A systematic review of non-pharmacological interventions used for pain relief after orthopedic surgical procedures

Improving the Patient Experience During Care in the Orthopedic Cast Room

Patients regularly have casts, splints, and wounds that require attention in the clinic. Patients commonly experience anxiety and pain during such visits. We hypothesized that aromatherapy and music would improve these patients' pain and anxiety when compared with no exposure. Patients in the orthopedic cast room were randomly exposed to no experience, music, or aromatherapy. Postprocedural surveys using an abbreviated form of the Spielberger State-Trait Anxiety Inventory (5 items; 4-point Likert scale) and a visual analog scale (0 to 10) were used to collect patient perceptions that were then compared using Spearman rank correlation calculations, t tests, and ordinal regression. Correlation results for the anxiety inventory were not different for patients with music or aromatherapy exposure vs no exposure; however, lower anxiety inventory scores were correlated with lower pain scores for upset, frightened, nervous, and confused measures. Mean reported pain scores were statistically lower for patients exposed to music (3.0) or aromatherapy (3.9) compared with patients who had no exposure (5.1; P=.004). These results support our hypothesis that exposure to music or aromatherapy improves pain. Although neither music nor aromatherapy resulted in significantly lower scores on the anxiety inventory items, the attention to patients' pain could have an indirect effect on their anxiety. [Orthopedics. 2024;47(2):e90-e92.].

Acute Perioperative Pain Management of the Orthopaedic Patient: Guidance for Operationalizing Evidence Into Practice

Orthopaedic surgery often results in pain, with less than half of patients reporting adequate relief. Unrelieved acute pain occurring after surgery increases the risk of negative sequelae, including delayed healing, increased morbidity, pulmonary complications, limited rehabilitation participation, anxiety, depression, increased length of stay, prolonged duration of opioid use, and the development of chronic pain. Interventions that are individualized, evidence-informed, and applied within an ethical framework improve healthcare delivery for patients, clinicians, and healthcare organizations. Recommendations for using the principles of effective pain management from preoperative assessment through discharge are detailed, including recommendations for addressing barriers and challenges in applying these principles into clinical practice.

Effects of virtual reality on pain during intrauterine device insertions: A randomized controlled trial

OBJECTIVES

The trial aimed to compare the pain perceived by women during intrauterine device (IUD) insertion, with or without virtual reality (VR) therapy. Furthermore, anxiety during the insertions, pain after the insertions, and satisfaction with the insertions were compared.

METHODS

The trial was designed as a prospective, bi-centric, randomized, open-label interventional trial. All adult women that chose an IUD during a contraceptive consultation, and who provided informed consent were eligible. Women under legal guardianship, not affiliated to a national social security system, and with pre-existing dizziness, severe facial wounds, or epilepsy were not eligible. Eligible women were randomly allocated either standard care without VR therapy (Control group) or with VR therapy (Experimental group). Pain, anxiety, and satisfaction were measured using a 10-cm numerical scale.

RESULTS

Between September 2020 and April 2022, 100 women were randomized: 50 to each group. The mean pain scores during IUD insertion were 5.4 cm in the Control group versus 5.1 cm in the Experimental group (p = 0.54). Mean anxiety during insertion were 4.8 cm in the Control group versus 4.2 cm in the Experimental group (p = 0.13). While mean pain perceived after insertions were 2.4 cm in the Control Group and 2.4 cm in the Experimental group (p = 0.98). Mean satisfaction with the insertions was 9.6 cm in both groups (p = 0.87). Anxiety before IUD insertion, as well as anticipated pain, were significantly correlated with pain perceived during insertions.

CONCLUSIONS

VR therapy performed during the procedure did not alleviate perceived pain in women undergoing IUD insertions.

Enhancing recovery in older patients undergoing abdominal surgery: Examining the effect of a preoperative preparation program using a quasi-experimental design

Background

Older adult patients often experience delayed postoperative recovery due to a lack of self-efficacy in engaging in physical activities during early rehabilitation. Concurrently, family caregivers play a crucial role in caring for older adults. However, the extent of family involvement in improving self-efficacy and facilitating recovery following major abdominal surgeries in older adults remains largely unexplored.

Objective

This study aimed to examine the effect of a preoperative preparation program on the recovery of older patients undergoing major abdominal surgeries.

Methods

A quasi-experimental study with a two-group, pretest-posttest design was conducted. The participants included 60 older adult patients undergoing abdominal surgeries at Thammasat University Hospital, Thailand, between September 2019 and March 2020. Participants were selected by purposive sampling with the inclusion criteria and were assigned to the experimental (n = 30) or the control (n = 30) groups using matched pair according to the type of operation. The control group received standard care, while the intervention group underwent a two-week preoperative preparation program developed based on self-efficacy theory and family support. Data were collected using validated tools. Recovery was assessed at one week and two weeks after surgery. Descriptive statistics, as well as dependent and independent t-tests, were used for data analysis.

Results

The results revealed that the intervention group had significantly higher mean recovery scores than the control group at one week (M = 56.93, SD = 16.42; M = 44.60, SD = 16.30, t = -2.92, df = 58, p <0.01) and two weeks after surgery (M = 66.64, SD = 8.63; M = 61.68, SD = 7.86, t = -2.33, df = 58, p <0.05) when comparing between the two groups.

Conclusion

The preoperative preparation program effectively enhanced recovery one week and two weeks after surgery. The study findings can be valuable for nurses in implementing the preoperative preparation program to facilitate recovery among older adult patients undergoing abdominal surgeries.

Effects of Footbath on Postoperative Pain and Sleep Quality in Patients With Lumbar Degenerative Disc Disease: A Randomized Controlled Study

ABSTRACT

BACKGROUND: Pain management and good sleep are essential for patients after surgical procedures. This study aimed to evaluate the effects of footbath on postoperative pain severity and sleep quality levels of patients who have undergone degenerative lumbar spine surgery. METHODS: Sixty patients were randomly assigned to the footbath intervention group or the control group. The intervention was a 20-minute footbath in 42°C water before patients fell asleep on the evening of the surgery day. On the morning of the surgery day and the morning of postoperative day, the patient's pain severity and sleep quality scores were obtained using the visual analog scale and the Visual Analog Sleep Scale. RESULTS: There was no significant difference between the pain severity scores of the study groups (P > .05). The sleep quality level of the intervention group was statistically significantly higher than that of the control group (P < .05). CONCLUSION: Consequently, a footbath is effective in increasing sleep quality levels of patients who have undergone degenerative lumbar spine surgery. It may be used as a simple and practical nonpharmacological nursing strategy for improving patients' sleep quality.

Postoperative Rehabilitation After Superior Labrum Anterior Posterior Repair

The 4-phase rehabilitation protocol outlined in this article provides a comprehensive 26-week program to return patients with superior labrum anterior posterior repairs to their preinjury states. It is guided by the principle of gradual return to preinjury function while preserving the integrity of the surgical repair. Objective criteria are present at the conclusion of each phase to ensure patients are progressing appropriately. The goal is to allow patients to return to their previous functional ability in their sport-specific or occupational-specific training.

Nurses Experience and Perceived Challenges of Using Nonpharmacological Pain Interventions for Musculoskeletal Pain: A Qualitative Study

Introduction

Current musculoskeletal pain management guidelines encourage utilizing nonpharmacological pain measures. Despite their positive effect in alleviating musculoskeletal pain, nurses reported negative attitudes toward utilizing nonpharmacological pain measures. Therefore, assessing nurses' perception of nonpharmacological pain measures is essential to promote patient comfort.

Objective

The aim of the study was to explore the nurses' experience and perceived challenges in using nonpharmacological pain measures in caring for patients with musculoskeletal pain.

Materials & Methods

A descriptive qualitative design was carried out. Face-to-face semistructured interviews were conducted among 11 nurses. Colaizzi's method was employed in analyzing the data.

Results

Four themes emerged, namely, constant monitoring and observation, selection of nonpharmacological pain measures, and various barriers related to patients and nurses. One of the ways to overcome these barriers or challenges, we should promote interprofessional teams in planning patient-centered pain management care. Also, defining the role of the pain management nurse would be pivotal to ensuring effective pain management measures.

Conclusion

The nursing workforce needs to initiate and utilize these measures as a common practice in managing musculoskeletal pain and in turn create a culture that strongly supports the utilization of nonpharmacological pain measures.

Effect of meditation music and comedy movie interventions on postoperative kinesiophobia and pain in patients undergoing total knee arthroplasty

BACKGROUND

This study aimed to investigate the effects of music and comedy movie interventions on postoperative pain and kinesiophobia in patients who underwent total knee arthroplasty.

METHODS

This randomized-controlled study was carried out with the participation of patients who underwent total knee arthroplasty. The patients were divided into three groups. To reduce surgical pain and kinesiophobia, the patients in group 1 watched a comedy movie, those in group 2 listened to music, and those in group 3 did not participate in any intervention other than the routine practices of the clinic.

RESULTS

The personal and medical characteristics of the patients in all groups were similar. The patients in all three groups were kinesiophobic, and their surgical pain levels were moderate despite pharmaceutical interventions. Groups 1 and 2 had a statistically significant decrease in kinesiophobia and pain scores after the interventions. The effects of having patients watch a comedy movie and having them listen to meditation music were not significantly different.

CONCLUSIONS

The results of the study showed that listening to meditation music or watching comedy movie scenes had significant positive effects in alleviating postoperative pain and kinesiophobia after TKA. Based on the results of this study, it is recommended that patients watch comedy movies and listen to meditation music to alleviate their postoperative pain and kinesiophobia.

TRIAL REGISTRATION

NCT, NCT05471778. The study was registered at ClinicalTrials.gov.

Acute Pain Management Pearls: A Focused Review for the Hospital Clinician

Acute pain management is a challenging area encountered by inpatient clinicians every day. While patient care is increasingly complex and costly in this realm, the availability of applicable specialists is waning. This narrative review seeks to support diverse hospital-based healthcare providers in refining and updating their acute pain management knowledge base through clinical pearls and point-of-care resources. Practical guidance is provided for the design and adjustment of inpatient multimodal analgesic regimens, including conventional and burgeoning non-opioid and opioid therapies. The importance of customized care plans for patients with preexisting opioid tolerance, chronic pain, or opioid use disorder is emphasized, and current recommendations for inpatient management of associated chronic therapies are discussed. References to best available guidelines and literature are offered for further exploration. Improved clinician attention and more developed skill sets related to acute pain management could significantly benefit hospitalized patient outcomes and healthcare resource utilization.

Effect of virtual reality technology as intervention for people with kinesiophobia: A meta-analysis of randomised controlled trials

AIMS AND OBJECTIVE

To explore the effectiveness of Virtual Reality Technology in reducing kinesiophobia in people.

BACKGROUND

Kinesiophobia is an important psychosocial factor affecting the pain experience and has a significant negative impact on rehabilitation. Virtual reality technology has been widely used in the treatment of phobias, mental disorders and anxiety disorders. However, the effect of virtual reality technology on people with kinesiophobia has been reported with inconsistent results.

DESIGN

A meta-analysis of randomised controlled trials.

METHODS

This study systematically searched PubMed, Web of Science, PsycINFO, CINAHL, Embase, Cochrane Library, Medline, Scopus and four Chinese databases. The standardised mean difference (SMD) was calculated using random-effects models, and the Cochrane Collaboration's tool was used to assess the risk of bias in each study. The PRISMA 2020 checklist provided by the EQUATOR network was used.

RESULTS

Eleven randomised controlled trials involving a total of 488 subjects were included. Meta-analysis showed the effect sizes of virtual reality intervention on kinesiophobia (SMD = -0.53, 95% CI [-0.90, -0.17], p = .004). Virtual reality intervention was more effective in reducing kinesiophobia in people with chronic low back pain (SMD = -1.00, 95% CI [-1.71, -0.29], p = .006). Compared with fully immersive virtual reality (SMD = -0.29, 95% CI [-0.62, 0.05], p = 0.09), non-immersive virtual reality was more effective in reducing kinesiophobia (SMD = -0.66, 95% CI [-1.24, -0.09], p = 0.02). Compared with virtual reality intervention alone (SMD = -0.35, 95% CI [-1.40, 0.71], p = 0.52), virtual reality combined with exercise was more effective in reducing kinesiophobia (SMD = -0.59, 95% CI [-0.95, -0.22], p = 0.002).

CONCLUSIONS

Virtual reality technology has the potential to reduce the degree of kinesiophobia in people. In addition, virtual reality technology was more effective in people with chronic low back pain; non-immersive virtual reality was more effective in reducing kinesiophobia; and virtual reality technology combined with exercise was more effective in reducing kinesiophobia than virtual reality intervention alone. Clinical nursing staff should be encouraged to use virtual reality to speed up patient recovery. However, to achieve immersion and apply this technology to different diseases, more studies are required to provide clearer suggestions.

RELEVANCE TO CLINICAL PRACTICE

This study suggests that healthcare staff should pay attention to kinesiophobia, and early identification and intervention of kinesiophobia can help patients recover their health and improve the quality of nursing.

Pain Management Strategies After Orthopaedic Trauma: A Mixed-Methods Study with a View to Optimizing Practices

PURPOSE

To examine 1) pain management strategies within the care trajectory of orthopaedic trauma patients and patients' perception of their effectiveness, 2) adverse effects (AEs) associated with pharmacological treatments, particularly opioids and cannabis, and 3) patients' perceptions of strategies that should be applied after an orthopaedic trauma and support that they should obtain from health professionals for their use.

PATIENTS AND METHODS

This study was conducted with orthopaedic trauma patients in a level 1 trauma center. A convergent mixed-methods design was used. Data on pain experience, pain management strategies used and AEs were collected with self-administered questionnaires at hospital discharge (T1) and at 3 months after injury (T2). Patients' preferences about the pain management strategies used, the required support and AEs were further examined through semi-structured individual interviews at the same time measures. Descriptive statistics and thematic analyses were performed.

RESULTS

Seventy-one patients were recruited and 30 individual interviews were undertaken. Pharmacological pain management strategies used at T1 and T2 were mainly opioids (95.8%; 20.8%) and acetaminophen (91.5%; 37.5%). The most frequently applied non-pharmacological strategies were sleep (95.6%) and physical positioning (89.7%) at T1 and massage (46.3%) and relaxation (32.5%) at T2. Findings from quantitative and qualitative analyses highlighted that non-pharmacological strategies, such as comfort, massage, distraction, and physical therapy, were perceived as the most effective by participants. Most common AEs related to opioids were dry mouth (78.8%) and fatigue (66.1%) at T1 and insomnia (30.0%) and fatigue (20.0%) at T2. Dry mouth (28.6%) and drowsiness (14.3%) were the most reported AEs by patients using recreational cannabis. An important need for information at hospital discharge and for a personalized follow-up was identified by participants during interviews.

CONCLUSION

Despite its AEs, we found that opioids are still the leading pain management strategy after an orthopaedic trauma and that more efforts are needed to implement non-pharmacological strategies. Cannabis was taken for recreational purposes but patients also used it for pain relief. Support from health professionals is needed to promote the adequate use of these strategies.

Making a business plan for starting a transitional pain service within the US healthcare system

Chronic pain imposes a tremendous economic burden of up to US$635 billion per year in terms of direct costs (such as the costs of treatment) and indirect costs (such as lost productivity and time away from work). In addition, the initiation of opioids for pain is associated with a more than doubling of pharmacy and all-cause medical costs. The high costs of chronic pain are particularly relevant for anesthesiologists because surgery represents an inciting event that can lead to chronic pain and long-term opioid use. While the presence of risk factors and an individual patient's postoperative pain trajectory may predict who is at high risk for chronic pain and opioid use after surgery, to date, there are few interventions proven to reduce these risks. One promising approach is the transitional pain service. Programs like this attempt to bridge the gap between acute and chronic pain management, provide continuity of care for complicated acute pain patients after discharge from the hospital, and offer interventions for patients who are on abnormal trajectories of pain resolution and/or opioid use. Despite awareness of chronic pain after surgery and the ongoing opioid epidemic, there are few examples of successful transitional pain service implementation in the USA. Key issues and concerns include financial incentives and the required investment from the hospital or healthcare system. We present an economic analysis and discussion of important considerations when developing a business plan for a transitional pain service.

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a "roadmap" for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.