# Pre-op CBT to Reduce the Risk for Development of Chronic Post-surgical Pain in Patients undergoing Total Knee Arthroplasty

> **NIH NIH R21** · UNIVERSITY OF PENNSYLVANIA · 2020 · $243,063

## Abstract

ABSTRACT
Knee joint replacement is among the most common elective surgeries performed in the United States, and only
expected to increase as the population ages. Total knee arthroplasty (TKA) is the definitive treatment for
patients suffering degenerative joint disease or arthritis causing limited function and persistent pain, which
most often results in improvements in function and quality of life. However, a not inconsequential proportion of
patients (up to 53%) undergoing TKA develop chronic post-surgical pain (CPSP) following the procedure.
CPSP brings with it significant consequences not only to functionality and quality of life, but often leading to
long-term opioid therapy and economic burden. Risk factors for the development of CPSP have been
identified, the most predictive of which are pre-existing chronic pain; pre-operative chronic opioid use;
depression; anxiety; and pain catastrophizing. In addition, more severe post-operative pain has been
linked to the increased likelihood for developing CPSP, due to postulated central pain sensitization processes
which set the stage for ongoing and in some cases magnified chronic pain. Despite increased understanding of
the role of these predictors in the development of CPSP, little is provided to at-risk patients prior to
surgery to mitigate the occurrence of these life-changing outcomes. Proposed is the development and
preliminary efficacy testing of a targeted cognitive-behavioral therapy (CBT) opioid taper intervention
delivered in the 4 weeks immediately prior to planned TKA to mitigate pre-operative risk factors for CPSP,
reduce the severity of acute post-operative pain, and thereby the risk for development of CPSP following
surgery. Specifically, in a sample of adult men and women with chronic pain, on opioid therapy and undergoing
a planned TKA, a randomized clinical trial will be implemented to evaluate the ability of this novel intervention
to decrease pre-operative chronic pain intensity, opioid use, anxiety, depression and pain catastrophizing from
baseline will be evaluated immediately prior to the surgical procedure, and group differences in post-operative
72hr pain intensity and incidence of CPSP at 3 and 6 months will be compared subjects randomized to
treatment-as-usual. The novel intervention will be based upon modification of an existing, validated computer-
assisted CBT intervention for chronic pain (PAINTrainer) to include a motivational interviewing opioid taper
component. The proposed work is developmental research reflecting the early, conceptual stage of a project
designed to prevent the transition of acute post-surgical pain into CPSP. It is anticipated the findings will result
in a novel, cost-effective, and evidence-based intervention that will meaningfully impact pain outcomes
following joint replacement surgery, and ready for testing in a subsequent randomized clinical trial. In that
CPSP brings with it significant health consequences, including diminished functionali...

## Key facts

- **NIH application ID:** 10128566
- **Project number:** 1R21NR019047-01A1
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** MARTIN D CHEATLE
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $243,063
- **Award type:** 1
- **Project period:** 2020-09-23 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10128566

## Citation

> US National Institutes of Health, RePORTER application 10128566, Pre-op CBT to Reduce the Risk for Development of Chronic Post-surgical Pain in Patients undergoing Total Knee Arthroplasty (1R21NR019047-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10128566. Licensed CC0.

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