Randomized Controlled Trial of Mind-Body Interventions for Preoperative Pain Management and Postoperative Health

Background: Postoperative pain continues to be mismanaged in the U.S., with 80% of the 100 million surgical patients each year reporting acute postoperative pain. Opioid analgesics remain the primary, postoperative pain management strategy, despite serious iatrogenic risks. For many people, their first opioid exposure occurs after surgery. Postoperative opioid prescription rates range from 74% - 100%, and receiving an opioid prescription after surgery results in a 44% increased risk in long-term opioid use. Long-term opioid use can evolve into misuse when when opioid medications become mismanaged following post-surgical prescription. More than 2 million people are estimated to transition to persistent opioid use after elective surgery each year -- a rate of 1 in 16 -- contributing to record numbers of Americans meeting criteria for opioid use disorder. The NIH HEAL initiative explicitly identifies mind-body interventions (MBIs), such as mindfulness meditation and hypnotic suggestion, as preferred treatment modalities to alleviate both chronic preoperative and acute postoperative pain. Social workers are uniquely positioned to teach surgical patients mind-body pain management strategies before their surgeries to a) improve coping with the physical pain and emotional distress of surgery, thereby b) reducing the likelihood that this high risk population transitions to opioid use disorder.

Methods: This study was a three-arm, randomized controlled trial conducted at a university-based orthopedic clinic during a preoperative information session for patients scheduled for surgery. Patients (N=261) were assigned to one of three, 15-minute psychosocial intervention conditions delivered by either a social worker or a psychologist: mindfulness (n=96), hypnotic suggestion (n=82), or psychoeducation based on cognitive-behavioral therapy (n=86). Patients completed a survey measuring pain, desire for pain medication, and anxiety pre- and post-intervention. Participants also completed the PROMIS Global Physical Health scale at their first post-surgical outpatient medical visit: x̅=29 (SD=25) days post-surgery.    

Results: Repeated measures ANOVA with Tukey’s HSD post hoc analysis revealed a pattern of significantly reduced pain severity (F_2,258=4.64, p=.010), desire for pain medication (F_2,257=3.19, p= .043), and anxiety (F_2,261=7.32, p=.001) for participants receiving one of the two MBIs (mindfulness or hypnosis) compared with psychoeducation. Results indicated the two MBIs did not significantly differ in their effectiveness. Additionally, participants receiving one of the two MBIs reported better physical health at their first post-surgical provider visit compared with participants receiving psychoeduction (F_2,179=3.79, p= .025), after accounting for pre-surgical pain severity.          

Conclusions and Implications: Findings from this study indicate that a brief MBI, conducted by a social worker, is likely to immediately alleviate pain severity by 23%, decrease medication desire by 31%, and relieve anxiety by 35% in patients preparing for elective, orthopedic surgery. Furthermore, involvement in a pre-surgical MBI resulted in better self-reported physical health nearly one-month post-surgery, suggesting durable effects from a single session intervention. As such, mind-body interventions may be useful adjuncts to medical pain management that a) can be easily disseminated in clinical settings via social workers, b) provide considerable pre-surgical pain and anxiety relief, c) potentially reduce patients’ reliance on opioid analgesics (and thereby reduce opioid misuse risk), and d) encourage better post-surgical outcomes.