For joint replacement patients, cognitive therapy (CT) via Skype to mitigate catastrophizing is almost as effective as in-person therapy, according to a poster presented at the 2017 meeting of the American Society of Anesthesiologists (abstract A4153).
People who catastrophize—that is, who view their likely outcomes pessimistically—are more likely to have persistent postsurgical pain after an otherwise successful knee replacement surgery, according to the poster. From published effect sizes, the investigators estimated that 52.2% of high pain catastrophizers were at high risk for developing persistent postsurgical pain after the procedure, compared with 25% of low catastrophizers.
“We have known for a long time that preparing people emotionally for postoperative pain can reduce the painful experience and improve satisfaction,” said Lynn R. Webster, MD, the vice president of scientific affairs at PRA Health Sciences, in Salt Lake City, and a past president of the American Academy of Pain Medicine, who was not involved in the research.
In the study, 80 patients awaiting either elective surgery for total knee, hip or shoulder joint replacement, who had Pain Catastrophizing Scale (PCS) scores in the top 33% (PCS score ≥16) were randomly assigned to one of four treatment groups. In the first group, patients had eight weekly CT sessions: The first and last sessions were face to face with a clinical psychologist, and the rest were conducted by video teleconference. The second group consisted of four weekly therapy sessions; the first and last sessions were face to face. The third group consisted of four weekly face-to-face sessions with the clinical psychologist, and the last was routine care with no CT.
Outcomes were reduction in scores on the PCS and the Coping Strategies Questionnaire Catastrophizing Subscale.
The study showed only slightly better results for patients who had live CT than those who had CT via video teleconference. Among those receiving four weeks of live CT, PCS scores declined from 31 pretreatment to 17 post-treatment (P=0.007). Patients receiving four weeks of CT via video teleconference experienced reductions from 28 to 18 (P=0.0097). Patients receiving eight weeks of CT via video teleconference had a reduction from 31 to 20 (P=0.0018). Patients in the control group, who received routine care, had an insignificant reduction in PCS scores (25-20; P=0.338).
First author Mario Moric, MS, a biostatistician at Rush University Medical Center, in Chicago, noted that Skyping could reduce costs for patients, who could now receive CT in their homes. “[Patients] have been really positive about these sessions,” Mr. Moric said. “I think they feel a lot better going into surgery and coming out. These are the high-risk patients.”
In response to a question from the audience, Mr. Moric said joint replacements were chosen as a model for testing CT via Skype “because we do so many of them.”
Dr. Webster praised what he called a “preliminary study,” and highlighted the potential for providing therapy to joint replacement patients.
“Much more research needs to be conducted, but this is a great start,” he said. “The use of telemedicine to provide cognitive therapy may be a practical method to help manage postoperative pain.”