Preoperative Cognitive Therapy for Improving Health Outcomes After TKA in High-risk Catastrophizing Subjects

Aim 1 is to determine which CT protocol is most effective in reducing Pain Catastrophizing Scale (PCS) and Coping Strategies Questionnaire Catastrophizing Subscale (CSQ-CAT) scores in high-risk TKR candidates. CT will consist of four-to-eight weekly 1-hr individual cognitive therapy sessions prior to surgery.

Aim 2 is to compare the most efficient treatment from Aim 1 with a control group to evaluate pain relief at 3 months.

Inclusion criteria

• undergoing standard primary TKR; THR or Shoulder Surgery
• 18- 85 yrs of age;
• Surgical joint is the primary source of patient's pain;
• Patient agrees to preoperative visits and treatment, follow-up visits and treatment, and to comply with the assessment tests;
• Patient consents to standard anesthetic and analgesic protocol, with medical care as deemed necessary by the anesthesiologist, and has no contraindications.
• Patient has been diagnosed with osteoarthritis.

Exclusion criteria

• Currently using antidepressant medication or undergoing cognitive therapy;
• chronic opioid use ≥ 10 mg/day of morphine equivalents within one wk prior to the surgery, and duration of use > 4 wks;
• history of opioid abuse;
• inability to understand and communicate with the investigators to complete the study related questionnaires
• patient is planning to undergo another elective joint procedure during the 6-mo period of participation;
• any co-morbidity which results in severe systemic disease limiting function {as defined by the American Society of Anesthesiology (ASA) physical status classification > 3}.