Preoperative Cognitive Therapy for Improving Health Outcomes After TKA in High-risk Catastrophizing Subjects

Aim 1 is to determine which CT protocol is most effective in reducing Pain Catastrophizing
Scale (PCS) and Coping Strategies Questionnaire Catastrophizing Subscale (CSQ-CAT) scores in
high-risk TKR candidates. CT will consist of four-to-eight weekly 1-hr individual cognitive
therapy sessions prior to surgery.

Inclusion Criteria:

1. undergoing standard primary TKR; THR or Shoulder Surgery

2. 18- 85 yrs of age;

3. Surgical joint is the primary source of patient's pain;

4. Patient agrees to preoperative visits and treatment, follow-up visits and treatment,
and to comply with the assessment tests;

5. Patient consents to standard anesthetic and analgesic protocol, with medical care as
deemed necessary by the anesthesiologist, and has no contraindications.

6. Patient has been diagnosed with osteoarthritis.

Exclusion Criteria:

1. Currently using antidepressant medication or undergoing cognitive therapy;

2. chronic opioid use ≥ 10 mg/day of morphine equivalents within one wk prior to the
surgery, and duration of use > 4 wks;

3. history of opioid abuse;

4. inability to understand and communicate with the investigators to complete the study
related questionnaires

5. patient is planning to undergo another elective joint procedure during the 6-mo period
of participation;

6. any co-morbidity which results in severe systemic disease limiting function {as
defined by the American Society of Anesthesiology (ASA) physical status classification
> 3}.