Online Psychology Program for Post-Surgical Pain

(ADOPT-TPS Trial)

Overseen By Hance Director of Pain Services, MD, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University Health Network, Toronto

Disqualifiers: Serious mental illness, Dementia, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 4-6 weeks

60 Participants Needed

Trial Summary

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Self-Guided Online ACT Program for post-surgical pain?

Research shows that psychological treatments like acceptance and commitment therapy (ACT) can help manage post-surgical pain. Online and brief behavioral treatments are recognized as important for pain management after surgery, especially when in-person access is limited. ^{1 2 3 4 5}

Is the Online Psychology Program for Post-Surgical Pain safe for humans?

The Online Psychology Program, including approaches like Acceptance and Commitment Therapy (ACT), has been used safely in managing post-surgical pain and reducing opioid use, with no significant safety concerns reported in the studies reviewed. ^{1 6 7 8 9}

How is the Self-Guided Online ACT Program different from other treatments for post-surgical pain?

The Self-Guided Online ACT Program is unique because it is an online, self-directed therapy that helps patients manage post-surgical pain by teaching them acceptance and commitment strategies. Unlike traditional in-person therapies, this program can be accessed from home, making it more convenient and accessible, especially during times when in-person treatment options are limited. ^{1 2 3 5 10}

What is the purpose of this trial?

This project will evaluate the feasibility of a new fully self-guided online Acceptance and Commitment Therapy (ACT) program entitled Advancing Online Psychology Tools for the Transitional Pain Service (ADOPT-TPS), developed on an online health application platform called Manage My Pain (MMP). The ACT program is designed to teach mindfulness skills and provide psychoeducation about post-surgical pain. The feasibility of the self-guided online program will be compared to a pre-existing psychologist-guided workshop that delivers the same program. It is anticipated that the self-guided online ACT program will be deemed feasible by participants.

Research Team

Maxwell Slepian, PhD, C Psych

Principal Investigator

Toronto General Hospital

Eligibility Criteria

This trial is for individuals experiencing chronic pain after surgery. Participants should be interested in trying an online program to manage their pain, but specific inclusion and exclusion criteria are not provided.

Inclusion Criteria

Patients who have access to a device that can connect to the Internet

I was referred to the TPS after surgery.

Exclusion Criteria

I have undergone TPS psychology therapy.

Patients with a known history of serious mental illness (e.g., psychosis and/or active mania)

Patients who have limited comprehension of English or comprehension deficits due to dementia

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants engage in a self-guided or psychologist-guided online ACT program for post-surgical pain and opioid use

4-6 weeks

Follow-up

Participants are monitored for feasibility, acceptability, and treatment adherence after completing the program

4 weeks

Online surveys and interviews

Treatment Details

Interventions

• Self-Guided Online ACT Program

Trial Overview The study tests a self-guided online Acceptance and Commitment Therapy (ACT) program called ADOPT-TPS, which aims to teach mindfulness and educate about post-surgical pain, against the usual psychologist-guided workshops.

Participant Groups

Group I: Self-guided Online ACT Experimental Treatment 1 Intervention

The intervention is a self-guided ACT program delivered on an online platform. The program is developed based on the psychologist-guided ACT group intervention for chronic pain and opioid use after surgery.

Group II: Psychologist-guided Online ACT Active Control 1 Intervention

The psychologist-guided ACT group workshop is an evidence-based psychology intervention for chronic pain and opioid use after surgery.

Who Is Running the Clinical Trial?

University Health Network, Toronto

Lead Sponsor

Trials

1,555

Recruited

526,000+

Academic Medical Organization of Southwestern Ontario

Collaborator

Trials

17

Recruited

1,600+

York University

Collaborator

Trials

64

Recruited

521,000+

Toronto General Hospital

Collaborator

Trials

27

Recruited

15,500+

Findings from Research

A systematic review of five trials involving various surgical procedures found that cognitive behavioral therapy (CBT) significantly reduces pain intensity and disability in patients experiencing postsurgical pain.

The review highlights the need for further research to optimize the delivery and efficacy of CBT and explore newer psychological approaches for managing postsurgical pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychological treatments for the management of postsurgical pain: a systematic review of randomized controlled trials. Nicholls, JL., Azam, MA., Burns, LC., et al.[2022]

Psychoeducation before spinal surgery significantly reduces the consumption of postoperative analgesics, indicating that informed patients may experience less pain after surgery.

Involving a psychologist in surgical care not only enhances patients' physical and mental recovery but also lowers rehabilitation costs, highlighting the importance of addressing patients' fears and anxieties.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[The effect of surgical psychoeducation on the outcome of spinal surgery]. Sütő, J., Klekner, Á., Nagy, J., et al.[2023]

Chronic postsurgical pain (CPSP) is influenced by psychological factors, with negative emotions like anxiety and depression identified as significant risk factors, while protective factors are less studied.

The Acceptance and Commitment Therapy (ACT) approach used in the Transitional Pain Service at Toronto General Hospital shows promise in reducing pain and opioid use, with patients receiving this intervention reporting greater improvements in pain management and lower depression scores.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management. Weinrib, AZ., Azam, MA., Birnie, KA., et al.[2020]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

Transforming Standard of Care for Spine Surgery: Integration of an Online Single-Session Behavioral Pain Management Class for Perioperative Optimization. [2022]

2. New Zealand pubmed.ncbi.nlm.nih.gov

Psychological treatments for the management of postsurgical pain: a systematic review of randomized controlled trials. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

The effectiveness of online pain resources for health professionals: a systematic review with subset meta-analysis of educational intervention studies. [2021]

4. England pubmed.ncbi.nlm.nih.gov

One-day Acceptance and Commitment Therapy workshop for preventing persistent post-surgical pain and dysfunction in at-risk veterans: A randomized controlled trial protocol. [2021]

5. England pubmed.ncbi.nlm.nih.gov

Effectiveness of perioperative pain science education on pain, psychological factors and physical functioning: A systematic review. [2022]

6. Hungary pubmed.ncbi.nlm.nih.gov

[The effect of surgical psychoeducation on the outcome of spinal surgery]. [2023]

7. England pubmed.ncbi.nlm.nih.gov

The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management. [2020]

8. England pubmed.ncbi.nlm.nih.gov

Results of a feasibility randomized controlled trial (RCT) of the Toolkit for Optimal Recovery (TOR): a live video program to prevent chronic pain in at-risk adults with orthopedic injuries. [2022]

9. Germany pubmed.ncbi.nlm.nih.gov

[Impact of preoperative patient education on postoperative pain in consideration of the individual coping style]. [2021]

10. United States pubmed.ncbi.nlm.nih.gov

Acceptance and Commitment Therapy to manage pain and opioid use after major surgery: Preliminary outcomes from the Toronto General Hospital Transitional Pain Service. [2022]