Some Psychological Interventions May Effectively Reduce Postoperative Pain and Disability

The results of a systematic review and meta-analysis showed that psychological interventions effectively reduced (sub)acute and chronic postsurgical pain and disability outcomes. These findings were published in the journal Pain.

Publication databases were searched through March 2020 for randomized controlled trials of psychological interventions for patients undergoing surgery. A total of 21 studies met the inclusion criteria.

(Sub)acute pain, defined as occurring <3 months after surgery, was evaluated in 12 studies and chronic pain in 10. Surgical interventions were total knee arthroplasty (n=6), spinal fusion surgery (n=4), mastectomy or lumpectomy (n=3), total join arthroplasty (n=1), hip surgery (n=1), anterior cingulate ligament reconstruction (n=1), coronary bypass graft surgery (n=1), orthopedic surgery (n=1), upper or lower fracture fixation (n=1), prostatectomy (n=1), and mixed surgeries (n=1).

The psychological interventions included cognitive behavioral therapy (n=12), acceptance and commitment therapy (n=3), psychoeducation (n=1), mindfulness (n=1), expectation manipulation (n=1), pain management (n=1), relaxation and guided imagery (n=1), and stress management training (n=1). These interventions were delivered in person (n=14), by mixed media (n=3), via telephone (n=2), online (n=1), or via text messaging (n=1).

Psychological interventions were effective for (sub)acute postoperative pain (d, -0.26; 95% CI, -0.48 to -0.04; P =.02; Q₁₀, 30.29) and disability (d, -0.43; 95% CI, -0.84 to -0.03; P =.03; Q₈, 78.71). Stratified by provider, (sub)acute disability was affected by interventions provided by a psychologist (d, -0.64; P =.02) but not by another healthcare staff member (d, 0.04; P =.67). Interventions that were delivered postoperatively had a significant effect (d, -1.10; P =.01), but interventions delivered before and after surgery did not (d, -0.07; P =.41).

For chronic outcomes, psychological interventions were significant for pain (d, -0.33; 95% CI, -0.61 to -0.06; P =.02; Q₁₅, 87.86) and disability (d, -0.43; 95% CI, -0.68 to -0.18; P =.001; Q₁₅, 76.96). Similar to (sub)acute pain, interventions delivered postoperatively were significant (d, -1.13; P =.01) but not preoperatively only (d, -0.10; P =.58) nor both before and after surgery (d, -0.06; P =.32).

This study may have been limited by not considering interventions that did not target emotion and cognition, such as hypnosis.

These data indicated that psychological interventions provided by a psychologist after surgery had significant impacts to (sub)acute and chronic pain and disability outcomes. Additional studies are needed to assess which interventions may be most effective.

Reference

Nadinda PG, van Ryckeghem DML, Peters ML. Can perioperative psychological interventions decrease the risk of post-surgical pain and disability? A systematic review and meta-analysis of randomized controlled trials. Pain. Published online October 26, 2021. doi:10.1097/j.pain.0000000000002521