Enhancing the Biopsychosocial Approach to Perioperative Care: A Pilot Randomized Trial..., 2020, Hadlandsmyth et al

[Andy]

Full title: Enhancing the Biopsychosocial Approach to Perioperative Care: A Pilot Randomized Trial of the Perioperative Pain Self-Management (PePS) Intervention

Objective:
The current study aimed to pilot the Perioperative Pain Self-management (PePS) intervention, based on principles of 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. Cognitive behavioral therapy (CBT) can reduce distress and improve functioning among patients with chronic pain. Adapting CBT to target acute pain management in the post-operative period may impact longer-term post-operative outcomes.

Methods:
This was a mixed-methods randomized controlled trial in a mixed surgical sample with assignment to standard care (SC) or PePS, with primary outcomes at 3-months post-surgery. 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 post-surgery, controlling for pre-operative moderate-severe pain: Adjusted odds ratio = 0.25 (95% CI: 0.07 - 0.95, p < .05). At 3-months post-surgery, 15% (6/39) of SC 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.

Paywall, https://journals.lww.com/annalsofsu...ng_the_Biopsychosocial_Approach_to.93858.aspx
Sci hub, no access

 

[Mithriel]

I may have missed research debunking the theory, but using nerve blockers and machines that people could use to self administer opiods were meant to prevent the pain gates in the nerves opening so that there was less long term pain. Letting patients decide how much pain relief they need can lead to less usage rather than a doctor having to guess.

For orthopaedic surgery, adequate pain relief means the patient can move more easily which helps with healing and less long term painkillers.

I am dubious about surgery (as opposed to botched operations) leading to long term opiod abuse and even then it is more likely to be a response to real pain than anything else. The answer is to be more careful about surgery not BPS claws into something else.

 

[rvallee]

Well, now we know that if you discourage people suffering in pain from using painkillers, they will use less painkillers. It's great because we didn't know that before, that if you manipulate people from a position of authority, some won't even question how absurd the premise of your manipulation is. This is groundbreaking stuff. Right there with "if you don't feed your kids, they will eat less and thus save you money and if you scold them hard enough they will even stop complaining about the hunger".

Before analgesics were invented, people sucked it up. Doesn't mean it "worked", it just means they endured the pain with no relief. Humans can endure a lot of pain, survive a ridiculous amount of suffering. They suffer the whole time, though. But they can successfully raise their thumbs up no matter how much they are in pain. Just focus on the thumbs.

Will they be next testing the value of giving someone a bit of leather to chew on instead of anesthesia? It used to "work", after all, as long as you don't define work as anything relevant to alleviating suffering.

The odd thing about this is that in a time of war, this would be a war crime. In a time of peace, though, it's feelings-based medicine and all well and good. Somehow.