Psychotherapy for surgical patients is effective for reducing persistent pain and physical impairment, while simply providing education has no effect, suggests a study led by McMaster University researchers.
Persistent post-surgical pain affects between 10 to 80 per cent of patients after common operations. In addition, surgical patients with psychological factors such as depression or anxiety are more likely to develop chronic pain.
The researchers found that cognitive behavioural therapy or relaxation therapy, on average, reduced ongoing pain and physical impairment by 10 per cent, but education had no effect.
They conducted an analysis of pre-existing trial data to better understand the impact of psychotherapy on post-operative outcomes when administered before or after surgery. Their results were published in the British Journal of Anaesthesia.
"This is the first review that explores perioperative psychotherapy for persistent post-surgical pain and function," said Jason Busse, senior author of the study and an associate professor of anesthesia at McMaster. He is also a researcher for the Michael G. DeGroote Institute for Pain Research and Care.
"Our results suggest that providing information and support alone for surgical patients is not sufficient and that more active psychotherapy is needed to improve long-term outcomes."
Researchers searched through five electronic databases up to Sept. 1, 2016. They found 15 trials with a total of 2,220 adult patients eligible for review. The trials enrolled patients undergoing orthopedic surgery, coronary artery bypass graft, or colonic and colorectal surgery.
Studies eligible for their review compared any perioperative psychological intervention against usual care, and explicitly reported data on persistent post-surgical pain or physical impairment from three to 12 months after surgery.
"Persistent post-surgical pain is associated with reduced quality of life, physical and psychological impairment, increased health care costs, and accounts for a substantial portion of chronic pain in general," said Busse. "Our meta-analysis suggests long-term benefits of perioperative psychological intervention for patients undergoing surgical procedures."
Researchers recommended that future studies should explore targeted psychotherapy for surgical patients at higher risk for poor outcomes.
Additional researchers on the study came from McMaster, University of Toronto, University of Ottawa, and St. Joseph's Healthcare Hamilton. The study required no external funding.
Read the study here.