Article
What is the role of psychological distress, pain catastrophizing and illness perceptions in pre-operative pain of CMC-1 patients?
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Authors
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Mark Van Der Oest
- ErasmusMC, Rotterdam, Netherlands
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Lisa Hoogendam
- ErasmusMC, Rotterdam, Netherlands
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Ralph Poelstra
- ErasmusMC, Rotterdam, Netherlands
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Guus Vermeulen
- Xpert Clinic, Eindhoven, Netherlands
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Harm Slijper
- Xpert Clinic, Eindhoven, Netherlands
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Ruud Selles
- ErasmusMC, Rotterdam, Netherlands
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Ana-Maria Vranceanu
- Massachusetts General Hospital, Integrated Brain Health Clinical and Research Program, Boston, United States
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Jarry Porsius
- ErasmusMC, Rotterdam, Netherlands
| Published: | February 6, 2020 |
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Outline
Text
Objectives/Interrogation: In recent studies the role of psychology in hand surgery patients is being investigated, particularly in first carpometacarpal osteoarthritis (CMC-1). Several studies suggest an influence of psychological factors on pre-operative pain in CMC-1 patients. However, the role of illness perception - the set of beliefs that a patient holds about their illness - and its relative importance compared to other better studied psychological constructs in explaining pain has not been studied before. We aimed to assess the relative contribution of psychological distress, pain catastrophizing and illness perceptions in pre-operative pain of CMC-1 patients.
Methods: Between September 2017 and September 2018 patients with CMC-1 OA who were scheduled for surgery after at least three months of treatment with a hand orthosis and hand therapy were included. Patients were excluded from the analysis when they had not completed the Dutch translation of Michigan Hand Questionnaire before surgery and had not completed the psychological screening questionnaires before surgery. All measurements were part of routine outcome data collection. A hierarchical linear regression analysis was used to assess the relative contribution of patients' characteristics, psychological distress and pain catastrophizing and illness perceptions.
Results and Conclusions: 214 patients were included in the analysis, of which 59% female with an average age of 59 (7 SD). Patients mean (± SD) pain (0 = severe pain - 100 = no pain) was 35 ± 13. The hierarchical model showed that 8% of the variance in pain was explained by patient demographics, 21% was explained by psychological distress and pain catastrophizing and an additional 12% was explained by illness perceptions. In the final model, more pain was significantly associated with female sex, pain catastrophizing and more negative illness perceptions.
Modifiable psychological factors were independently associated with pre-operative pain in CMC-1 patients explaining considerably more variance than other nonmodifiable patient characteristics such as female sex. These outcomes suggest that psychological interventions targeting pain catastrophizing and illness perception may improve pre-operative pain.
