Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 5, pp 743–743 | Cite as

Letter to the Editor concerning pain catastrophizing as a predictor for postoperative pain and opiate consumption in total joint arthroplasty patients. Arch Orthop Trauma Surg. 2017 ;137:1623–1629

  • Mark C. Kendall
  • Lucas J. Castro Alves
Letter to the Editor

Dear Editor,

We read with great interest the article of Wright et al. [1] in a recent issue of the journal. The authors performed a prospective cohort study in 123 patients and concluded that the pain catastrophizing scale is a poor predictor of postoperative pain at 3-month follow-up. However, the scale may be a risk factor for increased length of hospital stay. The authors should be congratulated for performing a study on an important topic (e.g., acute pain) in patients undergoing orthopedic surgeries [2, 3]. If patients at high risk to develop pain can be identified, effective multimodal analgesic strategies can be tailored to those patients to improve postoperative pain [4, 5].

Although the study of Wright et al. was well-conducted, there are some questions that need to be clarified. First, it is unclear if the authors standardized the intraoperative and postoperative analgesic regimen for these patients, as this can significantly alter the studied outcomes. Second, the authors powered their study on a 2-point difference on VAS score; however, most pain investigations consider a one point difference in the VAS score as clinically significant. One may argue that the authors were underpowered to detect clinically significant differences. Lastly, the authors evaluated multiple outcomes as demonstrated on Tables 2 and 3, but did not correct their statistical analysis to avoid Type I errors.

We would welcome some comments to address the aforementioned issues, as they were not discussed by the authors. This would help to further substantiate the findings of this important study.



No funding was sought.

Compliance with ethical standards

Conflict of interest

Authors declare that they have no conflict of interest.


  1. 1.
    Wright D, Hoang M, Sofine A, Silva JP, Schwarzkopf R (2017) Pain catastrophizing as a predictor for postoperative pain and opiate consumption in total joint arthroplasty patients. Arch Orthop Trauma Surg 137:1623–1629CrossRefPubMedGoogle Scholar
  2. 2.
    Harbell MW, Cohen JM, Kolodzie K et al (2016) Combined preoperative femoral and sciatic nerve blockade improves analgesia after anterior cruciate ligament reconstruction: a randomized controlled clinical trial. J Clin Anesth 33:68–74CrossRefPubMedGoogle Scholar
  3. 3.
    Bierke S, Petersen W (2017) Influence of anxiety and pain catastrophizing on the course of pain within the first year after uncomplicated total knee replacement: a prospective study. Arch Orthop Trauma Surg 137(12):1735–1742CrossRefPubMedGoogle Scholar
  4. 4.
    Sakae TM, Marchioro P, Schuelter-Trevisol F, Trevisol DJ (2017) Dexamethasone as a ropivacaine adjuvant for ultrasound-guided interscalene brachial plexus block: a randomized, double-blinded clinical trial. J Clin Anesth 38:133–136CrossRefPubMedGoogle Scholar
  5. 5.
    Vora MU, Nicholas TA, Kassel CA, Grant SA (2016) Adductor canal block for knee surgical procedures: review article. J Clin Anesth 35:295–303CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology, Rhode Island HospitalThe Warren Alpert Medical School of Brown UniversityProvidenceUSA

Personalised recommendations