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Can perioperative psychological interventions decrease the risk of postsurgical pain and disability? A systematic review and meta-analysis of randomized controlled trials
Pain ( IF 5.9 ) Pub Date : 2022-07-01 , DOI: 10.1097/j.pain.0000000000002521
Putu G Nadinda 1, 2 , Dimitri M L van Ryckeghem 1, 3, 4 , Madelon L Peters 1
Affiliation  

Many patients experience pain after surgery. Psychological factors such as emotion and cognition are shown to be associated with the development of acute and chronic postsurgical pain (CPSP). Therefore, the question arises whether targeting these psychological factors can reduce negative postsurgical outcomes. The aim of the current review was to investigate the efficacy of perioperative psychological interventions in reducing (sub)acute postsurgical pain and CPSP and disability in adults. Randomized controlled trials were identified through 4 databases (Web of Science, PsychINFO, PubMed, and Cumulative Index to Nursing and Allied Health Literature [CINAHL]). The outcomes of interest were (sub)acute (ie, within 3 months after surgery) and chronic (>3 months after surgery) pain and disability. After screening, 21 studies were included in the final analyses. It was found that psychological interventions significantly reduced (sub)acute pain (d = −0.26, 95% confidence interval [CI] [−0.48 to −0.04]) and disability (d = −0.43, 95% CI [−0.84 to −0.03]) as well as CPSP (d = −0.33, 95% CI [−0.61 to −0.06]) and disability (d = −0.43, 95% CI [−0.68 to −0.18]). In addition, interventions delivered after surgery and interventions delivered by a psychologist tended to be more effective than interventions delivered before surgery and interventions delivered by another healthcare provider. Furthermore, the current review points to the need for more research to determine which specific type of intervention may be most beneficial for surgical patients. Finally, the current review identified that research in this domain has concerns regarding bias in missing outcome data due to withdrawal and drop out.



中文翻译:

围手术期心理干预能否降低术后疼痛和残疾的风险?随机对照试验的系统回顾和荟萃分析

许多患者在手术后都会经历疼痛。研究表明情绪和认知等心理因素与急性和慢性术后疼痛(CPSP)的发生有关。因此,出现了针对这些心理因素是否可以减少术后负面结果的问题。本次综述的目的是调查围手术期心理干预在减少成人(亚)急性术后疼痛、CPSP 和残疾方面的功效。通过 4 个数据库(Web of Science、PsychINFO、PubMed 和护理和联合健康文献累积索引 [CINAHL])确定随机对照试验。感兴趣的结果是(亚)急性(即手术后 3 个月内)和慢性(手术后 > 3 个月)疼痛和残疾。经过筛选,21项研究纳入最终分析。研究发现,心理干预可显着减少(亚)急性疼痛(d = -0.26,95% 置信区间 [CI] [-0.48 至 -0.04])和残疾(d = -0.43,95% CI [-0.84 至 - 0.03])以及 CPSP(d = -0.33,95% CI [-0.61 至 -0.06])和残疾(d = -0.43,95% CI [-0.68 至 -0.18])。此外,手术后提供的干预措施和心理学家提供的干预措施往往比手术前提供的干预措施和其他医疗保健提供者提供的干预措施更有效。此外,当前的审查指出需要进行更多研究,以确定哪种特定类型的干预措施可能对手术患者最有益。最后,当前的审查发现,该领域的研究对由于退出和退出而导致的结果数据缺失的偏差存在担忧。

更新日期:2022-06-23
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