Generalized anxiety disorder seen as modifiable risk factor for pain after TJA

ByMax R. Wursta

For patients undergoing total joint arthroplasty, preoperative generalized anxiety disorder is a risk factor for poor postoperative pain control; however, appropriate treatment may improve outcomes, according to the published results.

Yale A. Fillingham, MD, and colleagues from the department of orthopedics at Dartmouth Hitchcock Medical Center analyzed results of 319 patients undergoing TJA between March 2019 and July 2019. Researchers organized patients based on preoperative serotonin reuptake inhibitor (SSRI/SNRI) use and generalized anxiety disorder 2-item screening tool (GAD-2) scores. The control group exhibited no SSRI/SNRI use and had a GAD-2 score less than three. The appropriately treated GAD group exhibited SSRI/SNRI use and had a GAD-2 score less than 3. The untreated GAD group exhibited no SSRI/SNRI use and had a GAD-2 score greater than or equal to three. The poorly treated GAD group exhibited SSRI/SNRI use and had a GAD-2 score greater than or equal to three.

According to the study, researchers used 6-week postoperative pain catastrophizing scale (PCS) scores as the primary outcome measure to determine postoperative pain.

Fillingham and colleagues found patients with preoperative GAD-2 scores greater than or equal to three had a PCS score of 9.90 compared with 5.19 for patients with preoperative GAD-2 scores less than three. Additionally, patients with appropriately treated GAD and the control group showed “statistically equivalent” PCS scores, suggesting treatment can improve postoperative pain.

“We have demonstrated preoperative GAD is a modifiable risk factor for postoperative pain control when appropriately treated with serotonin reuptake inhibitor therapy,” the researchers wrote in the study. “Screening and treating patients with preoperative GAD affords the benefits of improved postoperative pain control, but more importantly offers the opportunity to make a much greater impact on the patient’s overall health and wellbeing,” they added.

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Sources/Disclosures

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Source:

Fillingham YA, et al. J Arthroplasty. 2021;doi:10.1016/j.arth.2021.02.023.

Disclosures: Fillingham reports he receives royalties from Medacta; is a paid consultant for Johnson & Johnson and Medacta; has stock or stock options in Parvizi Surgical Innovations and receives royalties, financial or material support from Saunders Mosby-Elsevier. Please see the study for all other authors’ relevant financial disclosures.

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Generalized anxiety disorder seen as modifiable risk factor for pain after TJA

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