Acceptance and Commitment Therapy to Prevent Chronic Pain After Total Knee Arthroplasty

Overview

This preliminary study evaluated the NOPAIN treatment, an acceptance and commitment therapy (ACT)-based intervention delivered early after total knee arthroplasty (TKA) to prevent chronic postsurgical pain. Results showed significant improvements in pain intensity, knee pain, stiffness, and function at 3 months, with female sex and age associated with lower risk of moderate-to-severe pain, while central sensitization and pain catastrophizing predicted higher risk.

Background

Chronic postsurgical pain after TKA affects approximately 20% of patients and can severely impair quality of life. Psychological factors such as pain catastrophizing and anxiety contribute to the risk of developing chronic pain. ACT-based treatments focus on increasing psychological flexibility and have shown promise in reducing pain catastrophizing and improving adherence to rehabilitation. Early postoperative interventions targeting these factors may help prevent chronic pain development.

Data Highlights

Key Findings

• The NOPAIN ACT-based treatment was feasible and integrated well into standard postoperative rehabilitation with 81.3% retention through all sessions.
• Significant improvements were observed in pain intensity, knee pain, stiffness, and function at 3 months post-TKA.
• Female sex and older age were associated with lower odds of experiencing moderate-to-severe pain at 3 months.
• Presence of central sensitization, higher baseline pain intensity, and pain catastrophizing components such as rumination and helplessness predicted higher odds of moderate-to-severe pain.
• Changes in helplessness during treatment were also linked to pain outcomes, suggesting a target for intervention refinement.

Clinical Implications

Early implementation of ACT-based interventions like NOPAIN during postoperative rehabilitation may reduce the risk of chronic pain after TKA by addressing psychological factors such as catastrophizing and central sensitization. Identifying patients with high baseline pain and central sensitization can help tailor interventions to improve outcomes. Incorporating psychological flexibility training may enhance adherence and functional recovery.

Conclusion

The NOPAIN ACT-based treatment shows promise as a feasible and effective approach to prevent chronic postsurgical pain after TKA. Further controlled studies are warranted to confirm these findings and optimize intervention components based on identified predictors.

References

1. NOPAIN Study Group 2024 -- Utilizing Acceptance and Commitment Therapy to Mitigate Chronic Pain Following Total Knee Arthroplasty