Preoperative Cognitive Therapy for Improving Health Outcomes After TKA in High-risk Catastrophizing Subjects

Aim 1 is to determine which CT protocol is most effective in reducing Pain Catastrophizing Scale (PCS) and Coping Strategies Questionnaire Catastrophizing Subscale (CSQ-CAT) scores in high-risk TKR candidates. CT will consist of four-to-eight weekly 1-hr individual cognitive therapy sessions prior to surgery.

Aim 2 is to compare the most efficient treatment from Aim 1 with a control group to evaluate pain relief at 3 months.

• Other: Cognitive Therapy
  CT will be used as a preemptive treatment in an effort to minimize the effects of catastrophic thinking.
• Other: Routine Care
  Routine Care. No Cognitive Therapy Intervention

• Experimental: 4 weekly CT sessions - in person
  4 weekly CT sessions; all will be 1-hr individual cognitive therapy sessions with the psychology staff (under the supervision of John Burns, PhD).
  Intervention: Other: Cognitive Therapy
• Experimental: 8 weekly CT sessions
  8 weekly CT sessions; 1st and 8th will be 1-hr individual cognitive therapy session with the psychology staff (under the supervision of John Burns, PhD). The intermediate CT sessions will be by telephone call or video/"Skype". Our group will purchase and setup a web camera and headphone/microphone for the subjects in the CT groups that use "Skype". The 1-hr CT protocol was adapted from Dr. Beverly E. Thorn's CT manual (Cognitive Therapy for Chronic Pain: A Step-by-Step Guide; Thorn, 2004; with the Client and Therapy Workbooks.
  Intervention: Other: Cognitive Therapy
• Experimental: 4 weekly CT sessions - Tele-video
  4 weekly CT sessions; 1st and 4th will be 1-hr individual cognitive therapy session with the psychology staff. The intermediate CT sessions will be by telephone call or video/"Skype".
  Intervention: Other: Cognitive Therapy
• Placebo Comparator: Routine care
  Routine care; no CT sessions
  Intervention: Other: Routine Care

Inclusion Criteria:

1. undergoing standard primary TKR; THR or Shoulder Surgery
2. 18- 85 yrs of age;
3. Surgical joint is the primary source of patient's pain;
4. Patient agrees to preoperative visits and treatment, follow-up visits and treatment, and to comply with the assessment tests;
5. Patient consents to standard anesthetic and analgesic protocol, with medical care as deemed necessary by the anesthesiologist, and has no contraindications.
6. Patient has been diagnosed with osteoarthritis.

Exclusion Criteria:

1. Currently using antidepressant medication or undergoing cognitive therapy;
2. chronic opioid use ? 10 mg/day of morphine equivalents within one wk prior to the surgery, and duration of use > 4 wks;
3. history of opioid abuse;
4. inability to understand and communicate with the investigators to complete the study related questionnaires
5. patient is planning to undergo another elective joint procedure during the 6-mo period of participation;
6. any co-morbidity which results in severe systemic disease limiting function {as defined by the American Society of Anesthesiology (ASA) physical status classification > 3}.