Generalized anxiety disorder observed as modifiable risk fac
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Patients with mood disorders undergoing total joint arthroplasty (TJA) are at increased risk for poor outcomes. This study seeks to examine the effect of anxiety disorders on pain following TJA and evaluate if anxiety disorders are a modifiable risk factor.

Analysis included 319 TJA patients who had preoperative anxiety screening using the Generalized Anxiety Disorder 2-item screening tool (GAD-2) and 6-week postoperative Pain Catastrophizing Scale (PCS) scores. Patients were organized into 4 cohorts based on preoperative serotonin reuptake inhibitor (SSRI/SNRI) use and GAD-2 scores:
Group 1
No SSRI/SNRI use and GAD-2 score less than 3–Control patients
Group 2
SSRI/SNRI use and GAD-2 score less than 3–Appropriately treated GAD patients
Group 3
No SSRI/SNRI use and GAD-2 score more than 3–Untreated GAD patients
Group 4
SSRI/SNRI use and GAD-2 score more than 3–Poorly treated GAD patients
The cohorts underwent multivariate linear regression analysis and equivalence testing.

Results-
--Patients with preoperative GAD-2 scores more than 3 had worse postoperative pain with significantly higher average 6-week postoperative PCS score than patients with GAD-2 scores less than 3 (9.90 vs. 5.19, respectively).

--Patients with appropriately treated GAD and the control group had statistically equivalent postoperative pain while patients with poorly treated or untreated GAD had worse postoperative pain.

In particular, preoperative GAD is a risk factor for inadequate control of postoperative pain, but when patients are treated properly, it is a modifiable risk factor. GAD-2 preoperative GAD screening and referral for care can improve patient outcomes and decrease the consumption of opioids following TJA.

Source: https://www.arthroplastyjournal.org/article/S0883-5403(21)00162-5/fulltext
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