{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T09:20:14Z","timestamp":1792747214845,"version":"4.5.0"},"reference-count":30,"publisher":"BMJ","issue":"4","funder":[{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","award":["WI173357"],"award-info":[{"award-number":["WI173357"]}],"id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2020,12,30]]},"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Cognitive\u2013behavioral therapy (CBT) can reduce preoperative pain catastrophizing and may improve postsurgical pain outcomes. We hypothesized that CBT would reduce pain catastrophizing more than no-CBT controls and result in improved pain outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The study was a randomized controlled trial of patients undergoing elective total knee arthroplasty between January 2013 and March 2020. In phase 1, the change in pain catastrophizing scores (PCS) among 4-week or 8-week telehealth, 4-week in person and no-CBT sessions was compared in 80 patients with a PCS &gt;16. In phase 2, the proportion of subjects that achieved a 3-month decrease in Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain subscale &gt;4 following 4-week telehealth CBT with no-CBT controls were compared in 80 subjects.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In phase 1, 4-week telehealth CBT had the highest completion rate 17\/20 (85%), demonstrated an adjusted median reduction in PCS of \u22129 (95% CI \u22121 to \u221214, p&lt;0.01) compared with no-CBT and was non-inferior to 8-week telehealth CBT at a margin of 2 (p=0.02). In phase 2, 29 of 35 (83%) in the 4-week telehealth CBT and 26 of 33 (79%) subjects in the no-CBT demonstrated a decrease in the WOMAC pain subscale &gt;4 at 3 months, difference 4% (95% CI \u221218% to 26%, p=0.48), despite a median decrease in the PCS for the 4-week CBT and no-CBT group of \u22126 (\u221210 to \u22122, p=0.02).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our findings demonstrate that CBT interventions delivered prior to surgery in person or via telehealth can reduced PCS scores; however, this reduction did not lead to improved 3-month pain outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>ClinicalTrials.gov (NCT 01772329, registration date 21 January 2013).<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2020-102258","type":"journal-article","created":{"date-parts":[[2021,1,15]],"date-time":"2021-01-15T11:41:07Z","timestamp":1610710867000},"page":"313-321","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":67,"title":["Preoperative cognitive\u2013behavioral therapy for reducing pain catastrophizing and improving pain outcomes after total knee replacement: a randomized clinical trial"],"prefix":"10.1136","volume":"46","author":[{"given":"Asokumar","family":"Buvanendran","sequence":"first","affiliation":[{"name":"Anesthesiology, Rush Medical College of Rush University, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda C","family":"Sremac","sequence":"additional","affiliation":[{"name":"Anesthesiology, Rush Medical College of Rush University, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia A","family":"Merriman","sequence":"additional","affiliation":[{"name":"Anesthesiology, Rush Medical College of Rush University, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig J","family":"Della Valle","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, Rush Medical College of Rush University, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W","family":"Burns","sequence":"additional","affiliation":[{"name":"Behavioral Sciences, Rush Medical College of Rush University, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0966-5311","authenticated-orcid":false,"given":"Robert J","family":"McCarthy","sequence":"additional","affiliation":[{"name":"Anesthesiology, Rush Medical College of Rush University, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,1,15]]},"reference":[{"key":"2025101109405090000_46.4.313.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2017.07.022"},{"key":"2025101109405090000_46.4.313.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2010.11.023"},{"key":"2025101109405090000_46.4.313.3","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2011-000435","article-title":"What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? 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