Abstract

Objectives

Recent brief mindfulness-based interventions (MBI) provided before surgery have shown promising results in improving clinical outcomes in patients undergoing total joint arthroplasty (TJA). However, they have not been delivered in the subacute phase after surgery to target patients at risk for chronic postsurgical pain (CPSP). The use of technologies allowing remote and online delivery can help increase the accessibility of these interventions.

Method

We conducted a single site, two-arm pilot randomized controlled trial to evaluate the feasibility, acceptability, and preliminary effects of online Mini More (i.e., a condensed, 4-week mindfulness-based program) promoting pain self-management during the subacute postoperative phase. We randomized 36 patients into two groups (Mini MORE, n = 18 and Pain Coping Education, n = 18). Postoperative outcomes were: pain intensity, pain interference, analgesic medication use, pain catastrophizing, pain acceptance and mindfulness.

Results

Results indicated that Mini MORE was highly feasible and well received. Further, results indicated that pain intensity (d = 1.47, p < 0.001) as well as pain interference levels (d = 1.04, p = 0.005) and medication use (Cliff’s Delta=-0.56, p = 0.02) were significantly different between groups after treatment. Statistically significant group by time interactions were found for both pain intensity (p < 0.001) and pain interference (p = 0.003), and a trend toward a decrease in pain medication use (p = 0.05) was observed in favor of the Mini MORE group. No statistically significant differences were found between groups for pain acceptance (d = -0.58), pain catastrophizing (d = 0.01) and mindfulness (d = -0.23).

Conclusions

Our results suggest Mini MORE is a feasible and acceptable brief, online MBI potentially capable of decreasing pain intensity and pain interference in the subacute period after TJA, thus Mini MORE may be a promising tool for preventing CPSP.

Preregistration

NCT04848428

中文翻译：

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全髋关节或膝关节置换术后亚急性疼痛的基于正念的在线简短干预：一项试点随机对照试验

摘要

目标

最近在手术前提供的简短的基于正念的干预措施（MBI）在改善接受全关节置换术（TJA）的患者的临床结果方面显示出有希望的结果。然而，它们尚未在手术后的亚急性阶段针对有慢性术后疼痛（CPSP）风险的患者进行治疗。使用允许远程和在线交付的技术可以帮助提高这些干预措施的可及性。

方法

我们进行了一项单中心、双臂试点随机对照试验，以评估在线 Mini More（即，一个精简的、为期 4 周的正念项目）促进亚急性术后疼痛自我管理的可行性、可接受性和初步效果。阶段。我们将 36 名患者随机分为两组（Mini MORE，n =  18 组和疼痛应对教育组，n =  18）。术后结果为：疼痛强度、疼痛干扰、镇痛药物的使用、疼痛灾难化、疼痛接受度和正念。

结果

结果表明，Mini MORE具有较高的可行性和良好的反响。此外，结果表明，疼痛强度（d =  1.47，p <  0.001）以及疼痛干扰水平（d =  1.04，p =  0.005）和药物使用（Cliff's Delta = -0.56，p  = 0.02）在各组之间显着不同治疗后。疼痛强度 ( p  < 0.001) 和疼痛干扰 ( p = 0.003)均发现按时间分组的交互作用具有统计学意义 ，并且观察到止痛药物使用量减少的趋势 ( p =  0.05) 有利于 Mini MORE 组。在疼痛接受度（ d = -0.58）、疼痛灾难化（d =  0.01）和正念（d = -0.23）方面，各组之间没有发现统计学上的显着差异。

结论

我们的结果表明，Mini MORE 是一种可行且可接受的简短在线 MBI，可能能够降低 TJA 后亚急性期的疼痛强度和疼痛干扰，因此 Mini MORE 可能是预防 CPSP 的有前途的工具。

预登记

NCT04848428