TJA is ultimately an elective procedure, and improvement in pain is the primary outcome of TJA (even though functional outcome scores attempt to balance the emphasis on pain, pain remains an integral part of all these scoring systems).  Pain has a psychological component, and is affected by psychology and pathology.  As a result, the outcomes of TJA are also influenced by the psychologic disposition of patients.  Psychiatric pathologies, like catastrophising, depression, poor motivation, and perceived disability all negatively impact the benefits of TJA.  Preoperative pain management therapy sessions using cognitive behavioral therapy appear to reduce the perioperative pain experience and affect outcomes.  CBT empowers patients to take control of their pain and teaches methods of diverting attention from pain. 

[1] [2]

1.         Witvrouw, E., et al., Catastrophic thinking about pain as a predictor of length of hospital stay after total knee arthroplasty: a prospective study. Knee Surg Sports Traumatol Arthrosc, 2009. 17(10): p. 1189-94.

2.         Berge, D.J., et al., Pre-operative and post-operative effect of a pain management programme prior to total hip replacement: a randomized controlled trial. Pain, 2004. 110(1-2): p. 33-9.