"My Surgical Success": Feasibility and Impact of a Single-Session Digital Behavioral Pain Medicine Intervention on Pain Intensity, Pain Catastrophizing, and Time to Opioid Cessation After Orthopedic Trauma Surgery-A Randomized Trial.
"My Surgical Success": Feasibility and Impact of a Single-Session Digital Behavioral Pain Medicine Intervention on Pain Intensity, Pain Catastrophizing, and Time to Opioid Cessation After Orthopedic Trauma Surgery-A Randomized Trial.
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DOI：
10.1213/ane.0000000000006088
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发表时间：
2022-08-01
影响因子：
5.7
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中科院分区：
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行为疼痛治疗可以改善术后镇痛和恢复;然而，有效和可扩展的选择并不广泛。本研究测试了骨科创伤手术患者的数字围手术期行为医学干预的可行性和有效性，以减少疼痛强度，疼痛灾难化和术后3个月的阿片类药物停用。在一家大型学术医院的骨科创伤外科进行了一项随机对照临床试验，以比较数字行为疼痛管理干预（“我的手术成功”[MSS]）与数字一般健康教育（HE）干预（HE;无疼痛管理技能）。入组样本包括133例患者; 84例患者接受随机化（MSS，n = 37; HE，n = 47）并完成研究程序。大多数患者在手术后3天内接受了指定的干预（85%）。样本主要是男性（61.5%）、白色（61.9%）和伴侣（65.5%），至少有学士学位（69.0%）。通过自我报告电子调查和电子病历审查，在干预后1-3个月收集结果;应用意向治疗分析框架。可行性由参与分配治疗的患者比例和患者报告可接受性的80%阈值双重确定。我们假设，与数字HE对照组相比，MSS将导致手术后疼痛强度和疼痛灾难性的更大程度降低以及更早的阿片类药物停用。指定干预措施的参与率为63%，超过了全自动互联网电子保健干预措施的普遍报告率。MSS治疗的可行性得到了证实，>80%的患者报告治疗可接受性。总体而言，两组在所有研究变量的术后数月内均有所改善。随着时间的推移，发现治疗组的疼痛强度存在显著的相互作用效应，MSS组在术后和术后3个月内疼痛强度的绝对降低幅度更大（治疗×时间固定效应; F[215] = 5.23; P = 0.024）。虽然研究样本的亚临床基线疼痛灾难性评分显著（M = 14.10; 95%置信区间，11.70-16.49），但在至阿片类药物停用时间或疼痛灾难性减轻方面未观察到统计学显著的组间差异（F[215] = 0.20; P = 0.653）。研究结果显示，全自动行为疼痛管理技能干预（MSS）可能对有动机的骨科创伤手术患者有用，并减少术后疼痛长达3个月。与HE对照干预相比，MSS与阿片类药物停药时间缩短无关。
Behavioral pain treatments may improve postsurgical analgesia and recovery; however, effective and scalable options are not widely available. This study tested a digital perioperative behavioral medicine intervention in orthopedic trauma surgery patients for feasibility and efficacy for reducing pain intensity, pain catastrophizing, and opioid cessation up to 3 months after surgery. A randomized controlled clinical trial was conducted at an orthopedic trauma surgery unit at a major academic hospital to compare a digital behavioral pain management intervention (“My Surgical Success” [MSS]) to a digital general health education (HE) intervention (HE; no pain management skills). The enrolled sample included 133 patients; 84 patients were randomized (MSS, n = 37; HE, n = 47) and completed study procedures. Most patients received their assigned intervention within 3 days of surgery (85%). The sample was predominantly male (61.5%), White (61.9%), and partnered (65.5%), with at least a bachelor’s degree (69.0%). Outcomes were collected at 1–3 months after intervention through self-report e-surveys and electronic medical record review; an intention-to-treat analytic framework was applied. Feasibility was dually determined by the proportion of patients engaging in their assigned treatment and an application of an 80% threshold for patient-reported acceptability. We hypothesized that MSS would result in greater reductions in pain intensity and pain catastrophizing after surgery and earlier opioid cessation compared to the digital HE control group. The engagement rate with assigned interventions was 63% and exceeded commonly reported rates for fully automated Internet-based e-health interventions. Feasibility was demonstrated for the MSS engagers, with >80% reporting treatment acceptability. Overall, both groups improved in the postsurgical months across all study variables. A significant interaction effect was found for treatment group over time on pain intensity, such that the MSS group evidenced greater absolute reductions in pain intensity after surgery and up to 3 months later (treatment × time fixed effects; F[215] = 5.23; P = .024). No statistically significant between-group differences were observed for time to opioid cessation or for reductions in pain catastrophizing (F[215] = 0.20; P = .653), although the study sample notably had subclinical baseline pain catastrophizing scores (M = 14.10; 95% confidence interval, 11.70–16.49). Study findings revealed that a fully automated behavioral pain management skills intervention (MSS) may be useful for motivated orthopedic trauma surgery patients and reduce postsurgical pain up to 3 months. MSS was not associated with reduced time to opioid cessation compared to the HE control intervention.