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Psychological interventions to reduce postoperative pain and opioid consumption: a narrative review of literature
  1. Kevin Gorsky1,
  2. Nick D Black2,
  3. Ayan Niazi3,
  4. Aparna Saripella1,
  5. Marina Englesakis4,
  6. Timothy Leroux5,
  7. Frances Chung6 and
  8. Ahtsham U Niazi1
  1. 1 Department of Anesthesia and Pain Management, University of Toronto, Toronto, Ontario, Canada
  2. 2 Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
  3. 3 Department of Biology, Trent University, Peterborough, Ontario, Canada
  4. 4 Library & Information Services, University Health Network, Toronto, Ontario, Canada
  5. 5 The Arthritis Program, University Health Network, Toronto, Ontario, Canada
  6. 6 Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Ahtsham U Niazi, Department of Anesthesia and Pain Management, University of Toronto, Toronto, ON M5S, Canada; ahtsham.niazi{at}utoronto.ca

Abstract

Background Evidence suggests that over half of patients undergoing surgical procedures suffer from poorly controlled postoperative pain. In the context of an opioid epidemic, novel strategies for ameliorating postoperative pain and reducing opioid consumption are essential. Psychological interventions defined as strategies targeted towards reducing stress, anxiety, negative emotions and depression via education, therapy, behavioral modification and relaxation techniques are an emerging approach towards these endpoints.

Objective This review explores the efficacy of psychological interventions for reducing postoperative pain and opioid use in the acute postoperative period.

Evidence review An extensive literature search was conducted in MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Medline In-Process/ePubs, Embase, Ovid Emcare Nursing, and PsycINFO, Web of Science (Clarivate), PubMed-NOT-Medline (NLM), CINAHL and ERIC, and two trials registries, ClinicalTrials.Gov (NIH) and WHO ICTRP. Included studies were limited to those investigating adult human subjects, and those published in English.

Findings Three distinct forms of psychological interventions were identified: relaxation, psychoeducation and behavioral modification therapy. Study results showed a reduction in both postoperative opioid use and pain scores (n=5), reduction in postoperative opioid use (n=3), reduction in postoperative pain (n=5), no significant reduction in pain or opioid use (n=7), increase in postoperative opioid use (n=1) and an increase in postoperative pain (n=1).

Conclusion Some preoperative psychological interventions can reduce pain scores and opioid consumption in the acute postoperative period; however, there is a clear need to strengthen the evidence for these interventions. The optimal technique, strategies, timing and interface requires further investigation.

  • analgesics
  • opioid
  • pain
  • postoperative
  • pain management
  • acute pain

Data availability statement

Data are available on reasonable request to Dr Ahtsham U Niazi at ahtsham.niazi@utoronto.ca.

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Data availability statement

Data are available on reasonable request to Dr Ahtsham U Niazi at ahtsham.niazi@utoronto.ca.

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Footnotes

  • Twitter @nickdblack, @AhtshamNiazi

  • Contributors KG helped in data analysis, reviewing of literature, data extraction and preparation of manuscript. NDB helped in data analysis and preparation of manuscript. AN helped in protocol development, reviewing of literature and data extraction. AS helped in protocol development, reviewing of literature and data extraction. ME helped in protocol development and literature search. TL helped in protocol development, conduct of study and review of manuscript. FC helped in protocol development and review of manuscript. AUN helped in protocol development, conduct of study, data analysis, preparation and review of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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