While knee and hip replacements are intended to relieve pain and improve function, up to 44% of knee replacement patients and 27% of hip replacement patients report persistent postoperative joint pain. Improving surgical pain management is essential. We conducted a single-site, three-arm, parallel-group randomized clinical trial conducted at an orthopedic clinic, among patients undergoing total joint arthroplasty (TJA) of the hip or knee. Mindfulness meditation (MM), hypnotic suggestion (HS), and cognitive-behavioral pain psychoeducation (CBE) were each delivered in a single, 15-minute group session as part of a 2-hour, preoperative education program. Preoperative outcomes – pain intensity, pain unpleasantness, pain medication desire, and anxiety – were measured with numeric rating scales. Postoperative physical functioning at 6-week follow-up was assessed with the Patient-Reported Outcomes Measurement Information System Physical Function computer adaptive test. TJA patients were randomized to preoperative MM, HS, or CBE (n=285). MM and HS led to significantly less preoperative pain intensity, pain unpleasantness, and anxiety. MM also decreased preoperative pain medication desire relative to CBE and increased postoperative physical functioning at 6-week follow-up relative to HS and CBE. Moderation analysis revealed surgery type did not differentially impact the three interventions. Thus, a single session of a simple, scripted MM intervention may be able to immediately decrease TJA patients’ preoperative clinical symptomology and improve postoperative physical function. As such, embedding brief MM interventions in surgical care pathways has the potential to improve surgical outcomes for the millions of patients receiving TJA each year.

References

PubMed