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Cited by 56Anesthesia and Pain ManagementPediatric Pain Management TechniquesCardiac Health and Mental Health

Psychological interventions for acute pain after open heart surgery

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Ziehm, Susanne, Rosendahl, Jenny, Barth, Jürgen, Strauss, Bernhard M, Mehnert, Anja, Koranyi, Susan·2017·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd009984.pub3PMC PMC6432747
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Abstract

BACKGROUND: This is an update of a Cochrane review previously published in 2014. Acute postoperative pain is one of the most disturbing complaints in open heart surgery, and is associated with a risk of negative consequences. Several trials investigated the effects of psychological interventions to reduce acute postoperative pain and improve the course of physical and psychological recovery of participants undergoing open heart surgery. OBJECTIVES: To compare the efficacy of psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention control in adults undergoing open heart surgery for pain, pain medication, psychological distress, mobility, and time to extubation. SEARCH METHODS: For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, and PsycINFO for eligible studies up to February 2017. We used the 'related articles' and 'cited by' options of eligible studies to identify additional relevant studies. We checked lists of references of relevant articles and previous reviews. We searched the ProQuest Dissertations and Theses Full Text Database, ClinicalTrials and the WHO International Clinical Trials Registry Platform to identify any unpublished material or ongoing trials. We also contacted the authors of primary studies to identify any unpublished material. In addition, we wrote to all leading heart centres in Germany, Switzerland, and Austria to check whether they were aware of any ongoing trials. SELECTION CRITERIA: Randomised controlled trials comparing psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention in adults undergoing open heart surgery. DATA COLLECTION AND ANALYSIS: Two review authors (SZ and SK) independently assessed trials for eligibility, estimated the risk of bias and extracted all data. We calculated effect sizes for each comparison (Hedges' g) and meta-analysed data using a random-effects model. We assessed the evidence using GRADE and created 'Summary of findings' tables. MAIN RESULTS: We added six studies to this update. Overall, we included 23 studies (2669 participants).For the majority of outcomes (two-thirds), we could not perform a meta-analysis since outcomes were not measured, or data were provided by one trial only.No study reported data on the number of participants with pain intensity reduction of at least 50% from baseline. Only one study reported data on the number of participants below 30/100 mm on the Visual Analogue Scale (VAS) in pain intensity (very low-quality evidence). Psychological interventions did not reduce pain intensity in the short-term interval (g 0.39, 95% CI -0.18 to 0.96, 2 studies, 104 participants, low-quality evidence), medium-term interval (g -0.02, 95% CI -0.24 to 0.20, 4 studies, 413 participants, moderate-quality evidence) or in the long-term interval (g 0.05, 95% CI -0.20 to 0.30, 2 studies, 200 participants, moderate-quality evidence).No study reported data on median time to re-medication or on number of participants re-medicated. Only two studies provided data on postoperative analgesic use in the short-term interval, showing that psychological interventions did not reduce the use of analgesic medication (g 1.18, 95% CI -2.03 to 4.39, 2 studies, 104 participants, low-quality evidence). Studies revealed that psychological interventions reduced mental distress in the medium-term (g 0.37, 95% CI 0.13 to 0.60, 13 studies, 1388 participants, moderate-quality evidence) and likewise in the long-term interval (g 0.32, 95% CI 0.10 to 0.53, 14 studies, 1586 participants, moderate-quality evidence). Psychological interventions did not improve mobility in the medium-term interval (g 0.23, 95% CI -0.22 to 0.67, 3 studies, 444 participants, low-quality evidence), nor in the long-term interval (g 0.09, 95% CI -0.10 to 0.28, 4 studies, 458 participants, moderate-quality evidence). Only two studies reported data on time to extubation, indicating that psychological interventions reduced the time to extubation (g 0.56, 95% CI 0.08 to 1.03, 2 studies, 154 participants, low-quality evidence).Overall, the very low to moderate quality of the body of evidence on the efficacy of psychological interventions for acute pain after open heart surgery cannot be regarded as sufficient to draw robust conclusions.Most 'Risk of bias' assessments were low or unclear. We judged selection bias (random sequence generation) and attrition bias to be mostly low risk for included studies. However, we judged the risk of selection bias (allocation concealment), performance bias, detection bias and reporting bias to be mostly unclear. AUTHORS' CONCLUSIONS: In line with the conclusions of our previous review, there is a lack of evidence to support or refute psychological interventions in order to reduce postoperative pain in participants undergoing open heart surgery. We found moderate-quality evidence tha

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  • Most previous reviews examined specific surgery types or limited outcomes to the acute postoperative period.

    “Most of the previous reviews have examined the effects of psychological interventions for specific types of interventions, such as orthopedic surgery, cardiac surgery, or abdominal surgery, 52,56,64,70 and/or limited the outcomes to the acute postoperative period.1,34,52,56”

    From Can perioperative psychological interventions decrease the risk of postsurgical pain and disability? A systematic review and meta-analysis of randomized controlled trials (2022) · cites this paper as [70]

    The Objectives section confirms that this review focuses on adults undergoing open-heart surgery, supporting the specific-surgery part of the claim. But the Types of outcome measures section includes outcomes after discharge, so this review did not limit outcomes to the acute postoperative period. Page numbers were unavailable in our copy. (LLM, conf=0.89)

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Authors
Ziehm, S., Rosendahl, J., Barth, J., Strauss, B. M., Mehnert, A., & Koranyi, S.
Affiliations
  • University Hospital Leipzig (DE)
  • Jena University Hospital (DE)
  • University of Zurich (CH)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2017-07-12
Volume
2019
Issue
3
Pages
CD009984-CD009984
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd009984.pub3
PMC
PMC6432747
OpenAlex
W1479760213
Cited by
56
References
202
Citations by year
2026: 3 · 2025: 2 · 2024: 4 · 2023: 7 · 2022: 3 · 2021: 13 · 2020: 7 · 2019: 5 · 2018: 4 · 2017: 5 · 2016: 2 · 2012: 1
FWCI
1.22
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
Funders
  • National Institute for Health and Care Research
  • National Institutes of Health
  • Evidence Synthesis Programme
Topics
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords
psychological intervention, acute postoperative pain, open heart surgery, cardiac surgery, pain intensity, psychological distress, analgesic use, extubation time, mobility (physical function), postoperative recovery, attentional control, cognitive behavioral therapy, relaxation training, guided imagery, hypnosis, biofeedback, music therapy, progressive muscle relaxation
MeSH terms
Adult, Aged, Analgesics, Behavior Therapy, Female, Cardiac Surgical Procedures, Humans, Male, Middle Aged, Pain Measurement, Pain, Postoperative, Postoperative Pain, Relaxation Therapy, Stress, Psychological, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Acute Pain

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