This study provides moderate-level evidence for pain catastrophizing as an independent predictor of chronic pain post-TKA .
BACKGROUND Total knee arthroplasty ( TKA ) is a common and costly surgical procedure .
Despite high success rates , many TKA patients develop chronic pain  in the months and years following surgery , constituting a public health burden .
Pain catastrophizing is a construct that reflects anxious preoccupation with pain , inability to inhibit pain-related fears , amplification of the significance of pain vis-à-vis health implication s , and a sense of helplessness regarding pain .
Recent research suggests that it may be an important risk factor for untoward TKA outcomes .
To clarify this impact , we systematic ally review ed the literature to date on pain catastrophizing as a prospect i ve predictor of chronic pain following TKA .
Behavioral dimensions of adjustment in persons with chronic pain: pain-related anxiety and acceptance
Through empirical methods we now characterize patients with chronic pain as either dysfunctional , interpersonally distressed , or adaptive copers . Study ing factors that differentiate these groups may reveal the behavioral processes that determine adjustment to pain . Subjects for this study were 190 patients referred for treatment of chronic pain . They were classified as dysfunctional ( n = 41 ) , interpersonally distressed ( n = 28 ) or adaptive copers ( n = 59 ) based on the Multidimensional Pain Inventory ( Kerns , R.D. , Turk , D.C. and Rudy , T.E. , The West Haven-Yale Multidimensional Pain Inventory ( WHYMPI ) , Pain , 23 ( 1985 ) 345 - 356 ) and compared on measures of  pain-related anxiety and pain acceptance .  Our analyses showed that the dysfunctional group reported greater pain-related anxiety and less acceptance of pain than the other groups . Additional analyses , statistically controlling for pain severity and depression , showed that the patient subtypes continued to differ on pain-related anxiety and acceptance . Discriminant function analyses including pain-related anxiety and acceptance correctly classified 72.5 % of dysfunctional and 90.9 % of adaptive copers . Again , anxiety and acceptance contributed uniquely to classification independent of depression and pain intensity . Pain-related anxiety and acceptance of pain appear to be unique behavioral dimensions of adjustment to chronic pain . Decreasing anxiety and increasing acceptance may ' move ' patients with chronic pain from the dysfunctional to the adaptive coper category
This study provides moderate-level evidence for pain catastrophizing as an independent predictor of chronic pain post-TKA .
BACKGROUND Total knee arthroplasty ( TKA ) is a common and costly surgical procedure .
Despite high success rates , many TKA patients develop chronic pain  in the months and years following surgery , constituting a public health burden .
Pain catastrophizing is a construct that reflects anxious preoccupation with pain , inability to inhibit pain-related fears , amplification of the significance of pain vis-à-vis health implication s , and a sense of helplessness regarding pain .
Recent research suggests that it may be an important risk factor for untoward TKA outcomes .
To clarify this impact , we systematic ally review ed the literature to date on pain catastrophizing as a prospect i ve predictor of chronic pain following TKA .