Postoperative negative pain thoughts associated with poor outcomes after shoulder surgery
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Key takeaways:
- Postoperative negative pain thoughts were associated with worse patient-reported outcomes after arthroscopic rotator cuff repair.
- Preoperative negative pain thoughts were not associated with any outcomes.
Results showed patients with postoperative negative pain thoughts after arthroscopic rotator cuff repair may have worse patient-reported outcomes vs. patients without negative pain thoughts or preoperative negative pain thoughts.
Researchers from the University of Cincinnati performed a single-center, observational cohort study of 109 patients (mean age, 56.49 years) who were scheduled to undergo arthroscopic rotator cuff repair between July 2021 and August 2022.
Preoperatively, all patients completed the short form negative pain thoughts questionnaire (NPTQ-SF), as well as patient-reported outcome (PRO) surveys such as the SF-12, the American Shoulder and Elbow Surgeons shoulder evaluation form and VAS pain scores. Overall, 74 patients underwent arthroscopic rotator cuff repair and had complete NPTQ-SF scores and PROs at 6-month follow-up.
Mean preoperative NPTQ-SF score was 12.8, whereas mean postoperative NPTQ-SF score was 8.5. Researchers found postoperative NPTQ-SF scores were significantly negatively associated with postoperative SF-12 scores, ASES scores and patient satisfaction. In addition, they found postoperative NPTQ-SF scores were significantly positively associated with postoperative VAS pain scores.
“This correlation suggests a role for counseling and expectation management in the postoperative setting,” the researchers wrote.
Researchers noted preoperative NPTQ-SF scores were not associated with any postoperative PROs, and, therefore, should not be used as a preoperative tool.
Perspective
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This article is a prospective study examining the effect of negative thought patterns and pain perception on self-reported outcomes following arthroscopic rotator cuff repair. This study uniquely focuses on the specific effects of negative thoughts (SF Negative Pain Thought Questionnaire, NPTQ-SF) as opposed to more generic measurements of mental health, such as anxiety and depression. The study is well executed, examining both preoperative and postoperative NPTQ-SF scores on patient satisfaction, VAS pain and American Shoulder and Elbow Society scores. Seventy-four of 109 potentially eligible patients completed a minimum 6-month follow-up. The authors found that preoperative NPTQ-SF scores did not correlate with postoperative outcomes; however, postoperative NPTQ-SF scores were helpful in predicting higher pain scores and lower ASES scores following surgery.
The NPTQ-SF focuses specifically on patient reactions to pain and the resultant emotional effects including elements of catastrophizing symptoms. This study highlights the value of patient education on outcomes. There exists a need for ongoing education both preoperatively and throughout the recovery period to set expectations over and above objective parameters such as shoulder motion and strength. Rotator cuff repair is painful and has an extended recovery period. This study also highlights the potential value of cognitive behavioral therapy in higher-risk patients. Further studies are needed to better identify higher-risk patients for targeted expanded education and counseling treatments.
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