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

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.