Current Status of Pain Catastrophizing in Elderly Patients Following THA Based on the Behavioral/Inhibitory Activation System and Construction of a Structural Equation Model

Current Status of Pain Catastrophizing in Elderly Patients Following THA Based on the Behavioral/Inhibitory Activation System and Construction of a Structural Equation Model | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Current Status of Pain Catastrophizing in Elderly Patients Following THA Based on the Behavioral/Inhibitory Activation System and Construction of a Structural Equation Model 欣怡 尹, 靓靓 曲 This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8303093/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 19 You are reading this latest preprint version Abstract Objective : To explore the current situation of pain catastrophizing among patients after total hip arthroplasty, build a structural equation model based on Behavior Inhibition/Activation System theory, analyze the influencing factors and pathways of pain catastrophe, and provide reference for developing interventional measures to alleviate pain catastrophizing levels. Methods: Using convenience sampling, 285 patients undergoing total hip arthroplasty in the orthopedic department of a tertiary hospital in Liaoning Province from January to August 2025 were followed up. Research tools included a general information questionnaire, Pain Catastrophizing Scale, Visual Analogue Scale for pain, Central Sensitization Scale, Harris Hip Score, and Tampa Scale for Kinesiophobia. Univariate analysis and multiple linear regression were performed using SPSS 28.0 software. SEM modeling was conducted with AMOS 28.0 software. Results: Among the 285 total hip arthroplasty patients, the mean pain catastrophizing score was (25.70 ± 11.73), with a prevalence of 36.8%. The SEM model revealed that pain intensity, central sensitization, Kinesiophobia, and hip function directly influenced pain catastrophizing, with direct effect values of 0.398, 0.408, 0.165, and -0.302, respectively (all p < 0.01). Pain intensity also indirectly affected pain catastrophizing through central sensitization, phobia, and hip function. (Indirect effects accounted for 51.4% of the total effect) . Conclusion : The incidence of pain catastrophizing is high among elderly patients after total hip arthroplasty. Clinical practice should actively guide elderly patients toward accurate pain cognition, alleviate pain catastrophizing levels, and improve postoperative quality of life. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Signs and symptoms Total Hip Arthroplasty (THA) Pain Catastrophizing Behavioral Institution/Activation System (BIS/BAS) Influencing Factors Structural Equation Model (SEM) Figures Figure 1 Research background Total hip arthroplasty (THA) is the most common and effective treatment for primary or secondary hip osteoarthritis, femoral head necrosis, and acetabular fractures with dislocation [1] . With the accelerating aging of China's population, the number of patients undergoing this surgery has been increasing annually [2] . Although surgery is the preferred treatment for these conditions, a significant number of patients experience postoperative issues such as pain, decreased muscle strength, and functional limitations, with these problems being particularly pronounced in elderly patients [3] . These adverse outcomes are not solely attributable to the surgery itself or complications; they are closely linked to psychological factors. Pain catastrophization (PC) represents an erroneous cognitive interpretation of potential or existing pain [4] . As the most relevant psychological factor for poor postoperative outcomes, PC amplifies the perception of pain and generates thoughts such as “Has the pain disappeared? Was the surgery successful?” [5] The Behavioral Inhibition/Activation System (BIS/BAS) model [6] describes an individual's behavioral regulation mechanism that produces positive or negative coping responses under the influence of environmental stimuli and cognitive factors. In this study, the behavioral manifestation of the BIS system was observed in elderly patients undergoing THA, where acute and chronic pain stimuli heightened sensitivity to pain [7] , exacerbating emotional distress, generating negative cognitions, and ultimately leading to behavioral withdrawal. Central sensitization, resulting from prolonged nociception or disease states associated with injurious inputs, sensitizes the central nervous system to external stimuli, thereby increasing the occurrence of catastrophizing [8] . Phobia manifests as patients' prolonged avoidance of activities, irrational fear of functional exercises, lowered pain thresholds, and further reinforcement of catastrophic thinking [9] . Hip function is closely linked to phobia [10] , and reduced joint mobility further contributes to pain catastrophizing. The behavioral manifestation of the BAS system is that elderly patients who undergo THA actively engage in functional training, promoting recovery of the affected limb and reducing rehabilitation delays caused by pain or fear, thereby forming an intrinsic motivation for individual change. Therefore, based on the BIS-BAS system, pain, central sensitization, kinesiophobia, and hip joint function are integrated into a single analytical framework for the first time. The model validated the dynamic interactions between the BIS system (pain → central sensitization → pain catastrophizing; pain → fear of movement → pain catastrophizing; pain → fear of movement → hip joint function → pain catastrophizing) and the BAS system (improved hip joint function → reduced pain catastrophizing). This provides a theoretical basis for understanding postoperative psychophysiological interactions, overcoming the limitations of explanations based solely on psychological or physiological dimensions. This research provides exploratory evidence for psychological interventions targeting pain catastrophizing in elderly THA patients, aiming to enhance their pain coping abilities. Subjects and Methods 1.1 Study Population Cross-sectional study design was adopted, and the period from January 2025 to August 2025 was selected by convenient sampling method Follow-up investigation was carried out in the inpatients of orthopedic surgery in a 3A hospital in Liaoning Province in June. Inclusion criteria: (1) Age ≥ 60 years old; (2) Patients undergoing total hip arthroplasty for the first time; (3) Have good understanding ability and expression ability; (4) Know the content of this study and participate voluntarily. Exclusion criteria: (1) people with mental disorders; (2) Patients with major diseases and organ dysfunction; (3) Patients with chronic pain complicated with other diseases According to the calculation formula, Z α/2 2 P(1-P)/δ 2 ,α=0.05,δ=0.05. Based on the previous literature research, the probability of pain disaster in patients after total hip replacement is 21% [11]. Considering the 10% invalid sample rate, the sample size is calculated to be 280 cases, and 285 cases are actually included in the sample. This study has been approved by the Ethics Committee of Jinzhou Medical University (JZMULL2025010). All participants provided written informed consent prior to their involvement in this study.All procedures conducted in this study adhered to the ethical standards of the institution and the National Research Council, as well as the 1964 Declaration of Hel-sinki and its subsequent amendments or equivalent. 1.2 Research Tools 1.2.1 General Information Questionnaire The General Information Questionnaire was developed by the researchers based on literature review and expert consultation. It includes general demographic data such as gender, age, educational attainment, place of residence, per capita household income, marital status, and medical insurance status; as well as disease-related information including postoperative pain duration, postoperative days, body mass index, and disease duration. 1.2.2 Pain Catastrophizing Scale (PCS) Developed by Sullivan et al. [12] , this 13-item scale comprises three dimensions: rumination, helplessness, and magnification. It employs a 5-point Likert scale ranging from “Never” to “Always,” scored from 0 to 4 points per item, with a maximum total score of 52 points. A score ≥30 indicates catastrophic levels of pain. The Chinese version of the PCS was translated by Yap et al. [13] , demonstrating a Cronbach's alpha coefficient of 0.93 and is widely used in clinical practice. 1.2.3 Visual Analog Scale (VAS) This scale ranges from 0 to 10, recording the patient's subjective perception of pain intensity. Higher pain intensity corresponds to a higher score. The VAS demonstrates a test-retest reliability coefficient of 0.97 [14] . 1.2.4 Central Sensitization Scale (CSS) The Chinese version of the Central Sensitization Scale, developed by Mayer et al. [15] in 2012 and translated by Xu et al. [16] , yielded a Cronbach's alpha coefficient of 0.83. Section A comprises 25 items using a 5-point Likert scale, with each item scored 0–4 points, yielding a total score of 0–100 points. Higher scale scores indicate more severe central sensitization. Clinically, severity is categorized into five levels: subclinical (0–29), mild (30–39), moderate (40–49), severe (50–59), and very severe (60–100) [17] . 1.2.5 Harris Hip Score (HHS) First proposed by Harris [18] in 1969, this 100-point scale comprises four components: pain, walking ability, joint range of motion, and deformity. With a Cronbach's alpha coefficient of 0.94, it is currently the most widely used hip function assessment tool in China [19] . 1.2.6 Tampa Scale for Kinesiophobia (TSK) Developed by Miller et al. [20] in 1991, this is a unidimensional scale employing a 4-point Likert scale. Items 4, 8, 12, and 16 are reverse-scored, yielding a maximum total score of 68 points. A score ≥37 indicates a diagnosis of akathisia. Higher scores correlate with greater severity of akathisia. Hu Wen et al. [21] translated it into Chinese in 2012, achieving a Cronbach's alpha coefficient of 0.778 and a test-retest reliability coefficient of 0.86. 1.3 Data Collection Methods Researchers reviewed extensive literature to thoroughly understand the scale content. Study subjects were rigorously screened according to inclusion and exclusion criteria. Quality control measures were implemented during data collection, and patient inquiries were patiently addressed. Upon completion of data collection, questionnaires were meticulously reviewed for completion status, with all forms collected on-site. The survey duration ranged from 15 to 20 minutes. A total of 300 questionnaires were distributed, yielding 285 valid responses—a 95% response rate. 1.4 Statistical Methods Data were entered by two operators and analyzed using SPSS 28.0 software. General data were categorical variables expressed as rates (examples). Quantitative variables meeting normal distribution were represented as mean ± standard deviation. For skewed distributions, median was used. Intergroup comparisons employed t-tests or analysis of variance (ANOVA). Pearson correlation coefficients were used to explore relationships among variables. Significant demographic variables, along with central sensitization, pain intensity, hip function, and phobia, were included in regression analyses. Structural equation modeling was performed using AMOS 28.0 software. The significance level was set at α=0.05. Results 2.1 Common Method Bias Test The Harman single-factor test was employed to assess common method bias. All items from the Pain Catastrophizing Scale, Central Sensitization Scale, Visual Analogue Scale for Pain, Harris Hip Score, and Aphobia Scale were included. The variance explained by the first principal component was <50%, indicating no significant common method bias [22] . 2.2 Pain Catastrophizing Scores and Univariate Analysis in Elderly Patients After THA Among the 285 elderly patients surveyed, 105 patients had PCS scores ≥30, reaching the threshold for pain catastrophizing assessment. The prevalence of pain catastrophizing was 36.8% (107/285). Univariate analysis revealed statistically significant associations with age, per capita monthly household income, place of residence, postoperative pain duration, BMI, postoperative days, and disease duration among general characteristics (P < 0.05). Detailed results are presented in Table 1. Table 1 Pain catastrophic scores in elderly patients with different characters after THA (n = 285) Project Classification Number of cases (%) PCS score (points, Mean±SD)` Z/T value P value Gender Male 131 (46) 25.26 ± 12.78 1.569 0.211 Female 154 (54) 26.49 ± 13.07 Age 60 ~ 70 years old 83(29.1) 21.12 ± 12.47 38.941 < 0.001 71 ~ 80 years old 134 (47) 23.70 ± 10.68 Over 80 years old 68(23.9) 35.24 ± 6.33 Education Level Primary school and below 59(20.7) 27.71 ± 1.85 0.894 0.445 Junior high school 135(47.4) 24.02 ± 1.09 High school 34 (11.9) 25.81 ± 2.14 College and above 57 (20) 35.12 ± 1.69 Monthly income per family < 1000 20 (7) 19.56 ± 2, 21 19.448 3000 108(37.9) 26.92 ± 1.69 Marital Status Married 216(75.8) 30.10 ± 13.46 1.002 0.369 Widowed 52 (18.2) 33.79 ± 9.75 Others 17 (6) 31.01 ± 20.01 Place of Residence Urban 157(55.1) 24.20 ± 1.43 1.209 0.257 rural 128(44.9) 26.09 ± 1.46 Payment Method At one's own expense 13 (4.6) 25.73 ± 17.82 10.441 0.052 Rural cooperative 118(41.1) 32.68 ± 4.80 Medical insurance 148(51.9) 24.43 ± 14.12 Others 6 (2.1) 30.22 ± 11.23 Postoperative Pain Duration 3 months 117(41.1) 23.26 ± 10.25 BMI 24 63 (22.1) 25.75 ± 1.71 Postoperative Days < 7 days 143(50.2) 27.51 ± 11.50 3.549 0.009 ≥ 7 days 142(49.8) 23.88 ± 13.51 Disease Duration < 5 years 66 (23.1) 12.02 ± 7.391 3.510 10 years 78 (27.5) 36.87 ± 6.57 2.3 Correlation Analysis Among Pain Catastrophizing, Pain Severity, Central Sensitization, Hip Function, and Kinesiophobia Pearson correlation analysis revealed significant positive correlations between Pain Catastrophizing and Central Sensitization, Kinesiophobia, and Pain Intensity (p < 0.01), while showing a significant negative correlation with Hip Joint Function (p < 0.01). See Table 3. Table 3 Correlation Analysis of Scale (n = 285) Pearson Correlation Coefficients Project Pain Catastrophe Degree of pain Central sensitization Kinesiophobia Hip joint function Pain Catastrophe 1.000 Pain Intensity 0.847* Central Sensitization 0.715* 0.609* Kinesiophobia 0.606* 0.567* 0.272* Hip joint function -0.582* -0.435* -0.123* -0.439* 1.000 Note: * P < 0.01 2.4 Multivariate Regression Analysis of Pain Catastrophizing in Elderly Patients After THA Using the total score of pain catastrophizing as the dependent variable, factors that were statistically significant in univariate analysis and variables with statistical significance in correlation analysis were included as independent variables in the multiple linear regression model. The variable assignments are shown in Table 4. The results of the multiple linear regression analysis showed that age, postoperative pain duration, course of disease, pain intensity, hip joint function, central sensitization, and kinesiophobia are influencing factors for the occurrence of pain catastrophizing. See Table 5. Table 4 Independent variable assignment mode Independent Variable Assignment Method Age 60 ~ 70 years old = 1; 71 ~ 80 years = 2; ≥ 81 years = 3 Monthly Income Per Family 3000 = 3 Postoperative Pain Duration 3 months = 3 Postoperative Days ≤ 7 days = 1; > 7 days = 2 Disease Duration 10 years = 3 BMI 24=3 Other data are entered in their original values. Table 5 Multivariate regression analysis of postoperative PC in THA patients (n=285) variable Unstandardized Coefficient Standard Coefficient β Standard Error β P-value (Constant) -1.138 2.495 0.649 Age 0.727 0.353 0.045 0.04 Monthly Income Per Family 0.197 0.394 0.01 0.618 Postoperative Days 0.798 0.298 0.054 0.008 Days after operation 0.026 0.46 0.001 0.954 Disease Duration 2.714 0.447 0.164 < 0.01 BMI 0.275 0.698 0.010 0.614 Visual Analogue Pain Score 1.779 0.174 0.334 < 0.01 Hip Joint Function -0.098 0.008 -0.273 < 0.01 Central Sensitization 0.21 0.018 0.336 < 0.01 Kinesiophobia 0.15 0.045 0.114 < 0.01 2.5 Construction of a SEM Model on Factors Influencing Pain Catastrophizing in Elderly Patients After THA An initial model was established with pain catastrophizing as the dependent variable, pain as the independent variable, and central sensitization, hip joint function, and kinesiophobia as mediating variables. The Bootstrap method was used to repeatedly sample 5,000 times to test the mediating effects, with a confidence interval set at 95%. The initial model was repeatedly modified and adjusted, ultimately resulting in a well-fitting model diagram. Detailed results are shown in Figure 1. The model fit indices were as follows: χ²/df = 2.364, RMSEA = 0.069, AGFI = 0.883, CFI = 0.980, NFI = 0.966, IFI = 0.980. Path results indicated that pain intensity had a direct positive effect on pain catastrophizing (β = 0.398) and also indirectly influenced pain catastrophizing through three other paths. Detailed decomposition of effects is shown in Table 6. Table 6 Path Analysis of Factors Influencing Pain Catastrophizing in Elderly Patients After THA Project Effect Value (β) Proportion of Total Effect 95% CI P Total effect 0.819 1 0.767 ~ 0.900 0.003 Direct effect (Pain Intensity → Pain Catastrophizing) 0.398 0.486 0.294 ~ 0.462 0.03 Total Indirect Effect Pain Intensity → Central Sensitization → Pain Catastrophizing 0.251 0.306 0.204 ~ 0.319 0.005 Pain Intensity →Kinesiophobia → Pain Catastrophizing 0.096 0.117 0.064 ~ 0.144 0.003 Pain Intensity → Kinesiophobia → Hip Function → Pain Catastrophizing 0.075 0.091 0.053 ~ 0.106 0.005 Discussion 3.1 Elderly Patients Experience High Levels of Pain Catastrophizing After THA The results of this study show that the average pain catastrophizing score of patients after THA was 25.70 ± 11.73, slightly higher than the results reported by Li Liuyi [11] and others. This may be because the subjects included in this study were elderly patients with a longer duration of illness. Some elderly patients experienced prolonged pain before surgery and hoped for pain relief and functional recovery postoperatively. Although analgesic pumps and painkillers were used, the pain management plan lacked individualization, which could lead elderly patients to have catastrophic thoughts such as questioning whether the surgery was successful. Additionally, elderly patients often have muscle atrophy and poor balance, and rehabilitation exercises can be uncomfortable, making them more likely to develop negative expectations of pain catastrophizing. Elderly patients experiencing pain catastrophizing perceive pain more intensely and have a relatively higher incidence of disability [10] . In clinical practice, healthcare providers should attach importance to the problem of pain catastrophizing in patients undergoing total hip arthroplasty, and can adopt the Pain Catastrophizing Scale as a routine screening tool after hip joint surgery to assess patients' catastrophic thoughts in a timely manner. 3.2. The level of pain can directly affect pain catastrophizing. The intensity of pain can directly affect pain catastrophizing, which is consistent with the findings of both domestic and international studies [23–25] . Pain catastrophizing refers to an exaggerated and negative cognitive set that an individual holds towards actual or potential pain. Its physiological basis may lie in the overlap between brain regions responsible for processing pain perception and those in charge of cognitive and emotional processing. When a pain stimulus occurs, if the patient's attention is excessively drawn to and focused on it, it may disrupt the normal function of their own pain regulation system [26] . For elderly patients who have undergone Total Hip Arthroplasty (THA), their pain experience is influenced by multiple factors. Physiologically, elderly patients often have multiple comorbid chronic conditions, which may reduce their pain threshold to a certain extent and increase their pain sensitivity. Psychologically and socially, elderly patients may have specific anxieties about death and functional decline, and these emotions can intensify their negative interpretation of pain. In addition, the sense of loneliness experienced by elderly individuals who are widowed and living alone, as well as the insufficient social support they actually receive, may weaken their ability to cope with pain proactively [27] , Pain catastrophizing may bring significant feelings of fear and helplessness to patients, which in turn affects their enthusiasm for rehabilitation and quality of life. Therefore, in the perioperative pain management of elderly THA patients, a multi-dimensional comprehensive intervention strategy should be adopted. In addition to standardized pharmacologic analgesia, importance should be attached to the assessment and intervention of psychosocial factors. It is recommended that in clinical nursing, patients at high risk of pain catastrophizing be identified early, either preoperatively or postoperatively. Basic psychological counseling can be provided or patients can be guided to receive professional psychological consultation, helping them establish a more rational perception of pain and rehabilitation. At the same time, family members should be encouraged to participate, and medical and nursing resources should be used to build a social support network for patients, which is particularly important for alleviating patients' loneliness and enhancing their confidence in coping with pain. Through the above comprehensive measures, it is expected to reduce the level of pain catastrophizing in elderly THA patients to a certain extent, thereby promoting their postoperative rehabilitation. 3.3 Pain can indirectly influence pain catastrophizing through central sensitization and kinesiophobia. 3.3. 1 The Mediating Effect of Central Sensitization on Pain and Pain Catastrophizing Pain stimulation, as a trigger factor for the BIS system, can indirectly affect pain catastrophizing through central sensitization. The continuous transmission of pain signals can induce interactions between excitatory sensory neuropeptides and neuronal protein-coupled receptors, which lowers the action potential threshold of neurons and increases their sensitivity, leading to the development of central sensitization [28] . In the context of pain, enhanced sensitivity of the central nervous system due to pain stimulation can cause abnormal pain responses to non-painful stimuli (such as touch or pressure) [29] , thereby affecting pain perception, leading to misinterpretation of pain, and forming pain catastrophizing. After THA surgery, although joint function can be improved, most patients, especially elderly patients, still experience persistent postoperative pain [30] . For THA patients, central sensitization induced by pain stimulation is one of the reasons for long-term postoperative pain [31] . KOH [32] and colleagues investigated the relationship between pain catastrophizing and central sensitization in patients after total knee arthroplasty, and found that patients with central sensitization had pain catastrophizing scores 3.02 times higher than those without central sensitization. Central sensitization is the physiological basis of pain catastrophizing, while pain catastrophizing is the psychological manifestation of central sensitization; the two interact, jointly exacerbating the patient's pain experience and psychological burden. Research on the relationship between central sensitization and pain catastrophizing is still in its early stages in China, but these concepts are significant for improving patients’ quality of life and alleviating postoperative pain. 3.3. 2 The Mediating Effect of Kinesiophobia on Pain and Pain Catastrophizing Pain is one of the risk factors for kinesiophobia [33] . According to the 'fear-avoidance' model, patients adopt a confrontational and avoidant attitude when experiencing pain [34] . After THA surgery, elderly patients may avoid activity due to fear of pain, ultimately leading to musculoskeletal weakness and negative emotional reactions. Vlaeyen [35] and colleagues further extended the 'fear-avoidance' model to a cognitive-behavioral model of fear of movement. The higher the level of kinesiophobia, the more individuals tend to engage in pain catastrophizing thought patterns. For elderly patients after THA, fear itself brings anxiety and stress, which are closely related to pain catastrophizing. Activity avoidance caused by kinesiophobia makes it difficult for individuals to adapt to pain, thereby reducing pain-coping ability and enhancing catastrophic thinking. Both kinesiophobia and pain catastrophizing are psychologically mediated changes triggered by pain. After THA, elderly patients should be actively guided to have a correct understanding of pain, alleviate pain catastrophizing thoughts, and reduce fear of movement. 3.3. 3 The Chain Mediation Effect of Hip Joint Function and Kinesiophobia in Pain and Pain Catastrophizing Research results indicate that hip joint function is significantly negatively correlated with pain catastrophizing [36] . In this study, elderly patients after THA who fear pain or develop kinesiophobia reduce their activity and exercises that improve hip joint function. With the decline of physical abilities and the deterioration of various organs in elderly patients, joint stiffness and muscle atrophy occur. Dysfunction of the hip joint can affect the patient's mental state [37] , making them more sensitive to pain and increasing negative emotions, leading to the occurrence of pain catastrophizing. Improvement in hip joint function (β = –0.302) plays a positive regulatory role in the BAS system. The mobility gained through functional recovery can enhance patients' self-efficacy and break catastrophizing thought patterns. In the treatment and rehabilitation process of elderly patients after THA, it is important not only to focus on pain relief itself but also to emphasize interventions for kinesiophobia and hip joint function, reduce the patients' pain catastrophizing cognition, and promote the recovery of overall function. Conclusion In summary, this study revealed the influencing factors and pathways of pain catastrophizing included in the BIS-BAS model, suggesting that alleviating pain, kinesiophobia, central sensitization, and enhancing hip joint mobility can effectively reduce the occurrence of pain catastrophizing in patients after THA. Excessive activation of the BIS may be associated with hypervigilance to pain and negative cognition. In contrast, enhancing the motivational tendency of the BAS may help patients shift their attention toward positive rehabilitation goals, thereby improving their pain cognition. These findings provide preliminary clues for understanding the psychophysiological mechanisms underlying pain catastrophizing in patients after THA. In the future, greater attention should be paid to the identification and intervention of pain catastrophizing in post-THA patients. As a pain-related psychosocial characteristic, pain catastrophizing can also affect postoperative treatment outcomes, but these psychosocial traits are not easy to identify. Therefore, enhancing nurses' awareness of this issue and their ability to identify it is the crucial first step. Through the aforementioned comprehensive nursing interventions, the goal is to reduce patients' level of pain catastrophizing, with a view to better promoting their postoperative rehabilitation and improving their quality of life. Limitations Although this study aimed to construct a structural equation model of the psychophysiological factors of pain catastrophizing in elderly patients after total hip arthroplasty, it did not incorporate the social factors of pain catastrophizing. In addition, an important limitation was selection bias. A total of 285 elderly patients were recruited from tertiary hospitals in Liaoning Province using only the convenience sampling method. This sampling approach may result in the sample failing to fully represent all patients who have undergone total hip arthroplasty, especially those who did not receive treatment at these specific hospitals.Since the study was conducted at a specific time and location, and the level of pain catastrophizing, as a postoperative psychological trait, is characterized by dynamic changes, a cross-sectional study is insufficient to explain its dynamic trajectory. Therefore, the inference of the study results may be limited and should be interpreted with caution.Future research could adopt broader sampling strategies, including multicenter collaboration and random sampling, to reduce selection bias and improve the generalizability of the model. Longitudinal follow-up studies can also be conducted to explore the dynamic changes of pain catastrophizing in elderly patients after total hip arthroplasty. Furthermore, a structural equation model of pain catastrophizing related to psychosocial factors can be established to further investigate the influencing factors of pain catastrophizing. Declarations Author Contributions: Yin Xinyi (First Author): Conceptualization, Methodology, Investigation, Formal analysis, Visualization, Writing - Original Draft Qu Liangliang (Corresponding Author): Supervision, Project administration, Writing - Review & Editing All authors have read and approved the final manuscript. Data Availability Statement The data that support the findings of this study are available from the corresponding author upon reasonable request. Conflict of Interest Statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding source declaration This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. References XING G, WU D, YIN J, et al. Impact of enhanced recovery after surgery on psychological outcomes in total hip arthroplasty[J]. Orthopaedics & traumatology, surgery & research: OTSR, 2025: 104222. FERNÁNDEZ-DE-LAS-PEÑAS C, FLORENCIO L L, DE-LA-LLAVE-RINCÓN A I, et al. Prognostic Factors for Postoperative Chronic Pain after Knee or Hip Replacement in Patients with Knee or Hip Osteoarthritis: An Umbrella Review[J]. Journal of Clinical Medicine, 2023, 12(20): 6624. 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MALFLIET A, COPPIETERS I, VAN WILGEN P, et al. Brain changes associated with cognitive and emotional factors in chronic pain: A systematic review[J]. European Journal of Pain (London, England), 2017, 21(5): 769-786. SOMERS T J, KEEFE F J, PELLS J J, et al. Pain catastrophizing and pain-related fear in osteoarthritis patients: relationships to pain and disability[J]. Journal of Pain and Symptom Management, 2009, 37(5): 863-872. Li Jingyi, Zhang Qingqing, Qian Jun, et al. Research Progress on Loneliness Among Empty-Nest Elders [J]. China Medical Guide, 2024, 21(36): 56-60. PAK D J, YONG R J, KAYE A D, et al. Chronification of Pain: Mechanisms, Current Understanding, and Clinical Implications[J]. Current Pain and Headache Reports, 2018, 22(2): 9. MCCARBERG B, PEPPIN J. Pain Pathways and Nervous System Plasticity: Learning and Memory in Pain[J]. Pain Medicine (Malden, Mass.), 2019, 20(12): 2421-2437. NOORI A, SPRAGUE S, BZOVSKY S, et al. Predictors of Long-Term Pain After Hip Arthroplasty in Patients With Femoral Neck Fractures: A Cohort Study[J]. Journal of Orthopaedic Trauma, 2020, 34: S55. OHASHI Y, FUKUSHIMA K, UCHIDA K, et al. Adverse Effects of Higher Preoperative Pain at Rest, a Central Sensitization-Related Symptom, on Outcomes After Total Hip Arthroplasty in Patients with Osteoarthritis[J]. Journal of Pain Research, 2021, 14: 3345-3352. KOH H S, CHOI Y H, PARK D, et al. Association Between Pain Catastrophizing and Central Sensitization Among Patients With Severe Knee Osteoarthritis Awaiting Primary Total Knee Arthroplasty[J]. Orthopedics, 2022, 45(4): 197-202. DU X, SHAO Y, XUE J, et al. Prevalence and influencing factors of kinesiophobia after total knee arthroplasty: a systematic review and meta-analysis[J]. Journal of Orthopaedic Surgery and Research, 2025, 20(1): 332. RENEMAN M F, JORRITSMA W, DIJKSTRA S J, et al. Relationship between kinesiophobia and performance in a functional capacity evaluation[J]. Journal of Occupational Rehabilitation, 2003, 13(4): 277-285. VLAEYEN J W S, KOLE-SNIJDERS A M J, BOEREN R G B, et al. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance[J]. Pain, 1995, 62(3): 363-372. Zhang Xiaotai, Li Jun, Zhang Lingling, et al. Functional impairment and associated psychological factors in patients with chronic hip pain[J]. Chinese Journal of Rehabilitation Theory and Practice, 2022, 28(12): 1484-1488. HAMPTON S N, NAKONEZNY P A, RICHARD H M, et al. Pain catastrophizing, anxiety, and depression in hip pathology[J]. The Bone & Joint Journal, 2019, 101-B(7): 800-807. Additional Declarations No competing interests reported. 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With the accelerating aging of China's population, the number of patients undergoing this surgery has been increasing annually\u003csup\u003e\u0026nbsp;[2]\u003c/sup\u003e. Although surgery is the preferred treatment for these conditions, a significant number of patients experience postoperative issues such as pain, decreased muscle strength, and functional limitations, with these problems being particularly pronounced in elderly patients \u003csup\u003e[3]\u003c/sup\u003e. These adverse outcomes are not solely attributable to the surgery itself or complications; they are closely linked to psychological factors. Pain catastrophization (PC) represents an erroneous cognitive interpretation of potential or existing pain \u003csup\u003e[4]\u003c/sup\u003e. As the most relevant psychological factor for poor postoperative outcomes, PC amplifies the perception of pain and generates thoughts such as “Has the pain disappeared? Was the surgery successful?”\u003csup\u003e[5]\u0026nbsp;\u003c/sup\u003eThe Behavioral Inhibition/Activation System (BIS/BAS) model\u003csup\u003e[6]\u003c/sup\u003e describes an individual's behavioral regulation mechanism that produces positive or negative coping responses under the influence of environmental stimuli and cognitive factors. In this study, the behavioral manifestation of the BIS system was observed in elderly patients undergoing THA, where acute and chronic pain stimuli heightened sensitivity to pain\u003csup\u003e\u0026nbsp;[7]\u003c/sup\u003e, exacerbating emotional distress, generating negative cognitions, and ultimately leading to behavioral withdrawal. Central sensitization, resulting from prolonged nociception or disease states associated with injurious inputs, sensitizes the central nervous system to external stimuli, thereby increasing the occurrence of catastrophizing \u003csup\u003e[8]\u003c/sup\u003e. Phobia manifests as patients' prolonged avoidance of activities, irrational fear of functional exercises, lowered pain thresholds, and further reinforcement of catastrophic thinking \u003csup\u003e[9]\u003c/sup\u003e. Hip function is closely linked to phobia \u003csup\u003e[10]\u003c/sup\u003e, and reduced joint mobility further contributes to pain catastrophizing. The behavioral manifestation of the BAS system is that elderly patients who undergo THA actively engage in functional training, promoting recovery of the affected limb and reducing rehabilitation delays caused by pain or fear, thereby forming an intrinsic motivation for individual change. Therefore, based on the BIS-BAS system, pain, central sensitization, kinesiophobia, and hip joint function are integrated into a single analytical framework for the first time. The model validated the dynamic interactions between the BIS system (pain → central sensitization → pain catastrophizing; pain → fear of movement → pain catastrophizing; pain → fear of movement → hip joint function → pain catastrophizing) and the BAS system (improved hip joint function → reduced pain catastrophizing). This provides a theoretical basis for understanding postoperative psychophysiological interactions, overcoming the limitations of explanations based solely on psychological or physiological dimensions. This research provides exploratory evidence for psychological interventions targeting pain catastrophizing in elderly THA patients, aiming to enhance their pain coping abilities.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Subjects and Methods","content":"\u003ch2\u003e1.1\u0026nbsp;Study Population\u003c/h2\u003e\n\u003cp\u003eCross-sectional study design was adopted, and the period from January 2025 to August 2025 was selected by convenient sampling method\u003c/p\u003e\n\u003cp\u003eFollow-up investigation was carried out in the inpatients of orthopedic surgery in a 3A hospital in Liaoning Province in June. Inclusion criteria: (1) Age ≥ 60 years old; (2) Patients undergoing total hip arthroplasty for the first time; (3) Have good understanding ability and expression ability; (4) Know the content of this study and participate voluntarily. Exclusion criteria: (1) people with mental disorders; (2) Patients with major diseases and organ dysfunction; (3) Patients with chronic pain complicated with other diseases\u003c/p\u003e\n\u003cp\u003eAccording to the calculation formula, Z\u003csub\u003eα/2\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003eP(1-P)/δ\u003csup\u003e2\u003c/sup\u003e,α=0.05,δ=0.05. Based on the previous literature research, the probability of pain disaster in patients after total hip replacement is 21% \u003csup\u003e[11].\u003c/sup\u003e Considering the 10% invalid sample rate, the sample size is calculated to be 280 cases, and 285 cases are actually included in the sample. This study has been approved by the Ethics Committee of Jinzhou Medical University (JZMULL2025010). All participants provided written\u0026nbsp;informed consent prior to their involvement in this study.All procedures conducted in this study adhered to the\u0026nbsp;ethical standards of the institution and the National\u0026nbsp;Research Council, as well as the 1964 Declaration of Hel-sinki and its subsequent amendments or equivalent.\u003c/p\u003e\n\u003ch2\u003e1.2 Research Tools\u003c/h2\u003e\n\u003ch3\u003e1.2.1 General Information Questionnaire\u003c/h3\u003e\n\u003cp\u003eThe General Information Questionnaire was developed by the researchers based on literature review and expert consultation. It includes general demographic data such as gender, age, educational attainment, place of residence, per capita household income, marital status, and medical insurance status; as well as disease-related information including postoperative pain duration, postoperative days, body mass index, and disease duration.\u003c/p\u003e\n\u003ch3\u003e1.2.2 Pain Catastrophizing Scale (PCS)\u003c/h3\u003e\n\u003cp\u003eDeveloped by Sullivan et al.\u003csup\u003e[12]\u003c/sup\u003e, this 13-item scale comprises three dimensions: rumination, helplessness, and magnification. It employs a 5-point Likert scale ranging from “Never” to “Always,” scored from 0 to 4 points per item, with a maximum total score of 52 points. A score ≥30 indicates catastrophic levels of pain. The Chinese version of the PCS was translated by Yap et al.\u003csup\u003e\u0026nbsp;[13]\u003c/sup\u003e, demonstrating a Cronbach's alpha coefficient of 0.93 and is widely used in clinical practice.\u003c/p\u003e\n\u003ch3\u003e1.2.3 Visual Analog Scale (VAS)\u003c/h3\u003e\n\u003cp\u003eThis scale ranges from 0 to 10, recording the patient's subjective perception of pain intensity. Higher pain intensity corresponds to a higher score. The VAS demonstrates a test-retest reliability coefficient of 0.97\u003csup\u003e[14]\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003e1.2.4 Central Sensitization Scale (CSS)\u003c/h3\u003e\n\u003cp\u003eThe Chinese version of the Central Sensitization Scale, developed by Mayer et al. \u003csup\u003e[15]\u003c/sup\u003e in 2012 and translated by Xu et al. \u003csup\u003e[16]\u003c/sup\u003e, yielded a Cronbach's alpha coefficient of 0.83. Section A comprises 25 items using a 5-point Likert scale, with each item scored 0–4 points, yielding a total score of 0–100 points. Higher scale scores indicate more severe central sensitization. Clinically, severity is categorized into five levels: subclinical (0–29), mild (30–39), moderate (40–49), severe (50–59), and very severe (60–100)\u003csup\u003e\u0026nbsp;[17]\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003e1.2.5 Harris Hip Score (HHS)\u003c/h3\u003e\n\u003cp\u003eFirst proposed by Harris\u003csup\u003e[18]\u0026nbsp;\u003c/sup\u003ein 1969, this 100-point scale comprises four components: pain, walking ability, joint range of motion, and deformity. With a Cronbach's alpha coefficient of 0.94, it is currently the most widely used hip function assessment tool in China\u003csup\u003e[19]\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003e1.2.6 Tampa Scale for Kinesiophobia (TSK)\u003c/h3\u003e\n\u003cp\u003eDeveloped by Miller et al.\u003csup\u003e\u0026nbsp;[20]\u003c/sup\u003e in 1991, this is a unidimensional scale employing a 4-point Likert scale. Items 4, 8, 12, and 16 are reverse-scored, yielding a maximum total score of 68 points. A score ≥37 indicates a diagnosis of akathisia. Higher scores correlate with greater severity of akathisia. Hu Wen et al.\u003csup\u003e\u0026nbsp;[21]\u003c/sup\u003e translated it into Chinese in 2012, achieving a Cronbach's alpha coefficient of 0.778 and a test-retest reliability coefficient of 0.86.\u003c/p\u003e\n\u003ch2\u003e1.3 Data Collection Methods\u003c/h2\u003e\n\u003cp\u003eResearchers reviewed extensive literature to thoroughly understand the scale content. Study subjects were rigorously screened according to inclusion and exclusion criteria. Quality control measures were implemented during data collection, and patient inquiries were patiently addressed. Upon completion of data collection, questionnaires were meticulously reviewed for completion status, with all forms collected on-site. The survey duration ranged from 15 to 20 minutes. A total of 300 questionnaires were distributed, yielding 285 valid responses—a 95% response rate.\u003c/p\u003e\n\u003ch2\u003e1.4 Statistical Methods\u003c/h2\u003e\n\u003cp\u003eData were entered by two operators and analyzed using SPSS 28.0 software. General data were categorical variables expressed as rates (examples). Quantitative variables meeting normal distribution were represented as mean ± standard deviation. For skewed distributions, median was used. Intergroup comparisons employed t-tests or analysis of variance (ANOVA). Pearson correlation coefficients were used to explore relationships among variables. Significant demographic variables, along with central sensitization, pain intensity, hip function, and phobia, were included in regression analyses. Structural equation modeling was performed using AMOS 28.0 software. The significance level was set at α=0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003e2.1 Common\u0026nbsp;Method Bias Test\u003c/h2\u003e\n\u003cp\u003eThe Harman single-factor test was employed to assess common method bias. All items from the Pain Catastrophizing Scale, Central Sensitization Scale, Visual Analogue Scale for Pain, Harris Hip Score, and Aphobia Scale were included. The variance explained by the first principal component was \u0026lt;50%, indicating no significant common method bias\u003csup\u003e\u0026nbsp;[22]\u003c/sup\u003e.\u003c/p\u003e\n\u003ch2\u003e2.2 Pain Catastrophizing Scores and Univariate Analysis in Elderly Patients After THA\u003c/h2\u003e\n\u003cp\u003eAmong the 285 elderly patients surveyed, 105 patients had PCS scores \u0026ge;30, reaching the threshold for pain catastrophizing assessment. The prevalence of pain catastrophizing was 36.8% (107/285). Univariate analysis revealed statistically significant associations with age, per capita monthly household income, place of residence, postoperative pain duration, BMI, postoperative days, and disease duration among general characteristics (P \u0026lt; 0.05). Detailed results are presented in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1 Pain catastrophic scores in elderly patients with different characters after THA (n = 285)\u003c/p\u003e\n\u003ctable style=\"width: 100%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eProject\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eClassification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNumber of cases (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003ePCS score (points, Mean\u0026plusmn;SD)`\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u003cem\u003eZ/T value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e131 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e25.26 \u0026plusmn; 12.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\"\u003e\n \u003cp\u003e1.569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e154 (54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e26.49 \u0026plusmn; 13.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e60 ~ 70 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83(29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e21.12 \u0026plusmn; 12.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"3\"\u003e\n \u003cp\u003e38.941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"3\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e71 ~ 80 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e134 (47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e23.70 \u0026plusmn; 10.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eOver 80 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e68(23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e35.24 \u0026plusmn; 6.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eEducation Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003ePrimary school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59(20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e27.71 \u0026plusmn; 1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"4\"\u003e\n \u003cp\u003e0.894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"4\"\u003e\n \u003cp\u003e0.445\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e135(47.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e24.02 \u0026plusmn; 1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e25.81 \u0026plusmn; 2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eCollege and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e57 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e35.12 \u0026plusmn; 1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eMonthly income per family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026lt; 1000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e19.56 \u0026plusmn; 2, 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"3\"\u003e\n \u003cp\u003e19.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"3\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e1000 ~ 3000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e157(55.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e33.05 \u0026plusmn; 0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026gt; 3000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e108(37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e26.92 \u0026plusmn; 1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e216(75.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e30.10 \u0026plusmn; 13.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"3\"\u003e\n \u003cp\u003e1.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"3\"\u003e\n \u003cp\u003e0.369\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e52 (18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e33.79 \u0026plusmn; 9.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e31.01 \u0026plusmn; 20.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePlace of Residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e157(55.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e24.20 \u0026plusmn; 1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e1.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003erural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e128(44.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e26.09 \u0026plusmn; 1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003ePayment Method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eAt one\u0026apos;s own expense\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e25.73 \u0026plusmn; 17.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"4\"\u003e\n \u003cp\u003e10.441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" rowspan=\"4\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eRural cooperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e118(41.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e32.68 \u0026plusmn; 4.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eMedical insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e148(51.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e24.43 \u0026plusmn; 14.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e30.22 \u0026plusmn; 11.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003ePostoperative Pain Duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026lt; 7 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e70 (24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e29.04 \u0026plusmn; 11.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e6.432\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e7 days to 3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e98 (34.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e33.65 \u0026plusmn; 1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026gt; 3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e117(41.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e23.26 \u0026plusmn; 10.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026lt; 18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e15.50 \u0026plusmn; 5.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e2.539\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e18.5 ~ 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e209(73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e29.40 \u0026plusmn; 1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026gt; 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e63 (22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e25.75 \u0026plusmn; 1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePostoperative Days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026lt; 7 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e143(50.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e27.51 \u0026plusmn; 11.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e3.549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026ge; 7 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e142(49.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e23.88 \u0026plusmn; 13.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDisease Duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026lt; 5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e12.02 \u0026plusmn; 7.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e3.510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e5-10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e141(49.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e26.18 \u0026plusmn; 8.893\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026gt; 10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e78 (27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e36.87 \u0026plusmn; 6.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.3 Correlation Analysis Among Pain Catastrophizing, Pain Severity, Central Sensitization, Hip Function, and Kinesiophobia\u003c/p\u003e\n\u003cp\u003ePearson correlation analysis revealed significant positive correlations between Pain Catastrophizing and Central Sensitization, Kinesiophobia, and Pain Intensity (p \u0026lt; 0.01), while showing a significant negative correlation with Hip Joint Function (p \u0026lt; 0.01). See Table 3.\u003c/p\u003e\n\u003cp\u003eTable 3 Correlation Analysis of Scale (n = 285)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" colspan=\"6\" style=\"width: 586px;\"\u003e\n \u003cp\u003ePearson Correlation Coefficients\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003eProject\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePain Catastrophe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003eDegree of pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\n \u003cp\u003eCentral sensitization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 77px;\"\u003e\n \u003cp\u003eKinesiophobia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 93px;\"\u003e\n \u003cp\u003eHip joint function\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003ePain Catastrophe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 93px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003ePain Intensity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.847*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 93px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003eCentral Sensitization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.715*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.609*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 93px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003eKinesiophobia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.606*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.567*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.272*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 93px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 113px;\"\u003e\n \u003cp\u003eHip joint function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.582*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.435*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.123*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 77px;\"\u003e\n \u003cp\u003e-0.439*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: * P \u0026lt; 0.01\u003c/p\u003e\n\u003cp\u003e2.4 Multivariate Regression Analysis of Pain Catastrophizing in Elderly Patients After THA\u003c/p\u003e\n\u003cp\u003eUsing the total score of pain catastrophizing as the dependent variable, factors that were statistically significant in univariate analysis and variables with statistical significance in correlation analysis were included as independent variables in the multiple linear regression model. The variable assignments are shown in Table 4. The results of the multiple linear regression analysis showed that age, postoperative pain duration, course of disease, pain intensity, hip joint function, central sensitization, and kinesiophobia are influencing factors for the occurrence of pain catastrophizing. See Table 5.\u003c/p\u003e\n\u003cp\u003eTable 4 Independent variable assignment mode\u003c/p\u003e\n\u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIndependent Variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAssignment Method\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60 ~ 70 years old = 1; 71 ~ 80 years = 2; \u0026ge; 81 years = 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMonthly Income Per Family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt; 1000 = 1; 1000 ~ 3000 = 2; \u0026gt; 3000 = 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePostoperative Pain Duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt; 7 days = 1; 7 days ~ 3 months = 2; \u0026gt; 3 months = 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePostoperative Days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026le; 7 days = 1; \u0026gt; 7 days = 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDisease Duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt; 5 years = 1; 5 ~ 10 years = 2; \u0026gt; 10 years = 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt; 18.5=1; 18.5 ~ 24=2; \u0026gt; 24=3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003eOther data are entered in their original values.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5 Multivariate regression analysis of postoperative PC in THA patients (n=285)\u003c/p\u003e\n\u003ctable style=\"width: 100%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\"\u003e\n \u003cp\u003evariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"2\"\u003e\n \u003cp\u003eUnstandardized Coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"2\"\u003e\n \u003cp\u003eStandard Coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eStandard Error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e-1.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e2.495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.649\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.727\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eMonthly Income Per Family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.618\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003ePostoperative Days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.798\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eDays after operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.954\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eDisease Duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e2.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.447\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.698\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.614\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eVisual Analogue Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e1.779\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eHip Joint Function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e-0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e-0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eCentral Sensitization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eKinesiophobia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e2.5 \u0026nbsp;Construction of a SEM Model on Factors Influencing Pain Catastrophizing in Elderly Patients After THA\u003c/h2\u003e\n\u003cp\u003eAn initial model was established with pain catastrophizing as the dependent variable, pain as the independent variable, and central sensitization, hip joint function, and kinesiophobia as mediating variables. The Bootstrap method was used to repeatedly sample 5,000 times to test the mediating effects, with a confidence interval set at 95%. The initial model was repeatedly modified and adjusted, ultimately resulting in a well-fitting model diagram. Detailed results are shown in Figure 1. The model fit indices were as follows: \u0026chi;\u0026sup2;/df = 2.364, RMSEA = 0.069, AGFI = 0.883, CFI = 0.980, NFI = 0.966, IFI = 0.980. Path results indicated that pain intensity had a direct positive effect on pain catastrophizing (\u0026beta; = 0.398) and also indirectly influenced pain catastrophizing through three other paths. Detailed decomposition of effects is shown in Table 6.\u003c/p\u003e\n\u003cp\u003eTable 6 Path Analysis of Factors Influencing Pain Catastrophizing in Elderly Patients After THA\u003c/p\u003e\n\u003ctable style=\"width: 100%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eProject\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eEffect Value (\u0026beta;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eProportion of Total Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"2\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eTotal effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.819\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"2\"\u003e\n \u003cp\u003e0.767 ~ 0.900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eDirect effect (Pain Intensity \u0026rarr;\u0026nbsp;Pain Catastrophizing)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.486\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"2\"\u003e\n \u003cp\u003e0.294 ~ 0.462\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eTotal Indirect Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003ePain Intensity \u0026rarr;\u0026nbsp;Central Sensitization \u0026rarr;\u0026nbsp;Pain Catastrophizing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"2\"\u003e\n \u003cp\u003e0.204 ~ 0.319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003ePain Intensity \u0026rarr;Kinesiophobia \u0026rarr; Pain Catastrophizing \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"2\"\u003e\n \u003cp\u003e0.064 ~ 0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003ePain Intensity \u0026rarr; Kinesiophobia \u0026rarr; Hip Function \u0026rarr; Pain Catastrophizing \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"2\"\u003e\n \u003cp\u003e0.053 ~ 0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e3.1 Elderly Patients Experience High Levels of Pain Catastrophizing After THA \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe results of this study show that the average pain catastrophizing score of patients after THA was 25.70 \u0026plusmn; 11.73, slightly higher than the results reported by Li Liuyi\u003csup\u003e\u0026nbsp;[11]\u003c/sup\u003e and others. This may be because the subjects included in this study were elderly patients with a longer duration of illness. Some elderly patients experienced prolonged pain before surgery and hoped for pain relief and functional recovery postoperatively. Although analgesic pumps and painkillers were used, the pain management plan lacked individualization, which could lead elderly patients to have catastrophic thoughts such as questioning whether the surgery was successful. Additionally, elderly patients often have muscle atrophy and poor balance, and rehabilitation exercises can be uncomfortable, making them more likely to develop negative expectations of pain catastrophizing. Elderly patients experiencing pain catastrophizing perceive pain more intensely and have a relatively higher incidence of disability\u003csup\u003e\u0026nbsp;[10]\u003c/sup\u003e. In clinical practice,\u0026nbsp; healthcare providers should attach importance to the problem of pain catastrophizing in patients undergoing total hip arthroplasty, and can adopt the Pain Catastrophizing Scale as a routine screening tool after hip joint surgery to assess patients\u0026apos; catastrophic thoughts in a timely manner.\u003c/p\u003e\n\u003ch2\u003e3.2. The level of pain can directly affect pain catastrophizing.\u003c/h2\u003e\n\u003cp\u003eThe intensity of pain can directly affect pain catastrophizing, which is consistent with the findings of both domestic and international studies \u003csup\u003e[23\u0026ndash;25]\u003c/sup\u003e.\u003csup\u003e\u0026nbsp;\u003c/sup\u003ePain catastrophizing refers to an exaggerated and negative cognitive set that an individual holds towards actual or potential pain. Its physiological basis may lie in the overlap between brain regions responsible for processing pain perception and those in charge of cognitive and emotional processing. When a pain stimulus occurs, if the patient\u0026apos;s attention is excessively drawn to and focused on it, it may disrupt the normal function of their own pain regulation system\u003csup\u003e[26]\u003c/sup\u003e.\u0026nbsp;For elderly patients who have undergone Total Hip Arthroplasty (THA), their pain experience is influenced by multiple factors.\u0026nbsp;Physiologically, elderly patients often have multiple comorbid chronic conditions, which may reduce their pain threshold to a certain extent and increase their pain sensitivity.\u0026nbsp;Psychologically and socially, elderly patients may have specific anxieties about death and functional decline, and these emotions can intensify their negative interpretation of pain.\u0026nbsp;In addition, the sense of loneliness experienced by elderly individuals who are widowed and living alone, as well as the insufficient social support they actually receive, may weaken their ability to cope with pain proactively\u003csup\u003e[27]\u003c/sup\u003e, \u0026nbsp;Pain catastrophizing may bring significant feelings of fear and helplessness to patients, which in turn affects their enthusiasm for rehabilitation and quality of life. Therefore, in the perioperative pain management of elderly THA patients, a multi-dimensional comprehensive intervention strategy should be adopted. In addition to standardized pharmacologic analgesia, importance should be attached to the assessment and intervention of psychosocial factors. It is recommended that in clinical nursing, patients at high risk of pain catastrophizing be identified early, either preoperatively or postoperatively. Basic psychological counseling can be provided or patients can be guided to receive professional psychological consultation, helping them establish a more rational perception of pain and rehabilitation. At the same time, family members should be encouraged to participate, and medical and nursing resources should be used to build a social support network for patients, which is particularly important for alleviating patients\u0026apos; loneliness and enhancing their confidence in coping with pain. Through the above comprehensive measures, it is expected to reduce the level of pain catastrophizing in elderly THA patients to a certain extent, thereby promoting their postoperative rehabilitation.\u003c/p\u003e\n\u003cp\u003e3.3 Pain can indirectly influence pain catastrophizing through central sensitization and kinesiophobia.\u003c/p\u003e\n\u003ch3\u003e3.3. 1 The Mediating Effect of Central Sensitization on Pain and Pain Catastrophizing\u003c/h3\u003e\n\u003cp\u003ePain stimulation, as a trigger factor for the BIS system, can indirectly affect pain catastrophizing through central sensitization. The continuous transmission of pain signals can induce interactions between excitatory sensory neuropeptides and neuronal protein-coupled receptors, which lowers the action potential threshold of neurons and increases their sensitivity, leading to the development of central sensitization\u003csup\u003e\u0026nbsp;[28]\u003c/sup\u003e. In the context of pain, enhanced sensitivity of the central nervous system due to pain stimulation can cause abnormal pain responses to non-painful stimuli (such as touch or pressure)\u003csup\u003e\u0026nbsp;[29]\u003c/sup\u003e, thereby affecting pain perception, leading to misinterpretation of pain, and forming pain catastrophizing. After THA surgery, although joint function can be improved, most patients, especially elderly patients, still experience persistent postoperative pain \u003csup\u003e[30]\u003c/sup\u003e. For THA patients, central sensitization induced by pain stimulation is one of the reasons for long-term postoperative pain\u003csup\u003e\u0026nbsp;[31]\u003c/sup\u003e. KOH\u003csup\u003e\u0026nbsp;[32]\u003c/sup\u003e and colleagues investigated the relationship between pain catastrophizing and central sensitization in patients after total knee arthroplasty, and found that patients with central sensitization had pain catastrophizing scores 3.02 times higher than those without central sensitization. Central sensitization is the physiological basis of pain catastrophizing, while pain catastrophizing is the psychological manifestation of central sensitization; the two interact, jointly exacerbating the patient\u0026apos;s pain experience and psychological burden. Research on the relationship between central sensitization and pain catastrophizing is still in its early stages in China, but these concepts are significant for improving patients\u0026rsquo; quality of life and alleviating postoperative pain.\u003c/p\u003e\n\u003ch3\u003e3.3. 2 The Mediating Effect of Kinesiophobia on Pain and Pain Catastrophizing\u003c/h3\u003e\n\u003cp\u003ePain is one of the risk factors for kinesiophobia\u003csup\u003e\u0026nbsp;[33]\u003c/sup\u003e. According to the \u0026apos;fear-avoidance\u0026apos; model, patients adopt a confrontational and avoidant attitude when experiencing pain\u003csup\u003e\u0026nbsp;[34]\u003c/sup\u003e. After THA surgery, elderly patients may avoid activity due to fear of pain, ultimately leading to musculoskeletal weakness and negative emotional reactions. Vlaeyen\u003csup\u003e\u0026nbsp;[35]\u003c/sup\u003e and colleagues further extended the \u0026apos;fear-avoidance\u0026apos; model to a cognitive-behavioral model of fear of movement. The higher the level of kinesiophobia, the more individuals tend to engage in pain catastrophizing thought patterns. For elderly patients after THA, fear itself brings anxiety and stress, which are closely related to pain catastrophizing. Activity avoidance caused by kinesiophobia makes it difficult for individuals to adapt to pain, thereby reducing pain-coping ability and enhancing catastrophic thinking. Both kinesiophobia and pain catastrophizing are psychologically mediated changes triggered by pain. After THA, elderly patients should be actively guided to have a correct understanding of pain, alleviate pain catastrophizing thoughts, and reduce fear of movement.\u003c/p\u003e\n\u003ch3\u003e3.3. 3 The Chain Mediation Effect of Hip Joint Function and Kinesiophobia in Pain and Pain Catastrophizing\u003c/h3\u003e\n\u003cp\u003eResearch results indicate that hip joint function is significantly negatively correlated with pain catastrophizing \u003csup\u003e[36]\u003c/sup\u003e. In this study, elderly patients after THA who fear pain or develop kinesiophobia reduce their activity and exercises that improve hip joint function. With the decline of physical abilities and the deterioration of various organs in elderly patients, joint stiffness and muscle atrophy occur. Dysfunction of the hip joint can affect the patient\u0026apos;s mental state\u003csup\u003e\u0026nbsp;[37]\u003c/sup\u003e, making them more sensitive to pain and increasing negative emotions, leading to the occurrence of pain catastrophizing. Improvement in hip joint function (\u0026beta; = \u0026ndash;0.302) plays a positive regulatory role in the BAS system. The mobility gained through functional recovery can enhance patients\u0026apos; self-efficacy and break catastrophizing thought patterns. In the treatment and rehabilitation process of elderly patients after THA, it is important not only to focus on pain relief itself but also to emphasize interventions for kinesiophobia and hip joint function, reduce the patients\u0026apos; pain catastrophizing cognition, and promote the recovery of overall function.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, this study revealed the influencing factors and pathways of pain catastrophizing included in the BIS-BAS model, suggesting that alleviating pain, kinesiophobia, central sensitization, and enhancing hip joint mobility can effectively reduce the occurrence of pain catastrophizing in patients after THA. Excessive activation of the BIS may be associated with hypervigilance to pain and negative cognition. In contrast, enhancing the motivational tendency of the BAS may help patients shift their attention toward positive rehabilitation goals, thereby improving their pain cognition. These findings provide preliminary clues for understanding the psychophysiological mechanisms underlying pain catastrophizing in patients after THA. In the future, greater attention should be paid to the identification and intervention of pain catastrophizing in post-THA patients. As a pain-related psychosocial characteristic, pain catastrophizing can also affect postoperative treatment outcomes, but these psychosocial traits are not easy to identify. \u0026nbsp;Therefore, enhancing nurses' awareness of this issue and their ability to identify it is the crucial first step. Through the aforementioned comprehensive nursing interventions, the goal is to reduce patients' level of pain catastrophizing, with a view to better promoting their postoperative rehabilitation and improving their quality of life.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eAlthough this study aimed to construct a structural equation model of the psychophysiological factors of pain catastrophizing in elderly patients after total hip arthroplasty, it did not incorporate the social factors of pain catastrophizing. In addition, an important limitation was selection bias. A total of 285 elderly patients were recruited from tertiary hospitals in Liaoning Province using only the convenience sampling method. This sampling approach may result in the sample failing to fully represent all patients who have undergone total hip arthroplasty, especially those who did not receive treatment at these specific hospitals.Since the study was conducted at a specific time and location, and the level of pain catastrophizing, as a postoperative psychological trait, is characterized by dynamic changes, a cross-sectional study is insufficient to explain its dynamic trajectory. Therefore, the inference of the study results may be limited and should be interpreted with caution.Future research could adopt broader sampling strategies, including multicenter collaboration and random sampling, to reduce selection bias and improve the generalizability of the model. Longitudinal follow-up studies can also be conducted to explore the dynamic changes of pain catastrophizing in elderly patients after total hip arthroplasty. Furthermore, a structural equation model of pain catastrophizing related to psychosocial factors can be established to further investigate the influencing factors of pain catastrophizing.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contributions:\u003c/h2\u003e\n\u003cp\u003eYin Xinyi (First Author): Conceptualization, Methodology, Investigation, Formal analysis, Visualization, Writing - Original Draft\u003c/p\u003e\n\u003cp\u003eQu Liangliang (Corresponding Author): Supervision, Project administration, Writing - Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability Statement\u003c/h2\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003ch2\u003eConflict of Interest Statement\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\u003ch2\u003eFunding source declaration\u003c/h2\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eXING G, WU D, YIN J, et al. 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Journal of Orthopaedic Surgery and Research, 2023, 18(1): 960.\u003c/li\u003e\n\u003cli\u003e NEBLETT R, HARTZELL M M, MAYER T G, et al. Establishing Clinically Relevant Severity Levels for the Central Sensitization Inventory[J]. Pain Practice: The Official Journal of World Institute of Pain, 2017, 17(2): 166-175.\u003c/li\u003e\n\u003cli\u003e HARRIS W H. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation[J]. The Journal of Bone and Joint Surgery. American Volume, 1969, 51(4): 737-755.\u003c/li\u003e\n\u003cli\u003e Min, C.Y. A Study on Fear of Falling and Its Influencing Factors in Patients After Total Hip Arthroplasty [D]. Shihezi University, 2022.\u003c/li\u003e\n\u003cli\u003e MESAROLI G, VADER K, ROSENBLOOM B N, et al. Sensitivity and measurement properties of the Tampa Scale of Kinesiophobia for assessing fear of movement in children and adults in surgical settings[J]. Disability and Rehabilitation, 2023, 45(14): 2390-2397.\u003c/li\u003e\n\u003cli\u003e Hu Wen. Cultural Adaptation of Simplified Chinese Versions of TSK and FABQ Scales and Their Application in Degenerative Lumbar and Leg Pain[D]. Second Military Medical University, 2012.\u003c/li\u003e\n\u003cli\u003e Xiong Hongxing, Zhang Jing, Ye Baojuan, et al. Model Analysis of Common Method Variation Effects and Statistical Control Approaches[J]. Advances in Psychological Science, 2012, 20(5): 757-769.\u003c/li\u003e\n\u003cli\u003e Song, C.Y., Wang, G.L., Wu, H.Y. Analysis of pain catastrophizing levels and influencing factors among chronic pain patients [J]. Journal of Nursing Science, 2024, 39(4): 32-36.\u003c/li\u003e\n\u003cli\u003e SOBOL-KWAPINSKA M, BĄBEL P, PLOTEK W, et al. Psychological correlates of acute postsurgical pain: A systematic review and meta-analysis[J]. European Journal of Pain (London, England), 2016, 20(10): 1573-1586.\u003c/li\u003e\n\u003cli\u003e MALFLIET A, COPPIETERS I, VAN WILGEN P, et al. Brain changes associated with cognitive and emotional factors in chronic pain: A systematic review[J]. European Journal of Pain (London, England), 2017, 21(5): 769-786.\u003c/li\u003e\n\u003cli\u003e SOMERS T J, KEEFE F J, PELLS J J, et al. Pain catastrophizing and pain-related fear in osteoarthritis patients: relationships to pain and disability[J]. Journal of Pain and Symptom Management, 2009, 37(5): 863-872.\u003c/li\u003e\n\u003cli\u003e Li Jingyi, Zhang Qingqing, Qian Jun, et al. Research Progress on Loneliness Among Empty-Nest Elders [J]. China Medical Guide, 2024, 21(36): 56-60.\u003c/li\u003e\n\u003cli\u003e PAK D J, YONG R J, KAYE A D, et al. Chronification of Pain: Mechanisms, Current Understanding, and Clinical Implications[J]. Current Pain and Headache Reports, 2018, 22(2): 9.\u003c/li\u003e\n\u003cli\u003e MCCARBERG B, PEPPIN J. Pain Pathways and Nervous System Plasticity: Learning and Memory in Pain[J]. Pain Medicine (Malden, Mass.), 2019, 20(12): 2421-2437.\u003c/li\u003e\n\u003cli\u003e NOORI A, SPRAGUE S, BZOVSKY S, et al. Predictors of Long-Term Pain After Hip Arthroplasty in Patients With Femoral Neck Fractures: A Cohort Study[J]. Journal of Orthopaedic Trauma, 2020, 34: S55.\u003c/li\u003e\n\u003cli\u003e OHASHI Y, FUKUSHIMA K, UCHIDA K, et al. Adverse Effects of Higher Preoperative Pain at Rest, a Central Sensitization-Related Symptom, on Outcomes After Total Hip Arthroplasty in Patients with Osteoarthritis[J]. Journal of Pain Research, 2021, 14: 3345-3352.\u003c/li\u003e\n\u003cli\u003e KOH H S, CHOI Y H, PARK D, et al. Association Between Pain Catastrophizing and Central Sensitization Among Patients With Severe Knee Osteoarthritis Awaiting Primary Total Knee Arthroplasty[J]. Orthopedics, 2022, 45(4): 197-202.\u003c/li\u003e\n\u003cli\u003e DU X, SHAO Y, XUE J, et al. Prevalence and influencing factors of kinesiophobia after total knee arthroplasty: a systematic review and meta-analysis[J]. Journal of Orthopaedic Surgery and Research, 2025, 20(1): 332.\u003c/li\u003e\n\u003cli\u003e RENEMAN M F, JORRITSMA W, DIJKSTRA S J, et al. Relationship between kinesiophobia and performance in a functional capacity evaluation[J]. Journal of Occupational Rehabilitation, 2003, 13(4): 277-285.\u003c/li\u003e\n\u003cli\u003e VLAEYEN J W S, KOLE-SNIJDERS A M J, BOEREN R G B, et al. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance[J]. Pain, 1995, 62(3): 363-372.\u003c/li\u003e\n\u003cli\u003e Zhang Xiaotai, Li Jun, Zhang Lingling, et al. Functional impairment and associated psychological factors in patients with chronic hip pain[J]. Chinese Journal of Rehabilitation Theory and Practice, 2022, 28(12): 1484-1488.\u003c/li\u003e\n\u003cli\u003e HAMPTON S N, NAKONEZNY P A, RICHARD H M, et al. Pain catastrophizing, anxiety, and depression in hip pathology[J]. The Bone \u0026amp; Joint Journal, 2019, 101-B(7): 800-807.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Total Hip Arthroplasty (THA), Pain Catastrophizing, Behavioral Institution/Activation System (BIS/BAS), Influencing Factors, Structural Equation Model (SEM)","lastPublishedDoi":"10.21203/rs.3.rs-8303093/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8303093/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective : \u003c/strong\u003eTo explore the current situation of pain catastrophizing among patients after total hip arthroplasty, build a structural equation model based on Behavior Inhibition/Activation System theory, analyze the influencing factors and \u0026nbsp;pathways of pain catastrophe, and provide reference for developing interventional measures to alleviate pain catastrophizing levels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Using convenience sampling, 285 patients undergoing total hip arthroplasty in the orthopedic department of a tertiary hospital in Liaoning Province from January to August 2025 were followed up. Research tools included a general information questionnaire, Pain Catastrophizing Scale, Visual Analogue Scale for pain, Central Sensitization Scale, Harris Hip Score, and Tampa Scale for Kinesiophobia. Univariate analysis and multiple linear regression were performed using SPSS 28.0 software. SEM modeling was conducted with AMOS 28.0 software.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Among the 285 total hip arthroplasty patients, the mean pain catastrophizing score was (25.70 ± 11.73), with a prevalence of 36.8%. The SEM model revealed that pain intensity, central sensitization, Kinesiophobia, and hip function directly influenced pain catastrophizing, with direct effect values of 0.398, 0.408, 0.165, and -0.302, respectively (all p \u0026lt; 0.01). Pain intensity also indirectly affected pain catastrophizing through central sensitization, phobia, and hip function. (Indirect effects accounted for 51.4% of the total effect) .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion : \u003c/strong\u003eThe incidence of pain catastrophizing is high among elderly patients after total hip arthroplasty. Clinical practice should actively guide elderly patients toward accurate pain cognition, alleviate pain catastrophizing levels, and improve postoperative quality of life.\u003c/p\u003e","manuscriptTitle":"Current Status of Pain Catastrophizing in Elderly Patients Following THA Based on the Behavioral/Inhibitory Activation System and Construction of a Structural Equation Model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-01 10:14:50","doi":"10.21203/rs.3.rs-8303093/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-22T03:38:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-14T14:57:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"91685883765758234870804830793782226350","date":"2026-04-06T12:09:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337663572425693534880064619811708092976","date":"2026-04-05T10:48:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-05T10:46:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8873793163630274813187002811624590392","date":"2026-04-05T05:09:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-04T15:06:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-02T19:56:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65444326702348916711833195115331722756","date":"2026-04-02T00:21:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26393289999614818534452651604258390431","date":"2026-04-01T15:29:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"232602901962041225325288302639305351478","date":"2026-03-31T05:48:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"179554169225538308677359682702125958215","date":"2026-03-31T04:07:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"78544441776420300674008995720244952558","date":"2026-03-30T18:57:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87273093218169188883583625636911533690","date":"2026-03-30T13:44:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-30T13:10:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-30T12:57:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-17T15:09:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-16T12:22:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-12-15T08:46:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5b232102-b1a7-446e-a607-10b713bfde4c","owner":[],"postedDate":"April 1st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":65488931,"name":"Health sciences/Diseases"},{"id":65488932,"name":"Health sciences/Health care"},{"id":65488933,"name":"Health sciences/Medical research"},{"id":65488934,"name":"Health sciences/Signs and symptoms"}],"tags":[],"updatedAt":"2026-04-22T03:53:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-01 10:14:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8303093","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8303093","identity":"rs-8303093","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}