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Psychological interventions could play an important role in pain management as acceptance and commitment therapy significantly reduced the use of opioids and improved pain interference and mood in patients with CPSP.
<>Chronic postsurgical pain (CPSP) and the use of opioids in it is becoming a threat to patients undergone surgeries. A clinical practice–based study conducted by Dr Weinrib reports on preliminary outcomes of the Toronto General Hospital Transitional Pain Service (TPS) psychology program providing acceptance and commitment therapy (ACT) to patients at risk of CPSP and associated opioid use. A total of 91 patients received ACT, and 252 patients without ACT compared. The first and last outcomes were examined at visits at TPS. The results; pain, pain interference, sensitivity to pain traumatisation, pain catastrophizing, anxiety depression, and opioids were analysed using two-way ANOVA. The TPS treatment included the referral of patients willing to improve their pain management to the clinical psychologist where patients were taught coping skills and kept engaged in some other meaningful life activities to reduce pain intensities. Three or four counselling sessions were given to the patients to inform and observe them. Observations made at both time points for all the study patients and
<>Probability (P) calculated as;
1. More likely to have reported a mental health condition pre-operatively (P < 0.001)
2. Higher use of opioid at first postsurgical visit (P < 0.001)
3. Higher sensitivity to anxiety (P < 0.05).
4. Highly sensitive to traumatization (P < 0.05)
On the last visit, both groups have demonstrated a reduction in pain, pain interference, pain catastrophizing, anxiety, and opioid use (P < 0.05). A great reduction in pain observed. According to senior author Hance Clarke assistant professor, department of anaesthesia, University of Toronto "the recent guidelines framed in the United States and Canada says that for the management of non-cancer pain stress alternative treatments should be tried before using opioid to avoid addiction." Dr Clarke said that this study and TPS would help in tapering the opioid usage in pain. Ontario Ministry of Health and Long-Term Care and Canadian Institute of Health Research and the Department of Anaesthesia, University of Toronto were the major funding agencies for the entire study.
Canadian Journal of Pain
Psychological tools may help patients with chronica pain successfully taper opioid use, control pain
Aliza Z. Weinrib et. al.
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