Katherine Hadlandsmyth1,2,3, Mandy Conrad1,4,5, Kenda Stewart Steffensmeier2, Jennifer Van Tiem2, Ashlie Obrecht1,4, Joseph J Cullen6, Mark W Vander Weg1,2,7. 1. Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, Iowa. 2. Center for Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa. 3. University of Iowa, Carver College of Medicine, Department of Anesthesia, Iowa City, Iowa. 4. University of Iowa, College of Education, Department of Psychological and Quantitative Foundations, Iowa City, Iowa. 5. Stanford University School of Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford, California. 6. University of Iowa, Carver College of Medicine, Department of Surgery, Iowa City, Iowa. 7. University of Iowa, College of Public Health, Department of Community and Behavioral Health, Iowa City, Iowa.
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.
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.
Authors: Shay N Nguyen; Afton L Hassett; Hsou-Mei Hu; Chad M Brummett; Mark C Bicket; Noelle E Carlozzi; Jennifer F Waljee Journal: Reg Anesth Pain Med Date: 2022-08-16 Impact factor: 5.564
Authors: Anne Lukas; Maurice Theunissen; Dianne de Korte-de Boer; Sander van Kuijk; Lotte Van Noyen; Walter Magerl; Werner Mess; Wolfgang Buhre; Madelon Peters Journal: Trials Date: 2022-07-25 Impact factor: 2.728