Preoperative cognitive-behavioural intervention improves in-hospital mobilisation and analgesic use for lumbar spinal fusion patients, 2020

[rvallee]

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

https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1078-8

Background
Catastrophic 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).

Methods
Ninety 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.

Results
No 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.

Conclusion
Participation 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.

Shows no improvement and yet they still conclude it did improve things by rating irrelevant things. EBM is intellectually bankrupt. It shows no improvement and still the title of the paper is that it shows improvement. This field is 99% marketing. It even includes a purely speculative opinion about what may be happening. WTH?

 

[shak8]

Hmm. A lot of spinal surgery is unnecessary with no improvement in pain scores. Of course, that is not what the study 'studies.'

 

[Mithriel]

After orthopaedic surgery, many patients are reluctant to take adequate pain relief. When it is explained to them that taking pain killers will help them to move which will speed up their recovery so they will end up needing less analgesia in the long run they usually take what is prescribed.

This is most likely the effect they are picking up. No need for fancy theories just an explanation to the patient by medical staff and simple biology.