Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
Department of Health, Medical, and Neuropsychology, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, the Netherlands.
Pain. 2022 Jul 1;163(7):1254-1273. doi: 10.1097/j.pain.0000000000002521. Epub 2021 Oct 26.
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.
许多患者在手术后会经历疼痛。情绪和认知等心理因素与急性和慢性术后疼痛（CPSP）的发展有关。因此，出现了这样一个问题，即针对这些心理因素是否可以减少负面的术后结果。本综述的目的是调查围手术期心理干预在减少成人（亚）急性术后疼痛和 CPSP 及残疾方面的疗效。通过 4 个数据库（Web of Science、PsychINFO、PubMed 和 Cumulative Index to Nursing and Allied Health Literature [CINAHL]）确定了随机对照试验。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。筛选后，21 项研究纳入最终分析。结果发现，心理干预显著减轻了（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，本综述指出需要进行更多的研究，以确定哪种特定类型的干预措施对手术患者最有益。最后，本综述确定，该领域的研究存在因撤回和退出而导致数据缺失的偏倚问题。
