The effects of a psycho‐educational intervention to improve pain management after day surgery: A randomised clinical trial

Abstract

Aims and objectives To evaluate the effectiveness of a psycho‐educational intervention for shoulder and breast day surgery patients in decreasing pain intensity and pain interference with function and strengthening adherence with the analgesic regimen; and further to identify factors that influence average pain intensity and pain interference with function. Background Pain is one of the most prevalent symptoms after day surgery. However, pain management is left to the patients and family, and interventions to help patients are needed. Design Randomised clinical trial with an intervention (n = 101) and a usual care group (n = 119) using multiple measurements during 6 months postoperatively. The CONSORT checklist is used. Methods Patients in the intervention group received a booklet about pain and pain management and coaching by research nurses on postoperative days 2, 3 and 7. Differences between groups were identified using the chi‐squared analysis and t tests. Changes with time were identified using a linear mixed model with repeated measures. Results After controlling for covariates, group differences at any time in average pain intensity and pain interference with function were not statistically significant. Changes over time within any one group in average pain intensity and pain interference with function were statistically significant and decreased with time. Higher levels of average pain intensity and pain interference over time were associated with shoulder surgery, female, younger, pain expectation, preoperative pain and poorer adherence. Conclusions No group differences related to the intervention were revealed, and preoperative teaching together with a pain management booklet and coaching may help to strengthen the intervention's effects. Further research on interventions directed towards pain management is needed. Relevance to clinical practice Day surgery patients’ postoperative pain and pain management is not satisfactorily handled. To encourage and educate patients to use the prescribed analgesics in the immediate postoperative days may be necessary to enhance pain management. Clinical trial registration ClinicalTrials.gov (NCT01595035).

Postdischarge pain, nausea and patient satisfaction after diagnostic and breast‐conserving ambulatory surgery for breast cancer: A cross‐sectional study

“…In contrast, Susini et al 6 recently reported 40.6% postdischarge pain of NRS 4 or higher after ambulatory BC surgical procedures comparable to ours, but with a less extensive pain prophylaxis. In our study, younger patients had significantly 2–5 times higher odds for postdischarge pain than older patients, which is similar to prior studies 20,22–25 …”

“…In our study, younger patients had significantly 2-5 times higher odds for postdischarge pain than older patients, which is similar to prior studies. 20,[22][23][24][25] We found no association between pain and surgical procedure, which is in contrast to the study by Rehberg et al 24 Our result may be related to the overall low surgical invasiveness in our day-surgical study population. At OUH, all patients with planned mastectomy are offered an immediate reconstructive procedure, unless contraindicated, and subsequently transferred to inpatient care.…”

“…This is a problem also reported by Fahmy et al, 32 who experienced that 33% rated the efficacy of discharge analgesics as inadequate. Non‐adherence to analgesics instructions is another common problem 23,33,34 that may lead to unnecessary pain. In our study, 5.3% were non‐adherent and still had pain, that is, prophylactic analgesics were not used as prescribed, or they had not taken the opioids they had received as rescue medication.…”

“…In our study, 5.3% were non‐adherent and still had pain, that is, prophylactic analgesics were not used as prescribed, or they had not taken the opioids they had received as rescue medication. Recently, Valeberg et al 23 reported 37% non‐adherence to instructions on analgesic use, even though an intervention with extensive information and follow‐up was applied. A frequent cause for the non‐adherence in that study was that patients rather endured pain than risking the common known side‐effects of the opioids 23 …”

“…Recently, Valeberg et al 23 reported 37% non‐adherence to instructions on analgesic use, even though an intervention with extensive information and follow‐up was applied. A frequent cause for the non‐adherence in that study was that patients rather endured pain than risking the common known side‐effects of the opioids 23 …”