Automated Pain Management Intervention May Be Useful for Postsurgical Pain

The fully automated behavioral pain management skills intervention My Surgical Success (MSS) was found to reduce postsurgical pain at 3 months among patients who underwent orthopedic trauma surgery. These findings, from a randomized controlled clinical trial, were published in Anesthesia & Analgesia.

Study investigators recruited patients (N=133) undergoing orthopedic trauma surgery at the Stanford Orthopedic Trauma Clinic between 2018 and 2020. Participants were randomly assigned in a 1:1 ratio to receive MSS (n=37) or a digital general health education (n=47) intervention. The MSS intervention comprised 3 45-minute pain psychoeducational videos, a personalized plan for surgical success, and a 20-minute binaural relaxation response application for daily use. The goal of the study was to determine feasibility of the MSS intervention, which was defined as 80% acceptability. Secondary goals included change in pain intensity as evaluated with the Patient-Reported Outcomes Measurement Information Systems (PROMIS) and the Numerical Pain Rating Scale (NPRS), change in pain catastrophizing as evaluated with the Pain Catastrophizing Scale (PCS), and cessation of opioid use.

The mean age of the study population was 49.53 (standard deviation [SD], 17.14) years, 60.71% were men, 61.90% were White, 84.52% had undergone previous surgery, 72.62% underwent open reduction and internal fixation, and 77.4% underwent surgery of the lower extremity, respectively.

Using a 6-point scale, recipients of the MSS intervention scored the application for ease of understanding (mean, 5.70), usefulness (mean, 4.82), satisfaction (mean, 4.86), likelihood of use (mean, 5.00), and relevancy (mean, 4.77). Most of these measures met the 80% (4.8) threshold for feasibility. Positive satisfaction ratings were given by 88% of study participants.

At month 3, recipients of the MSS intervention reported lower pain intensity (absolute difference [AD], -1.14; 95% CI, -2.02 to -0.27) compared with recipients of the digital health education intervention.

The 2 treatment groups did not differ for PCS (AD, -0.47; 95% CI, -4.24 to 3.30), PROMIS pain interference (AD, -2.91; 95% CI, -7.22 to 1.41), PROMIS anxiety (AD, -0.01; 95% CI, -3.78 to 3.75), PROMIS depression (AD, -0.94; 95% CI, -4.21 to 2.33), PROMIS fatigue (AD, -1.29; 95% CI, -5.35 to 2.77), PROMIS sleep disturbance (AD, -0.70; 95% CI, -4.31 to 2.91), and PROMIS social isolation (AD, -0.45; 95% CI, -3.84 to 2.94).

The mean time to opioid cessation was 20.91 days for the MSS cohort compared with 24.21 days for the digital health education group (P =.239).

This study may have been limited by not evaluating satisfaction among the digital health education group; however, participants in the control group had a low attrition rate and engagement was similar to that demonstrated by the MSS group.

Study authors concluded, “Results suggest that a low-cost, efficient, fully automated behavioral pain medicine treatment may be a useful pain management adjunct for motivated orthopedic trauma surgery patients and may reduce postsurgical pain up to 3 months after surgery. MSS offers significant advantages for increasing access to behavioral pain medicine with low/no risks and low/no implementation costs, and may support enhanced recovery after orthopedic trauma surgery.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.