Psychological interventions for acute pain after open heart surgery

Ziehm, Susanne; Rosendahl, Jenny; Barth, Jürgen; Strauß, Bernhard; Mehnert, Anja; Koranyi, Susan

doi:10.1002/14651858.cd009984.pub3

Cited by 35 publications

(26 citation statements)

References 165 publications

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“…The existing literature on the effectiveness of perioperative psychological interventions is mixed. For instance, a Cochrane review and meta-analysis on perioperative psychological interventions in heart surgery patients revealed no impacts on postsurgical pain [36]. Only two studies measured analgesic use, as measured via PCA use in the hospital, and no effects were found for psychological interventions at this early stage of surgical recovery.…”

Section: Discussionmentioning

confidence: 99%

“My Surgical Success”: Effect of a Digital Behavioral Pain Medicine Intervention on Time to Opioid Cessation After Breast Cancer Surgery—A Pilot Randomized Controlled Clinical Trial

et al. 2019

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Objective This study aims to assess the feasibility of digital perioperative behavioral pain medicine intervention in breast cancer surgery and evaluate its impact on pain catastrophizing, pain, and opioid cessation after surgery. Design and Setting A randomized controlled clinical trial was conducted at Stanford University (Palo Alto, CA, USA) comparing a digital behavioral pain medicine intervention (“My Surgical Success” [MSS]) with digital general health education (HE). Participants A convenience sample of 127 participants were randomized to treatment group. The analytic sample was 68 patients (N = 36 MSS, N = 32 HE). Main Outcomes The primary outcome was feasibility and acceptability of a digital behavioral pain medicine intervention (80% threshold for acceptability items). Secondary outcomes were pain catastrophizing, past seven-day average pain intensity, and time to opioid cessation after surgery for patients who initiated opioid use. Results The attrition rate for MSS intervention (44%) was notably higher than for HE controls (18%), but it was lower than typical attrition rates for e-health interventions (60–80%). Despite greater attrition for MSS, feasibility was demonstrated for the 56% of MSS engagers, and the 80% threshold for acceptability was met. We observed a floor effect for baseline pain catastrophizing, and no significant group differences were found for postsurgical pain catastrophizing or pain intensity. MSS was associated with 86% increased odds of opioid cessation within the 12-week study period relative to HE controls (hazard ratio = 1.86, 95% confidence interval = 1.12–3.10, P = 0.016). Conclusions Fifty-six percent of patients assigned to MSS engaged with the online platform and reported high satisfaction. MSS was associated with significantly accelerated opioid cessation after surgery (five-day difference) with no difference in pain report relative to controls. Perioperative digital behavioral pain medicine may be a low-cost, accessible adjunct that could promote opioid cessation after breast cancer surgery.

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Section: Discussionmentioning

confidence: 99%

“My Surgical Success”: Effect of a Digital Behavioral Pain Medicine Intervention on Time to Opioid Cessation After Breast Cancer Surgery—A Pilot Randomized Controlled Clinical Trial

et al. 2019

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“…27,63 Inclusion of simple psychosocial and psychophysical assessment, or "phenotyping" in studies may allow estimation of important differences in pain processing between individuals, 13 informing more accurate prediction of which patients may struggle with pain in the early postoperative period, and allow better targeting of trials of novel analgesic drugs or therapies in "high-risk" samples, increasing study power. 66 This phenotyping of patients is a step towards greater personalization of care, and may allow more effective and targeted preventive perioperative planning.…”

Section: Resultsmentioning

confidence: 99%

Preoperative Psychosocial and Psychophysical Phenotypes as Predictors of Acute Pain Outcomes After Breast Surgery

Schreiber

Zinboonyahgoon

et al. 2019

The Journal of Pain

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The severity and impact of acute pain after breast surgery varies markedly among individuals, underlining the importance of comprehensively identifying specific risk factors, including psychosocial and psychophysical traits. In this prospective observational study, women (n=234) undergoing breast-conserving surgery, mastectomy, or mastectomy with reconstruction completed a brief bedside quantitative sensory testing (QST) battery, along with measures of psychosocial characteristics. Postoperative pain severity, impact, and opioid use at 2 weeks were assessed using Brief Pain Inventory (BPI) and procedure-specific breast cancer pain questionnaires. Moderatesevere average pain (>3/10) was reported by 29% of patients at 2 weeks. Regression analysis of pain outcomes revealed that pain severity was independently predicted by axillary dissection, presurgical pain, temporal summation of pain (TSP), (−)positive affect, and behavioral coping style. Pain impact was predicted by age, education, axillary dissection, reconstruction, but also by negative affect and depression scores. Lastly, opioid use was predicted by age, education, axillary dissection, reconstruction, TSP and reinterpreting coping style. Our findings suggest that, individuals with certain phenotypic characteristics, including high TSP and negative affect may be at greater risk of significant pain and continued opioid use at 2 weeks after surgery, independent of known surgical risk factors.

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“…A Cochrane review by Ziehm et al (2017) indicated that psychological interventions reduce mental distress in patients undergoing cardiac surgery [67]. Additionally, in a Cochrane review by Powell et al (2016) on psychological preparation targeting adults under general anesthesia improved postoperative pain, LOS, negative affect, and behavioral recovery [37].…”

Section: Further Evidence For Effects Of Psychological Interventions mentioning

confidence: 99%

Psychological Preparation for Cardiac Surgery

et al. 2020

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Purpose of Review To review the current state of preoperative psychological preparation to improve outcomes after cardiac surgery. Recent Findings Preoperative psychosocial factors are associated with short- and long-term outcomes after cardiac surgery. There are several approaches to optimize patients’ preoperative psychological status with promising effects on postoperative outcomes (e.g., less complications, improved quality of life). Preoperative psychological preparation often aims to improve patients’ knowledge or social support and to modify and optimize expectations and illness beliefs. Summary Preoperative psychological preparation is gaining importance for cardiac surgery. However, patients’ psychological status still does not get as much attention as it deserves. Preoperative psychological preparation seems to have positive effects on postoperative outcomes. Since overall evidence is still weak, further studies are warranted to understand which intervention works best for whom and why.

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Psychological interventions for acute pain after open heart surgery

Cited by 35 publications

References 165 publications

“My Surgical Success”: Effect of a Digital Behavioral Pain Medicine Intervention on Time to Opioid Cessation After Breast Cancer Surgery—A Pilot Randomized Controlled Clinical Trial

“My Surgical Success”: Effect of a Digital Behavioral Pain Medicine Intervention on Time to Opioid Cessation After Breast Cancer Surgery—A Pilot Randomized Controlled Clinical Trial

Preoperative Psychosocial and Psychophysical Phenotypes as Predictors of Acute Pain Outcomes After Breast Surgery

Psychological Preparation for Cardiac Surgery

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