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J Clin Med. 2019 May 16;8(5). pii: E697. doi: 10.3390/jcm8050697.

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

Author information

1
Universitätsklinik für Psychosomatische Medizin und Psychotherapie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany. matthias.vogel@med.ovgu.de.
2
Institut für Psychologie der Otto-von-Guericke-Universität Magdeburg, Universitätsplatz 2, Geb. 24, 39106 Magdeburg, Germany. martin.krippl@ovgu.de.
3
Universitätsklinik für Psychosomatische Medizin und Psychotherapie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany. Lydia.frenzel@med.ovgu.de.
4
Universitätsklinik für Orthopädie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany. christian.riediger@med.ovgu.de.
5
Universitätsklinik für Psychosomatische Medizin und Psychotherapie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany. joerg.frommer@med.ovgu.de.
6
Universitätsklinik für Orthopädie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany. christoph.lohmann@med.ovgu.de.
7
Universitätsklinik für Orthopädie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany. sebastian.illiger@med.ovgu.de.

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:

; dissociation; hierarchical structure; pain-catastrophizing; total knee arthroplasty (TKA)

PMID:
31100954
DOI:
10.3390/jcm8050697
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Conflict of interest statement

Conflict of interest statement: On behalf of all co-authors, I declare no conflict of interest regarding this submission.

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