Enhancing the Biopsychosocial Approach to Perioperative Care
Katherine Hadlandsmyth, Mandy Conrad, Kenda Stewart Steffensmeier, Jennifer Van Tiem, Ashlie Obrecht, Joseph J. Cullen, Mark W. Vander Weg
Abstract
Objective: The current study aimed to pilot the PePS intervention, based on principles of cognitive behavioral therapy (CBT), to determine feasibility and preliminary efficacy for preventing chronic pain and long-term opioid use. Summary Background Data: Surgery can precipitate the development of both chronic pain and long-term opioid use. CBT can reduce distress and improve functioning among patients with chronic pain. Adapting CBT to target acute pain management in the postoperative period may impact longer-term postoperative outcomes. Methods: This was a mixed-methods randomized controlled trial in a mixed surgical sample with assignment to standard care or PePS, with primary outcomes at 3-months postsurgery. The sample consisted of rural-dwelling United States Military Veterans. Results: Logistic regression analyses found a significant effect of PePS on odds of moderate-severe pain (on average over the last week) at 3-months postsurgery, controlling for preoperative moderate-severe pain: Adjusted odds ratio = 0.25 (95% CI: 0.07–0.95, P < 0.05). At 3-months postsurgery, 15% (6/39) of standard care participants and 2% (1/45) of PePS participants used opioids in the prior seven days: Adjusted Odds ratio = 0.10 (95% CI: 0.01–1.29, P = .08). Changes in depression, anxiety, and pain catastrophizing were not significantly different between arms. Conclusions: The findings from this study support the feasibility and preliminary efficacy of the PePS intervention.