Effectiveness of peri-operative psychological interventions for the reduction of postsurgical pain intensity, depression, anxiety and pain catastrophising

BACKGROUND: Evidence suggests that psychological interventions during the peri-operative period can help reduce the development of chronic postsurgical pain (CPSP); however, there is no evidence of their effects on other important pain-related variables. OBJECTIVES: This systematic review and meta-analysis evaluated the effectiveness of peri-operative psychological interventions for the reduction of postsurgical pain intensity, depression, anxiety, stress and pain catastrophising. STUDY DESIGN: Systematic review of randomised controlled trials (RCTs) with meta-analyses (registration number: CRD42023403384). The search for studies was carried out in Web of Science, PsychINFO, MEDLINE and CINAHL up to March 2023. ELIGIBILITY CRITERIA: RCTs comparing peri-operative psychological interventions with usual care or nonpsychological control interventions in adult patients with any type of surgery. The main outcome was pain intensity reduction after surgery. Secondary outcomes included patient-reported depression, anxiety, stress and pain catastrophising after surgery. RESULTS: Twenty-seven RCTs (psychological intervention: 1462 patients; control: 1528 patients) were included in the systematic review and 17 studies for the meta-analysis. Random-effect models were used to combine the effect sizes of the studies. Compared with usual care or control interventions, psychological interventions reduced pain intensity, d = -0.45 95% CI, (-0.77 to -0.13) and anxiety, d = -0.33 95% CI, (-0.54 to -0.11) after surgery. Moderator analyses revealed that psychological interventions delivered by a psychologist were more effective than those delivered by other professionals. CBT seemed the most beneficial for surgical patients. The findings in other moderator analyses were heterogeneous. CONCLUSIONS: Moderate-quality evidence exists that peri-operative psychological interventions can significantly reduce pain intensity and anxiety postsurgery. However, results should be interpreted with caution because of the presence of a high risk of bias in many trials.