Posted on 16-03-2018

Reviewing psychological interventions for post-surgical pain

Chronic post-surgical pain (CPSP) is pain following surgery that persists beyond the expected recovery period, and which cannot be explained by known biological causes. Psychological and behavioural interventions including cognitive behavioural therapy (CBT), acceptance commitment therapy (ACT) and mindfulness-based psychotherapy can reduce pain, distress, and disability associated with CPSP. Recently, strong evidence has been presented suggesting that psychological intervention could be an important part of the surgical process, and could assist patients who are pre- or post-surgery from ever developing pathological pain. However, the body of literature on behavioural interventions for CPSP is limited. UTCSP members Dr. Joel Katz and Dr. Hance Clarke, lead author Dr. Judith L. Nicholls, and colleagues performed a systemic review of randomized controlled trials (RCTs) on psychological interventions for CPSP.

The authors initially identified 521 citations that met their search criteria. The authors then hand-selected papers that employed CBT, ACT, or mindfulness intervention, which was initiated less than two months post-surgery. They only included trials which measured pain or CPSP as an outcome, employed RCTs, and only included studies performed on an adult population. Of these 521, only 5 trials met the inclusion criteria. This outlines the scarcity of clinical trials involving psychological intervention post-surgery. Of these 5 trials, no trials for ACT or mindfulness intervention were identified, highlighting the need for clinical trials investigating these interventions. Two trials integrated CBT with physiotherapy following surgery for back pain, and four studied CBT in cardiac and back surgery patients. These trials generally found significant reductions in pain, supporting CBT intervention for reduction in pain intensity and pain-related disability. However, the studies each used different CBT protocols and different protocol lengths, so effects specific to each protocol could not be established.

This review suggests that CBT may be a promising avenue to reduce pain intensity and disability following surgery. However, it also establishes the great need for further study to understand the efficacy of different psychological and behavioural interventions that have the potential to greatly improve patient outcomes.

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Reference: Nicholls JL, Azam MA, Burns LC, Englesakis, M, Sutherland AM, Weinrib AZ, Katz J, Clarke H. (2018). Psychological treatments for the management of postsurgical pain: a systematic review of randomized controlled trials. Patient Related Outcome Measures. 2018;9:49-64.