Approximately 25% of patients following knee arthroplasty have disabling pain following apparently successful surgery. Recent research suggests that pain catastrophizing plays a key role in determining which patients with knee arthroplasty have a poor outcome. In addition to this evidence, a substantial literature suggests that pain coping skills training is effective for patients with chronic pain but the intervention hs not been studied for surgical patients with severe arthritic knee pain. We designed the Knee Arthroplasty pain coping Skills Training (KASTpain) trial to address this research need. This Phase III three-arm randomized clinical trial seeks to combine a strong and diverse group of researchers to examine an important and understudied area in the joint arthroplasty literature. The KASTpain trial will be the first to examine the utility of a perioperative pain coping intervention for this substantial population of patients. The clinical trial grant is designed to met the following specific aims: 1) to determine if a pain coping skills training intervention provided by psychologists is more effective at reducing pain and improving function and is more cost effective than arthritis education or usual care and 2) to determine if changes in pain and function following pain coping skills training are mediated by changes in pain catastrophizing. A tertiary aim will be to determine if pain coping skills training is more cost effective than either arthritis education or usual care. We expect that the study will have a substantial impact on clinical practice by providing evidence in support of a new treatment paradigm;a perioperative pain coping skills training approach for knee arthroplasty patients at-risk for poor outcome.

Public Health Relevance

We expect that the study will have a substantial impact on public health by providing evidence in support of a new treatment paradigm;a perioperative pain coping skills training approach for thousands of knee arthroplasty patients at-risk for poor outcome.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project with Complex Structure Cooperative Agreement (UM1)
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Special Emphasis Panel (ZAR1-CHW (M1))
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Lester, Gayle E
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Virginia Commonwealth University
Other Health Professions
Schools of Allied Health Profes
United States
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Riddle, Daniel L; Jensen, Mark P; Ang, Dennis et al. (2018) Do Pain Coping and Pain Beliefs Associate With Outcome Measures Before Knee Arthroplasty in Patients Who Catastrophize About Pain? A Cross-sectional Analysis From a Randomized Clinical Trial. Clin Orthop Relat Res 476:778-786
Riddle, Daniel L; Slover, James D; Ang, Dennis C et al. (2018) Opioid use prior to knee arthroplasty in patients who catastrophize about their pain: preoperative data from a multisite randomized clinical trial. J Pain Res 11:1549-1557
Riddle, Daniel L; Slover, James; Ang, Dennis et al. (2017) Construct validation and correlates of preoperative expectations of postsurgical recovery in persons undergoing knee replacement: baseline findings from a randomized clinical trial. Health Qual Life Outcomes 15:232
Edmond, Sara N; Keefe, Francis J (2015) Validating pain communication: current state of the science. Pain 156:215-9
Keefe, F J; Porter, L; Somers, T et al. (2013) Psychosocial interventions for managing pain in older adults: outcomes and clinical implications. Br J Anaesth 111:89-94
Schroeder, David; Korsakov, Fedor; Jolton, Joseph et al. (2013) Creating widely accessible spatial interfaces: mobile VR for managing persistent pain. IEEE Comput Graph Appl 33:82-9
Keefe, Francis J; Wren, Anava A (2013) Optimism and pain: a positive move forward. Pain 154:7-8
Riddle, Daniel L; Keefe, Francis J; Ang, Dennis et al. (2012) A phase III randomized three-arm trial of physical therapist delivered pain coping skills training for patients with total knee arthroplasty: the KASTPain protocol. BMC Musculoskelet Disord 13:149
Keefe, Francis J; Huling, Dane A; Coggins, Michael J et al. (2012) Virtual reality for persistent pain: a new direction for behavioral pain management. Pain 153:2163-6