The Perceived Effectiveness of Brief Psychological Techniques for Acute Postoperative Pain

Abstract

Postoperative pain is still a challenge and patients are still suffering from postoperative pain, despite the administration of multiple analgesic methods for treating pain. In a systematic review and meta-analysis I found that brief psychological interventions such as relaxation techniques including simple breathing exercises or guided imagery, and simple distraction techniques such as listening to music, or practicing a script of self-hypnosis may help those patients to cope better with their pain. Although quality of these studies was not always of the highest level, the findings synthesized from 30 randomised controlled trials indicated that brief psychological interventions did reduce postoperative pain and anxiety 24 hours after surgery, and it was therefore surprising that these simple psychological interventions were not more widely adopted in clinical practice. I explored the perspectives of patients undergoing surgery, and healthcare practitioners involved in postoperative care. Interview data revealed a number of factors which may motivate patients and practitioners to adopt these interventions, as well as barriers to their wider use. Interviews conducted in both the UK and Saudi Arabia facilitated cross-cultural comparisons of patients’ and HCPs’ attitudes towards these brief psychological interventions. Most respondents expressed favourable opinions towards BPI: These opinions were often linked to concerns relating to painkillers, including side effects, tolerance, or dependence. Many patients reported spontaneous practice of non-drug interventions spontaneously to cope with their pain. However, interviews with patients revealed numerous barriers to the delivery of BPI in mainstream clinical practice: Lack of knowledge and expertise among HCPs, stigma associated with psychological treatments, and low self-efficacy. HCPs’ were likewise positive towards the use of BPI in principle, but highlighted a perceived lack of the scientific evidence and lack of time and resources as the primary barrier to wider adoption. These findings form an important foundation for the design, evaluation and dissemination of future BPI’s for postoperative pain relief. Better understanding of perceived barriers to use will inform the structure and presentation of future BPI packages, and may motivate additional evaluation studies, using structured, well-documented interventions that are designed for ease of dissemination. Initial work in the final chapter suggests that new BPI packages, designed with these barriers in mind, may be successful in overcoming patient objections and prove more practical than previous intervention packages in real-world use.