Perioperative psychotherapy for persistent post-surgical pain and physical impairment: a meta-analysis of randomised trials

Wang, L.; Chang, Y.; Kennedy, S.A.; Hong, P.J.; Chow, N.; Couban, R.J.; McCabe, R.E.; Bieling, P.J.; Busse, J.W.

doi:10.1016/j.bja.2017.10.026

Cited by 84Anesthesia and Pain ManagementMusculoskeletal pain and rehabilitationPediatric Pain Management Techniques

Perioperative psychotherapy for persistent post-surgical pain and physical impairment: a meta-analysis of randomised trials

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Wang, L., Chang, Y., Kennedy, S.A., Hong, P.J., Chow, N., Couban, R.J., McCabe, R.E., Bieling, P.J. +1 more·2018·British Journal of Anaesthesia

DOI 10.1016/j.bja.2017.10.026

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Abstract

Background Persistent post-surgical pain affects 10-80% of individuals after common operations, and is more common among patients with psychological factors such as depression, anxiety, or catastrophising.Methods We conducted a systematic review and meta-analysis of randomised, controlled trials to evaluate the efficacy of perioperative psychotherapy for persistent post-surgical pain and physical impairment. Paired independent reviewers identified studies, extracted data, and assessed risk of bias. The Grading of Recommendations, Assessment, Development and Evaluation system was used to assess the quality of evidence.Results Our search of five electronic databases, up to September 1, 2016, found 15 trials (2220 patients) that were eligible for review. For both persistent post-surgical pain and physical impairment, perioperative education was ineffective, while active psychotherapy suggested a benefit (test of interaction P=0.01 for both outcomes). Moderate quality evidence showed that active perioperative psychotherapy (cognitive-behaviour therapy, relaxation therapy, or both) significantly reduced persistent post-surgical pain [weighted mean difference (WMD) -1.06 cm on a 10 cm visual analogue scale for pain, 95% confidence interval (CI) -1.56 to -0.55 cm; risk difference (RD) for achieving no more than mild pain (≤3 cm) 14%, 95% CI 8-21%] and physical impairment [WMD -9.87% on the 0-100% Oswestry Disability Index, 95% CI -13.42 to -6.32%, RD for achieving no more than mild disability (≤20%) 21%, 95% CI 13-29%].Conclusions Perioperative cognitive behavioural therapy and relaxation therapy are effective for reducing persistent pain and physical impairment after surgery. Future studies should explore targeted psychotherapy for surgical patients at higher risk for poor outcome.Clinical trial registration PROSPERO CRD42016047335.

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In those studies, the difference in pain between intervention and non-intervention groups was about 1 on average on a 0-10 scale.
“However, the difference in pain between intervention and non-intervention groups was about 1 (on average) on a 0–10 scale [13].”
From A single-session acceptance and commitment therapy intervention among women undergoing surgery for breast cancer: A randomized pilot trial to reduce persistent postsurgical pain. (2019) · cites this paper as [13]
The Persistent post-surgical pain section (page unavailable) reports a mean difference of 1.06 points on a 0–10 scale for active psychological interventions versus usual care. But the pooled difference across interventions was 0.56 points, while education or psychological support showed a 0.12-point difference. Thus, about 1 point describes the active-intervention subgroup, not the studies overall. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Cognitive behavioral therapy and relaxation therapy have demonstrated positive effects in pain reduction following orthopedic, cardiac, and colorectal surgeries.
“Cognitive behavioral therapy and relaxation therapy have demonstrated positive effects in pain reduction following orthopedic, cardiac, and colorectal surgeries.”
From A single-session acceptance and commitment therapy intervention among women undergoing surgery for breast cancer: A randomized pilot trial to reduce persistent postsurgical pain. (2019) · cites this paper as [13]
A meta-analysis of psychological studies during the perioperative period found that single-session educational interventions demonstrated the greatest patient adherence.
“A meta-analysis of psychological studies during the perioperative period found that single-session educational interventions demonstrated the greatest patient adherence; however, education only sessions did not improve post-surgical pain outcomes [13].”
From A single-session acceptance and commitment therapy intervention among women undergoing surgery for breast cancer: A randomized pilot trial to reduce persistent postsurgical pain. (2019) · cites this paper as [13]
Education-only sessions did not improve post-surgical pain outcomes.
“A meta-analysis of psychological studies during the perioperative period found that single-session educational interventions demonstrated the greatest patient adherence; however, education only sessions did not improve post-surgical pain outcomes [13].”
From A single-session acceptance and commitment therapy intervention among women undergoing surgery for breast cancer: A randomized pilot trial to reduce persistent postsurgical pain. (2019) · cites this paper as [13]

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Additional file 1 of Effect of perioperative cognitive behavioural therapy on chronic post-surgical pain among breast cancer patients with high pain catastrophising characteristics: protocol for a double-blinded randomised controlled trial
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Additional file 1 of Comparative benefits and harms of perioperative interventions to prevent chronic pain after orthopedic surgery: a systematic review and network meta-analysis of randomized trials
Al-Asadi, M., Torabiardakani, K., Darzi, A. J., Gilron, I., Marcucci, M., Khan, J. S., Chaparro, L. E., Rosenbloom, B. N., Couban, R. J., Thomas, A., et al. (2024) · Figshare · doi:10.6084/m9.figshare.25706184
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Additional file 2 of Postoperative pain and pain management and neurocognitive outcomes after non-cardiac surgery: a protocol for a series of systematic reviews
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Authors: Wang, L., Chang, Y., Kennedy, S. A., Hong, P. J., Chow, N., Couban, R. J., McCabe, R. E., Bieling, P. J., & Busse, J. W.
Affiliations: McMaster University (CA)
University of Toronto (CA)
University of Ottawa (CA)
St. Joseph’s Healthcare Hamilton (CA)
Corresponding author: Busse, J.W.
ORCID: Wang, L.
Chang, Y.
Kennedy, S.A.
Chow, N.
Couban, R.J.
McCabe, R.E.
Bieling, P.J.
Busse, J.W.
Venue: British Journal of Anaesthesia
Publisher: Elsevier BV
Published: 2018-06
Volume: 120
Issue: 6
Pages: 1304-1314
ISSN: 0007-0912 (ISSN-L)
DOI: 10.1016/j.bja.2017.10.026
OpenAlex: W2793369614
Cited by: 84
References: 53
Citations by year: 2026: 8 · 2025: 10 · 2024: 11 · 2023: 10 · 2022: 13 · 2021: 14 · 2020: 10 · 2019: 6 · 2018: 2
FWCI: 1.78
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 365 d)
Locations: British Journal of Anaesthesia (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords: persistent post-surgical pain, physical impairment, cognitive behavioral therapy, relaxation training, perioperative education, Oswestry Disability Index, pain intensity, surgical patients
MeSH terms: Humans, Postoperative Pain, Pain, Postoperative, Psychotherapy, Relaxation Therapy, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Perioperative Care, Chronic Pain, Pain Management

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Perioperative psychotherapy for persistent post-surgical pain and physical impairment: a meta-analysis of randomised trials

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