Can a brief psychological expectancy intervention improve postoperative pain? A randomized, controlled trial in patients with breast cancer

Abstract

Pain after surgery remains a major health problem, calling for optimized treatment regimens to maximize the efficacy of pharmacological interventions. In this randomized controlled trial, we tested in a routine surgical treatment setting whether postoperative pain can be reduced by a brief preoperative intervention, ie, positive verbal suggestions in combination with sham acupuncture, designed to optimize treatment expectations. We hypothesized that the expectancy intervention as add-on to patient-controlled intravenous analgesia with morphine reduces patient-reported postoperative pain and improves satisfaction with analgesia. Ninety-six women undergoing breast cancer surgery were randomized at 2 stages: Before surgery, anesthesiologists delivered either positive or neutral verbal suggestions regarding the benefits of acupuncture needling on postoperative pain (“information condition”). Patients were then randomized to receive sham acupuncture or no sham acupuncture during postoperative care (“sham acupuncture condition”). Average pain during the 24-hour observation period after surgery as primary and satisfaction with analgesia as secondary outcome was assessed with standardized measures and analyzed with analysis of covariance accounting for morphine dose, surgery-related, and psychological parameters. Postoperative pain ratings were significantly reduced in patients who received positive treatment-related suggestions (F = 4.45, P = 0.038, main effect of information). Moreover, patients who received an intervention aimed at optimized treatment expectations reported significantly greater satisfaction with analgesia (F = 4.89, P = 0.030, interaction effect). Together, our proof-of-concept data support that optimizing treatment expectations through verbal suggestions may offer a promising approach to improve patient-reported outcomes. Future translational and clinical studies are needed to test such psychological strategies in different surgical interventions, patient groups, and pharmacological treatment regimens.

Behandlungserwartungen bei postoperativen Schmerzen

“…Benson et al. [ 3 ] konnten bei Patientinnen, die einer brusterhaltenden Operation unterzogen wurden, ergänzend zur Opioidanalgesie mithilfe einer kurzen psychologischen Erwartungsintervention postoperative Schmerzen reduzieren. Sie verglichen den Einfluss positiver Suggestionen mit neutralen Suggestionen und untersuchten zusätzlich den Einfluss von Sham-Akupunktur.…”

The Influence of Preoperative Mood and Treatment Expectations on Early Postsurgical Acute Pain After a Total Knee Replacement

“…Our findings suggest that emotional states predict treatment expectations and, therefore, play a critical role in the treatment outcome for postoperative pain. According to the literature concerning placebo mechanisms, positive treatment expectations are crucial to enhance surgical treatment outcomes ( 44 , 45 ). However, underlying mechanisms have to be uncovered to be able to influence treatment expectations.…”

Complementary interventions to reduce postoperative pain

“…Pain was significantly lower in the patients receiving positive suggestions, regardless of whether they also received sham acupuncture. The researchers concluded that these results suggest a benefit of psychological strategies targeting positive expectations for improving pain, although they likely are most effective when used in combination with other established elements of physician‐patient communication (e.g., enhanced empathy, trust, caring attitude) 9 …”