Non-Pharmacological Methods and Post-Operative Pain Relief: An Observational Study

Marcus Komann, Claudia Weinmann, Matthias Schwenkglenks, Winfried Meissner, Marcus Komann, Claudia Weinmann, Matthias Schwenkglenks, Winfried Meissner

Abstract

Background: Non-pharmacological methods (NPMs) like cold packs, acupuncture, meditation or distractions are supposed to ease acute post-surgical pain.

Objectives: This study assessed how frequently these methods are used in clinical routine and if their use is associated with pain relief or with the wish for more pain treatment.

Methods: Data from the world's largest acute post-operative pain registry, PAIN OUT, was used for this study. In PAIN OUT, patients report their pain levels and side effects related to pain therapy after surgery. Overall, 15 different NPMs were tested for their association with pain relief and the wish for more pain treatment using Mann-Whitney U test, Kruskal-Wallis test, General Linear Model, and Logistic Regression. The researchers adjusted for age and gender, and specifically looked at the three most frequent surgeries: total knee replacement, total hip replacement, and laparoscopic cholecystectomy.

Results: Data of 14 767 patients from 12 European hospitals were analyzed. Overall, 6563 (44.4%) patients used at least one NPM; with distraction and cold packs being the most frequently used. The 8204 (55.6%) patients, who did not use NPMs had little yet significantly more pain relief than patients, who used them (means of 71.2% ± 27.9% versus 68.6% ± 25.7%, P < 0.001). Using NPMs does not affect the wish for more pain treatment. This is true for every single NPM. The only exceptional sub-group included total knee replacement patients, where a positive effect of NPMs was observed.

Conclusions: Some NPMs are widely used while others are rarely applied. Their association with pain relief is doubtful. These findings add to a rather contradictory literature. Advantages and disadvantages of applying NPMs solely for pain relief should thus be considered carefully.

Keywords: Non-Pharmacological Methods; Pain Relief; Patient-Reported Outcome Measures; Postoperative Pain; Wish for More Pain Treatment.

Figures

Figure 1.. Questions for pain relief and…
Figure 1.. Questions for pain relief and wish for more pain treatment answered by the patient
Figure 2.. Question for NPM methods answered…
Figure 2.. Question for NPM methods answered by the patient
Figure 3.. Included and excluded patient numbers
Figure 3.. Included and excluded patient numbers
Figure 4.. Boxplot of pain relief for…
Figure 4.. Boxplot of pain relief for NPM use (no/yes)
Figure 5.. Percentage of patients, who wished…
Figure 5.. Percentage of patients, who wished for more pain treatment for NPM use (no/yes)

References

    1. Madsen MV, Gotzsche PC, Hrobjartsson A. Acupuncture treatment for pain: Systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ. 2009;338:a3115. doi: 10.1136/bmj.a3115.
    1. Lee MS, Ernst E. Acupuncture for surgical conditions: An overview of systematic reviews. Int J Clin Pract. 2014;68(6):783–9. doi: 10.1111/ijcp.12372.
    1. Johnson MI, Paley CA, Howe TE, Sluka KA. Transcutaneous electrical nerve stimulation for acute pain. Cochrane Database Syst Rev. 2015;(6):CD006142. doi: 10.1002/14651858.CD006142.pub3.
    1. Koc M, Tez M, Yoldas O, Dizen H, Gocmen E. Cooling for the reduction of postoperative pain: Prospective randomized study. Hernia. 2006;10(2):184–6. doi: 10.1007/s10029-005-0062-2.
    1. Finan MA, Roberts WS, Hoffman MS, Fiorica JV, Cavanagh D, Dudney BJ. The effects of cold therapy on postoperative pain in gynecologic patients: A prospective, randomized study. Am J Obstet Gynecol. 1993;168(2):542–4. doi: 10.1016/0002-9378(93)90489-6.
    1. Smith J, Stevens J, Taylor M, Tibbey J. A randomized, controlled trial comparing compression bandaging and cold therapy in postoperative total knee replacement surgery. Orthop Nurs. 2002;21(2):61–6. doi: 10.1097/00006416-200203000-00009.
    1. Gibbons CE, Solan MC, Ricketts DM, Patterson M. Cryotherapy compared with Robert Jones bandage after total knee replacement: A prospective randomized trial. Int Orthop. 2001;25(4):250–2. doi: 10.1007/s002640100227.
    1. Jegindo EM, Vase L, Skewes JC, Terkelsen AJ, Hansen J, Geertz AW, et al. Expectations contribute to reduced pain levels during prayer in highly religious participants. J Behav Med. 2013;36(4):413–26. doi: 10.1007/s10865-012-9438-9.
    1. Thomas KM, Sethares KA. Is guided imagery effective in reducing pain and anxiety in the postoperative total joint arthroplasty patient? Orthop Nurs. 2010;29(6):393–9. doi: 10.1097/NOR.0b013e3181f837f0.
    1. Zeidan F, Martucci KT, Kraft RA, Gordon NS, McHaffie JG, Coghill RC. Brain mechanisms supporting the modulation of pain by mindfulness meditation. J Neurosci. 2011;31(14):5540–8. doi: 10.1523/JNEUROSCI.5791-10.2011.
    1. Buhle JT, Stevens BL, Friedman JJ, Wager TD. Distraction and placebo: Two separate routes to pain control. Psychol Sci. 2012;23(3):246–53. doi: 10.1177/0956797611427919.
    1. Hole J, Hirsch M, Ball E, Meads C. Music as an aid for postoperative recovery in adults: A systematic review and meta-analysis. Lancet. 2015;386(10004):1659–71. doi: 10.1016/S0140-6736(15)60169-6.
    1. van der Wal-Huisman H, Dons KSK, Smilde R, Heineman E, van Leeuwen BL. The effect of music on postoperative recovery in older patients: A systematic review. J Geriatr Oncol. 2018;9(6):550–9. doi: 10.1016/j.jgo.2018.03.010.
    1. Zaslansky R, Chapman CR, Rothaug J, Backstrom R, Brill S, Davidson E, et al. Feasibility of international data collection and feedback on post-operative pain data: Proof of concept. Eur J Pain. 2012;16(3):430–8. doi: 10.1002/j.1532-2149.2011.00024.x.
    1. Rothaug J, Zaslansky R, Schwenkglenks M, Komann M, Allvin R, Backstrom R, et al. Patients' perception of postoperative pain management: Validation of the International Pain Outcomes (IPO) questionnaire. J Pain. 2013;14(11):1361–70. doi: 10.1016/j.jpain.2013.05.016.
    1. Gordon DB, Polomano RC, Pellino TA, Turk DC, McCracken LM, Sherwood G, et al. Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) for quality improvement of pain management in hospitalized adults: Preliminary psychometric evaluation. J Pain. 2010;11(11):1172–86. doi: 10.1016/j.jpain.2010.02.012.
    1. Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: A prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118(4):934–44. doi: 10.1097/ALN.0b013e31828866b3.

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