that 1 in 5 knee replacement patients still had pain when walking. These patients had higher preoperative pain, fatigue, and depression scores.

In recent research, doctors found that patients with knee osteoarthritis  often experience considerable physical disability with worsening symptoms linked to depression. Some of the research seeks to determine the “chicken or the egg,” if  depression causes more pain or more pain causes depression. Likely it is cyclical. Each causes the other with worsening effects if not treated.

Is anxiety and depression a cause of knee osteoarthritis pain that leads to failed knee replacement?

A  November 2018 study,(5)  also from researchers in the United Kingdom, presents these observations which can give credence to the idea that the knee can cause widespread body pain, a sense of pain worse than it should be in the knee, and a more accelerated recommendation to knee replacement surgery, and that these people, having had the knee replacement, are now in a high risk group for pain after surgery.

In this study, the researchers examined the impact of widespread body pain, anxiety, depression, and catastrophizing thoughts on the patient’s knee pain before and after knee replacement. Once these patients had a knee replacement, the problems of widespread body pain coming from the knee were multiplied to now include neuropathic-like pain and further pain catastrophizing.

Long-term pain is typical in patients we see here in our Cherry Hill, New Jersey office and is a signal that the patient may be suffering from depression. In these patients we provide a non-surgical treatment plan and after a consultation, address problems of depression that may impact their ability to heal.

1 Akin-Akinyosoye K, Frowd N, Marshall L, et al. Traits associated with central pain augmentation in the Knee Pain In the Community (KPIC) cohort. Pain. 2018;159(6):1035-1044.
2 Broderick JE, Keefe FJ, Schneider S, Junghaenel DU, Bruckenthal P, Schwartz JE, Kaell AT, Caldwell DS, McKee D, Gould E. Cognitive behavioral therapy for chronic pain is effective, but for whom? Pain. 2016 May 25.
3. Noiseux NO, Callaghan JJ, Geasland KM, Embree JL, Rakel BA. Relationships among pain intensity, pain-related distress, and psychological distress in pre-surgical total knee arthroplasty patients: a secondary analysis. Psychol Health Med. 2016 May 24:1-12.
4. Lindberg MF, Miaskowski C, RustøEn T, Rosseland LA, Cooper BA, Lerdal A. Factors that can predict pain with walking, 12 months after total knee arthroplasty. Acta Orthop. 2016 Dec;87(6):600-606.
5 Sarmanova A, Fernandes GS, Richardson H, et al. Contribution of central and peripheral risk factors to prevalence, incidence and progression of knee pain: a community-based cohort study. Osteoarthritis Cartilage. 2018;26(11):1461-1473.