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Dissociation and Pain-Catastrophizing: Absorptive Detachment as a Higher-Order Factor in Control of Pain-Related Fearful Anticipations Prior to Total Knee Arthroplasty (TKA)

1
Universitätsklinik für Psychosomatische Medizin und Psychotherapie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
2
Institut für Psychologie der Otto-von-Guericke-Universität Magdeburg, Universitätsplatz 2, Geb. 24, 39106 Magdeburg, Germany
3
Universitätsklinik für Orthopädie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
*
Author to whom correspondence should be addressed.
These authors contributed equally.
J. Clin. Med. 2019, 8(5), 697; https://doi.org/10.3390/jcm8050697
Received: 9 March 2019 / Revised: 9 May 2019 / Accepted: 10 May 2019 / Published: 16 May 2019
(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)
PDF [315 KB, uploaded 16 May 2019]

Abstract

Total Knee Arthroplasty (TKA) is the ultima-ratio therapy for knee-osteoarthritis (OA), which is a paradigmatic condition of chronic pain. A hierarchical organization may explain the reported covariation of pain-catastrophizing (PC) and dissociation, which is a trauma-related psychopathology. This study tests the hypotheses of an overlap and hierarchical organization of the two constructs, PC and dissociation, respectively, using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Childhood Trauma Screener (CTS), a shortened version of the Dissociative Experiences Scale (FDS-20), the Brief Symptom Inventory (BSI-18), the Pain-Catastrophizing Scale (PCS), and the Tampa Scale of Kinesiophobia (TSK) in 93 participants with knee-OA and TKA. Non-parametric correlation, linear regression, and an exploratory factor analysis comprising the PCS and the FDS-20 in aggregate were run. The three factors: 1) PC factor, 2) absorptive detachment, and 3) conversion altogether explained 60% of the variance of the two scales. Dissociative factors were related to childhood trauma, and the PC-factor to knee-pain. The latter was predicted by absorptive detachment, i.e., disrupted perception interfering with the integration of trauma-related experiences possibly including invasive surgery. Absorptive detachment represents negative affectivity and is in control of pain-related anxieties (including PC). The clinical associations of trauma, psychopathology, and maladaptation after TKA may be reflections of this latent hierarchical organization of trauma-related dissociation and PC.
Keywords: total knee arthroplasty (TKA); pain-catastrophizing; dissociation; hierarchical structure; total knee arthroplasty (TKA); pain-catastrophizing; dissociation; hierarchical structure;
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Vogel, M.; Krippl, M.; Frenzel, L.; Riediger, C.; Frommer, J.; Lohmann, C.; Illiger, S. Dissociation and Pain-Catastrophizing: Absorptive Detachment as a Higher-Order Factor in Control of Pain-Related Fearful Anticipations Prior to Total Knee Arthroplasty (TKA). J. Clin. Med. 2019, 8, 697.

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