Brief preoperative mind-body therapies for total joint arthroplasty patients: a randomized controlled trial

Adam W Hanley, Jeremy Gililland, Jill Erickson, Christopher Pelt, Christopher Peters, Jamie Rojas, Eric L Garland, Adam W Hanley, Jeremy Gililland, Jill Erickson, Christopher Pelt, Christopher Peters, Jamie Rojas, Eric L Garland

Abstract

Although 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, 3-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 (cognitive-behavioral pain psychoeducation) 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. Total joint arthroplasty patients were randomized to preoperative MM, HS, or cognitive-behavioral pain psychoeducation (n = 285). Mindfulness meditation and HS led to significantly less preoperative pain intensity, pain unpleasantness, and anxiety. Mindfulness meditation also decreased preoperative pain medication desire relative to cognitive-behavioral pain psychoeducation and increased postoperative physical functioning at 6-week follow-up relative to HS and cognitive-behavioral pain psychoeducation. Moderation analysis revealed the surgery type did not differentially impact the 3 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.

Conflict of interest statement

Conflict of interest disclosure:

The other authors declare that they have no competing interests.

Copyright © 2021 International Association for the Study of Pain.

Figures

Figure 1.
Figure 1.
Bar graphs representing baseline adjusted pain intensity, pain unpleasantness, pain medication desire, and anxiety by condition. MM=Mindfulness Meditation. HS = Hypnotic Suggestion. CBE = Cognitive Behavioral Pain Psychoeducation.
Figure 2.
Figure 2.
Bar graph depicting baseline adjusted physical function by condition. MM=Mindfulness Meditation. HS = Hypnotic Suggestion. CBE = Cognitive Behavioral Pain Psychoeducation.

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