Can perioperative psychological interventions decrease the risk of post-surgical pain and disability? A systematic review and meta-analysis of randomized controlled trials.

ABSTRACT 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 post-surgical pain. Therefore, the question arises whether targeting these psychological factors can reduce negative post-surgical outcomes. The aim of the current review is to investigate the efficacy of perioperative psychological interventions in reducing (sub)acute and chronic post-surgical pain and disability in adults. Randomized controlled trials were identified through four databases (Web of Science, PsycINFO, PubMed, and CINAHL). The outcomes of interest were (sub)acute (i.e., 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% CI [-0.48 to -0.04]), and disability (d = -0.43, 95% CI [-0.84 to -0.03]), as well as chronic post-surgical pain (d = -0.33, 95% CI [-0.61 to -0.06]), and disability (d = -0.43, 95% CI [-0.68 to -0.18]). Additionally, 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 outcomes data due to withdrawal and drop out.