Effects of psychological interventions on anxiety and pain in patients undergoing major elective abdominal surgery: a systematic review

Gianluca Villa, Iacopo Lanini, Timothy Amass, Vittorio Bocciero, Caterina Scirè Calabrisotto, Cosimo Chelazzi, Stefano Romagnoli, A Raffaele De Gaudio, Rosapia Lauro Grotto, Gianluca Villa, Iacopo Lanini, Timothy Amass, Vittorio Bocciero, Caterina Scirè Calabrisotto, Cosimo Chelazzi, Stefano Romagnoli, A Raffaele De Gaudio, Rosapia Lauro Grotto

Abstract

A maladaptive response to surgical stress might lead to postoperative complications. A multidisciplinary approach aimed at controlling the surgical stress response may reduce procedural complications and improve patients' quality of life in the short and long term. Several studies suggest that psychological interventions may interact with the pathophysiology of surgical stress response, potentially influencing wound repair, innate and adaptive immunity, inflammation, perception of pain, and patients' mood. The aim of this systematic review is to summarise the effects of perioperative psychological interventions on surgical pain and/or anxiety in adult patients scheduled for elective general abdominal and/or urologic surgery.We conducted a systematic review of controlled clinical trials and observational studies involving psychological interventions for adult patients scheduled for elective general abdominal and/or urologic surgery. Only studies reporting pain and/or anxiety among outcome measures were included in the systematic review. The following psychological interventions were considered: (1) relaxation techniques, (2) cognitive-behavioural therapies, (3) mindfulness, (4) narrative medicine, (5) hypnosis and (6) coping strategies.We examined 2174 papers. Among these, 9 studies were considered eligible for inclusion in this systematic review (1126 patients cumulatively): 8 are randomised controlled trials and 1 is an observational prospective pre/post study.Psychological characteristics widely influence the pathophysiological mechanisms underlying the neuroendocrine and inflammatory response to surgical stress, potentially interfering with surgical outcomes. Psychological interventions are technically feasible and realistically applicable perioperatively during abdominal and/or urologic surgery; they influence the pathophysiological mechanisms underlying maladaptive surgical stress response and might have positive effects on patients' surgical outcomes, such as pain and anxiety.

Keywords: Cognitive behaviour therapy; Hypnosis; Metabolic stress response; Mindfulness; Narrative medicine; Perioperative care.

Conflict of interest statement

The authors declare the following conflicts of interest. Dr Villa has received support for travel expenses, hotel accommodations, and registration to meetings from Baxter S.p.A. and Pall International. Dr Chelazzi has received honoraria for lectures by Orion Pharma; support for meetings (travels, hotel accommodations and/or registration) by BBraun, Astellas, MSD, Pfizer, Pall International, Baxter, and Orion Pharma. Prof. Romagnoli has received honoraria for lectures, grants for consultancy, and support for travel expenses, hotel accommodations, and registration to meetings from Baxter, Orion Pharma, Vygon, ICU Medical, MSD, Medtronic, Baxter, BBraun, and Pall International. Prof. De Gaudio has received research grants from MSD Italia, Baxter, and Pall international.

Figures

Fig 1.
Fig 1.
Flow chart of the screening process used to identify eligible studies. Exclusion criteria are not mutually exclusive and identified studies can fall into more than one category

References

    1. Arpino L, Iavarone A, Parlato C, Moraci A. Prognostic role of depression after lumbar disc surgery. Neurol. Sci. 2004;3:145–147.
    1. Broadbent E, Kahokehr A, Booth RJ, Thomas J, Windsor JA, Buchanan CM, et al. A brief relaxation intervention reduces stress and improves surgical wound healing response: A randomised trial. Brain Behav Immun. 2012;26(2):212–217. doi: 10.1016/j.bbi.2011.06.014.
    1. Broadbent E, Petrie K, Alley P, Booth R. Psychological Stress Impairs Early Wound Repair Following Surgery. Psychosom. Med. 2003;65(5):865–869.
    1. Ellis HB, Howard KJ, Khaleel MA, Bucholz R. Effect of psychopathology on patient-perceived outcomes of total knee arthroplasty within an indigent population. J Bone Joint Surg Am. 2012;94(12):e84.
    1. Glaser R, Kiecolt-Glaser JK, Marucha PT, MacCallum RC, Laskowski BF, Malarkey WB. Stress-related changes in proinflammatory cytokine production in wounds. Arch Gen Psychiatry. 1999;56(5):450–456.
    1. Good M, Albert JM, Anderson GC, Wotman S, Cong X, Lane D, et al. Supplementing relaxation and music for pain after surgery. Nurs Res. 2010;59(4):259–269.
    1. Granot M, Ferber SG. The roles of pain catastrophizing and anxiety in the prediction of postoperative pain intensity: A prospective study. Clin J Pain. 2005;21(5):439–445.
    1. Hansen MM. A feasibility pilot study on the use of complementary therapies delivered via mobile technologies on Icelandic surgical patients’ reports of anxiety, pain, and self-efficacy in healing. BMC Complement Altern Med. 2015;15(1):1–12.
    1. Hızlı F, Özcan O, Selvi İ, Eraslan P, Köşüş A, Baş O, et al. The effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety. Int Urol Nephrol. 2015;47(11):1773–1777.
    1. Jindal V, Gupta S, Das R. Molecular Mechanisms of Meditation. Mol Neurobiol. 2013;48(3):808–811.
    1. Johnston M, Vögele C. Benefits of psychological preparation for surgery: A meta-analysis. Ann Publ Soc Behav Med. 1993;15(4):245–256.
    1. Kaplan KH, Goldenberg DL, Galvin-Nadeau M. The impact of a meditation-based stress reduction program on fibromyalgia. Gen Hosp Psychiatry. 1993;15:284–289.
    1. Kehlet H, Ph D. Manipulation of the Metabolic Response in Clinical Practice. World J Surg. 2000;24:690–695.
    1. LaMontagne LL, Hepworth JT, Cohen F, Salisbury MH. Cognitive-behavioral intervention effects on adolescents’ anxiety and pain following spinal fusion surgery. Nurs Res. 2003;52:183–190.
    1. Lin LY, Wang RH. Abdominal surgery, pain and anxiety: Preoperative nursing intervention. J Adv Nurs. 2005;51(3):252–260.
    1. Maduka IC, Neboh EE, Ufelle SA. The relationship between serum cortisol , adrenaline , blood glucose and lipid profile of undergraduate students under examination stress. Afr Heal Sci. 2015;15(1):1–4.
    1. Manyande A, Berg S, Gettins D, Stanford SC, Mazhero S, Marks DF, et al. Preoperative rehearsal of active coping imagery influences subjective and hormonal responses to abdominal surgery. Psychosom Med. 1995;57(2):177–182.
    1. Mavros MN, Athanasiou S, Gkegkes ID, Polyzos KA, Peppas G, Falagas ME. Do psychological variables affect early surgical recovery? PLoS One. 2011;6(5):e20306.
    1. Michie S, Johnston M, Francis JJ, Hardeman W, Eccles M. From theory to intervention: Mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol An Int Rev. 2008;57:660–680.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
    1. Munafò MR, Stevenson J. Anxiety and surgical recovery: Reinterpreting the literature. J. Psychosom Res. 2001;51(4):589–596.
    1. Nelson EA, Dowsey MM, Knowles SR, Castle DJ, Salzberg MR, Monshat K, et al. Systematic review of the efficacy of pre-surgical mind-body based therapies on post-operative outcome measures. Complement Ther Med. 2013;21(6):697–711. doi: 10.1016/j.ctim.2013.08.020.
    1. Powell R, Scott N, Manyande A, Bruce J, Vögele C, Byrne-Davis L, et al. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev. 2016;26(5):CD008646. PMID: 27228096.
    1. Rainville P, Bao QVH, Chrétien P. Pain-related emotions modulate experimental pain perception and autonomic responses. Pain. 2005;118(3):306–318.
    1. Rejeh N, Heravi-Karimooi M, Vaismoradi M, Jasper M. Effect of systematic relaxation techniques on anxiety and pain in older patients undergoing abdominal surgery. Int J Nurs Pract. 2013;19(5):462–470.
    1. Richards SH, Anderson L, Jenkinson CE, Whalley B, Rees K, Davies P, et al. Psychological interventions for coronary heart disease. Cochrane database Syst Rev. 2017;4(4):CD002902.
    1. Rolving N, Oestergaard LG, Willert MV, Christensen FB, Blumensaat F, Bünger C, et al. Description and design considerations of a randomized clinical trial investigating the effect of a multidisciplinary cognitive-behavioural intervention for patients undergoing lumbar spinal fusion surgery. BMC Musculoskelet Disord. 2014;15:62.
    1. Rosenberger P, Jokl P, Ickovics J. Psychosocial factors and surgical outcomes: An evidence-based literature review. J Am Acad Orthop Surg. 2006;14(7):397–405.
    1. Roykulcharoen V, Good M, Bolton FP. Sytematic relaxation to relieve postoperative pain. J Adv Nurs. 2004;48(2):140–148.
    1. Sockalingam S, Leung SE, Hawa R, Wnuk S, Parikh SV, Jackson T, et al. Telephone-based cognitive behavioural therapy for female patients 1-year post-bariatric surgery: A pilot study. Obes Res Clin Pract. 2019;13(5):499–504. doi: 10.1016/j.orcp.2019.07.003.
    1. Szeverenyi C, Kekecs Z, Johnson A, Elkins G, Csernatony Z, Varga K. The Use of Adjunct Psychosocial Interventions Can Decrease Postoperative Pain and Improve the Quality of Clinical Care in Orthopedic Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Pain United States. 2018;19(11):1231–1252.
    1. Theunissen M, Peters ML, Bruce J, Gramke H-F, Marcus MA. Preoperative anxiety and catastrophizing: a systematic review and meta-analysis of the association with chronic postsurgical pain. Clin J Pain. 2012;28(9):819–841.
    1. Visioni A, Shah R, Gabriel E, Attwood K, Kukar M, Nurkin S. Enhanced Recovery After Surgery for Noncolorectal Surgery?: A Systematic Review and Meta-analysis of Major Abdominal Surgery. Ann Surg United States. 2018;267(1):57–65.
    1. Walburn J, Vedhara K, Hankins M. Psychological stress and wound healing in humans: a systematic review and meta-analysis. J Psychosom Res. 2009;67(3):253–271.
    1. Walton KG, Pugh ND, Gelderloos P, Macrae P. Stress reduction and preventing hypertension: preliminary support for a psychoneuroendocrine mechanism. J Altern Complement Med. 1995;1(3):263–283.
    1. Wolsko PM, Eisenberg DM, Davis RB, Phillips RS. Use of mind-body medical therapies. J Gen Intern Med. 2004;19(1):43–50.
    1. Zhang XD, Zhao QY, Fang Y, Chen GX, Zhang HF, Zhang WX, et al. Perioperative comprehensive supportive care interventions for Chinese patients with esophageal carcinoma: A prospective study. Asian Pacific J Cancer Prev. 2013;14(12):7359–7366.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться