Preoperative cognitive-behavioural intervention improves in-hospital mobilisation and analgesic use for lumbar spinal fusion patients

Abstract

BackgroundCatastrophic thinking and fear-avoidance belief are negatively influencing severe acute pain following surgery causing delayed ambulation and discharge. We aimed to examine if a preoperative intervention of cognitive-behavioural therapy (CBT) could influence the early postsurgical outcome following lumbar spinal fusion surgery (LSF).MethodsNinety patients undergoing LSF due to degenerative spinal disorders were randomly allocated to either the CBT group or the control group. Both groups received surgery and postoperative rehabilitation. In addition, the CBT group received a preoperative intervention focussed on pain coping using a CBT approach. Primary outcome was back pain during the first week (0–10 scale). Secondary outcomes were mobility, analgesic consumption, and length of hospitalisation. Data were retrieved using self-report questionnaires, assessments made by physical therapists and from medical records.ResultsNo difference between the groups’ self-reported back pain (p = 0.76) was detected. Independent mobility was reached by a significantly larger number of patients in the CBT group than the control group during the first three postoperative days. Analgesic consumption tended to be lower in the CBT group, whereas length of hospitalisation was unaffected by the CBT intervention.ConclusionParticipation in a preoperative CBT intervention appeared to facilitate mobility in the acute postoperative phase, despite equally high levels of self-reported acute postsurgical pain in the two groups, and a slightly lower intake of rescue analgesics in the CBT group. This may reflect an overall improved ability to cope with pain following participation in the preoperative CBT intervention.Trial registrationThe study was approved by the Danish Protection Agency (2011-41-5899) and the Ethics Committee of the Central Denmark Region (M-20110047). The trial was registered in Current Controlled Trials (ISRCTN42281022).

A web-based platform to accommodate symptoms of anxiety and depression by featuring social interaction and animated information in patients undergoing lumbar spine fusion: a randomized clinical trial

“…Web-based informative strategies before surgery and principles from cognitive behavioral therapy (CBT) have been applied in this patient group in recent years [14,15]. A rationale is found in using information and elements from CBT in order to reduce pre-and postoperatively symptoms of anxiety [16] and depression [6,17].…”

A Virtual Reality based intervention for surgical patients: study protocol of a randomized controlled trial

“…Similarly, a subsequent analysis conducted on 300 post-surgical patients (4) relived that up to 85% of people experienced acute postoperative pain, respectively pain severity was rated as moderate, severe or extreme in 75% of those cases. Besides, acute postoperative pain was associated with prolonged hospitalization (5), alveolar ventilation, tachycardia, insomnia, awed wound healing (6), as well as with an increased risk of chronic post-surgery pain (CPSP) (7). Described as the pain which persists beyond the expected recovery time after a surgical procedure (8), CPSP is reported in 10% to 70% of cases depending on the type of surgery (7,9,10), and several biological and psychological factors (11,12).…”

“…Current clinical guidelines for postoperative pain management recommend evidence-based treatments including pharmacological and psychological components (5). The large majority of non-pharmacological components for postoperative care are interventions based on Cognitive Behavioral Therapy (CBT) which had proved their e cacy in decreasing pain and distress in different surgical settings, such as lumbar spinal fusion (6,7), abdominal surgery (8), cardiac surgery (9) or orthopedic surgeries (10). These results were complemented with the ndings of a recent meta-analysis (11) estimating the effectiveness of psychological interventions on postoperative pain management after orthopedic surgery, with medium effect sizes for decreasing pain intensity (Hedges'g=0.31, 95% con dence interval (CI) 0.14 to 0.48) as for improving recovery (Hedges'g=0.38, 95% CI 0.22 to 0.54).…”

Patient-Reported Outcome Measures in Perspective

“…Participation in preoperative cognitive behavioral therapy did not significantly reduce self-reported back pain, but patient mobility was improved following the intervention. 6 Furthermore, cognitive behavioral therapy significantly reduced analgesic consumption by the second postoperative day. In this trial, cognitive behavioral therapy may have encouraged beneficial pain-coping behavior by altering patients' perception, thereby reducing the adverse effects of pain.…”

“…In a recent study, patients were randomized to either cognitive behavioral therapy or standard presurgical information prior to lumbar spinal fusion. 6 Cognitive behavioral therapy was offered in an effort to improve mobility and reduce analgesic use in the first week following surgery. Participation in preoperative cognitive behavioral therapy did not significantly reduce self-reported back pain, but patient mobility was improved following the intervention.…”