223: High pain catastrophizing worsens preoperative status but not outcomes after rotator cuff repair

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic postsurgical pain, Non-pharmacological treatments

Background and Aims: Pain catastrophizing is a key psychological factor associated with chronic postsurgical pain, particularly after total knee and hip arthroplasty. However, its role in shoulder surgery remains unclear. Arthroscopic rotator cuff repair (ARCR) effectively reduces nociceptive input from structural pathologies, which may influence the impact of psychological factors on outcomes. This study aimed to investigate the association of pain catastrophizing with preoperative status and postoperative outcomes in patients undergoing ARCR.

Methods: We retrospectively analyzed 81 patients (40 men, 41 women; mean age, 64 years) who underwent primary ARCR for painful rotator cuff tear. The mean follow-up period was 21 months. Patients were classified into PCS(+) (≥30) and PCS(–) (<30) groups using the Pain Catastrophizing Scale. Preoperative variables included demographics, worst pain VAS, active range of motion (ROM), quantitative sensory testing (QST), tear size, and clinical shoulder scores. Postoperative outcomes included time to reach “almost no pain” (ANP; ≤3, 3–6, 6–12, or >12 months), worst pain VAS, ROM, and clinical scores at one year.

Results: The PCS(+) group included 39 patients (median PCS 37 [IQR 32–42]), and the PCS(–) group included 42 patients (21 [14–26]). There were no significant differences in demographics, QST, tear size, or clinical scores between the groups. However, the PCS(+) group had significantly higher worst pain VAS (80 vs 71 mm, p<0.05) and lower active forward flexion (135° vs 160°, p<0.05). Postoperatively, both groups showed significant improvements in pain, ROM, clinical scores, and PCS (p<0.05), with no significant between-group differences in ANP timing, pain, ROM, or clinical outcomes at one year.

Conclusions: Pain catastrophizing was associated with greater preoperative pain intensity and shoulder dysfunction, but not with postoperative pain relief or clinical outcomes at one year. These findings suggest that catastrophic thinking in rotator cuff tears may be primarily driven by local nociceptive input from the structural pathology. Because the nature and duration of nociceptive input differ from those of chronic lower limb conditions, effective control of peripheral pathology by ARCR may reduce the impact of psychological factors on postoperative outcomes.

References: None

Presenting Author: Masashi Izumi
Submitting Author: Masashi Izumi

Senior Author: Masashi Izumi

IASP 2026 Global Year theme of Neuropathic Pain: No

• Kazuki Ozaki - Kochi Medical School, Kochi University
• Toru Morimoto - Kochi Prefectural Hata Kenmin Hospital
• Masahiko Ikeuchi - Kochi Medical School, Kochi University