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Fear and pessimism predict poor knee surgery outcomes

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

In the weird world of pain, fearing the worst is at least partially a self-fulfilling prophecy. Dr. Gary J Macfarlane, regarding a paper on knee replacement results:

“We identified 3 distinct response trajectories in patients undergoing knee replacement. Expectations of pain/limited function and poor coping strategies differentiated the trajectories, suggesting a role for preoperative psychosocial support in optimizing the clinical outcome.”

And so it also seems likely that anything at all that increases patient optimism and confidence would probably help. This is consistent with a large body of relevant evidence on the power of mind-over-pain — which is not an easily controlled power, but a power nevertheless.

It’s also a dilemma for health science reporting and clinicians: truth may be harmful! The discouraging reality about side effects, poor outcomes, and other bad science news may make patients more pessimistic and fearful, and actually cause worse outcomes. But we cannot lie or conceal the truth, either! Awkward. 🎵 The truth may be problematic, but also unavoidable and essential. There is no easy solution to this dilemma.

But consider this: the same confidence and optimism that helps surgical patients almost certainly also applies to outcomes for patients who do not get surgery. •head explodes•

I’ve updated PainScience.com’s knee replacement page.