Treatment for Pain, Postoperative

Phase-Based Estimates
1
Effectiveness
1
Safety
Pennsylvania Hospital, Philadelphia, PA
Pain, Postoperative+1 More
Eligibility
18+
All Sexes
Eligible conditions
Pain, Postoperative

Study Summary

This study is evaluating whether a behavioral intervention may help reduce the risk of chronic pain following knee replacement surgery.

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Eligible Conditions

  • Pain, Postoperative
  • Chronic Post-Surgical Pain

Treatment Effectiveness

Study Objectives

This trial is evaluating whether Treatment will improve 1 primary outcome and 10 secondary outcomes in patients with Pain, Postoperative. Measurement will happen over the course of baseline; prior to surgery.

3-months; 6-months
Chronic Post-Surgical Pain
Post-Op Anxiety
Post-Op Depression
Post-operative chronic pain intensity
48 hours post-operatively
Post-Op Pain Severity
Hour 48
Post-operative Opioid Use
baseline
Pre-Op Anxiety
Pre-Op Catastrophizing
Pre-Op Depression
baseline; prior to surgery
Preoperative Chronic Pain Severity
Preoperative Opioid Use

Trial Safety

Trial Design

1 Treatment Groups

Computer-Assisted Preoperative CBT Intervention

This trial requires 90 total participants across 1 different treatment groups

This trial involves a single treatment. Treatment is the primary treatment being studied. Participants will all receive the same treatment. There is no placebo group. The treatments being tested are not being studied for commercial purposes.

Computer-Assisted Preoperative CBT Intervention
Behavioral
Patients will receive the computer-assisted preoperative CBT intervention (n=75). A particularly promising internet-based CBT pain program for the population of interest, PAINTrainer, demonstrated improved pain, function, coping and global health in patients with chronic knee arthritic pain in comparison to an internet education control, with benefits persisting for up to 52 weeks. In addition to the PAINTrainer, there will be an integration of a motivational interviewing (MI) intervention delivered by a trained "coach" across the sessions about (1) the benefits of opioid tapering for post-operative pain control, (2) approaches for safely tapering, (3) identifying and managing withdrawal symptoms patients may experience.

Trial Logistics

Trial Timeline

Approximate Timeline
Screening: ~3 weeks
Treatment: Varies
Reporting: 48 hours post-operatively; 3-months; 6-months
This trial has the following approximate timeline: 3 weeks for initial screening, variable treatment timelines, and roughly 48 hours post-operatively; 3-months; 6-months for reporting.

Who is running the study

Principal Investigator
P. C. R.
Prof. Peggy Compton RN,, PhD
University of Pennsylvania

Closest Location

Pennsylvania Hospital - Philadelphia, PA

Eligibility Criteria

This trial is for patients born any sex aged 18 and older. There are 5 eligibility criteria to participate in this trial as listed below.

Mark “yes” if the following statements are true for you:
Chronic non-malignant pain of at least 3 months duration
Morphine equivalent daily dose (MEDD) > 40 milligrams for at least 3 months
Males and females, age > 21 years
Able to enroll at least 4 weeks prior to planned surgery
Able to speak, read and comprehend in English at the 6th grade or higher proficiency

Patient Q&A Section

Please Note: These questions and answers are submitted by anonymous patients, and have not been verified by our internal team.

What causes pain, postoperative?

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In a large number of people, postoperative pain is multifactorial, with many factors, including psychological. Pain perception is modulated by a variety of biological and psychological factors and, in particular, psychological pain processing.

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What are common treatments for pain, postoperative?

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Noninvasive therapy with pain medication, physical therapy, and counseling are commonly recommended for all kinds of people who have a physical disorder and who are currently undergoing treatment or evaluation. There are few studies that compare the treatment of people who are in acute pain with those who have chronic pain issues. Most of these studies recommend a single therapy or multi-modal approach. There is also a paucity of comprehensive guidelines for prescribing medication to treat chronic pain. In this article, we describe the treatments commonly recommended for adults with chronic pain who are being evaluated at a tertiary care center. Based on the scientific literature and the consensus of the clinical staff, we suggest an integrated approach incorporating multiple medications to control pain over the long term.

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What are the signs of pain, postoperative?

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Pain is a common symptom of acute pain, and postoperative pain in infants and children is a growing issue. The children are often treated empirically with acetaminophen or a nonsteroidal anti-inflammatory drug, and their pain is often inadequate. Pain assessment, education, and appropriate pain management for children with pain is key in acute pain management. Physicians and other health care providers should be counseled about a possible role for PONV in children with postoperative pain.

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Can pain, postoperative be cured?

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The study results provide support for the concept of a multifactorial etiology for postoperative pain and that pain may be more amenable to therapy than historically acknowledged.

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How many people get pain, postoperative a year in the United States?

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Around 810,000 Americans a year experience postoperative spinal-cord or epidural anesthesia associated [back pain](https://www.withpower.com/clinical-trials/back-pain) or pelvic-pelvic pains after a hysterectomy, prostatectomy, or colorectal tumor surgery.

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What is pain, postoperative?

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Postoperative pain is important in perioperative management. It has significant effects on patient's recovery, satisfaction, and quality of life. Inappropriate analgesics and opioid-related side effects are important factors for the postoperative pain management.

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Have there been any new discoveries for treating pain, postoperative?

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Despite the importance of postoperative [pain management](https://www.withpower.com/clinical-trials/pain-management), the treatment for the pain has not changed dramatically since the introduction of opioids in the surgical setting. There is still great need for effective analgesics that are convenient to administer such as non-opioid or non-psychotropic.

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What is the latest research for pain, postoperative?

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Our analyses suggest postoperative pain is a complex disorder. As many patients, we have not been able to reduce pain by using pharmacological or interventional methods. Therefore, as pain specialists we must be mindful of the need to increase our understanding of the pain experience and ensure the patient's safety and welfare. We also need to be aware of the emerging use of complementary analgesic, as some may be more effective than opioids. To date, no research has investigated the therapeutic potential of complementary analgesics. Therefore, we need to further understand their mechanism of action and their potential for side effects, to facilitate their use appropriately.

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How does treatment work?

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A good knowledge of the results of the published studies on treatment for chronic postoperative pain is indispensable when the decision to use systemic or local analgesic therapy is made.

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Who should consider clinical trials for pain, postoperative?

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Participation in clinical trials for pain is an option for patients recovering from a variety of surgeries, including major joint surgery. Because the studies are highly regulated, selection of appropriate surgical patients for these trials is a critical challenge for the surgeon. In our experience, patients with the expectation that they will not receive a full benefit from participating in a clinical trial for pain after surgery can make an informed decision about participating in a clinical trial. A pain trial may not be appropriate for patients who expect to regain full return to active functional status within 7 days of surgery. An attempt to collect data on their use of opioid after surgery should be part of routine postoperative pain management.

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Does treatment improve quality of life for those with pain, postoperative?

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Patients who received multimodal analgesia were significantly more likely to report no pain or mild/no pain compared with patients who did not receive multimodal pain relief.

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How serious can pain, postoperative be?

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With current technologies and treatment, postoperative pain is a manageable problem. In this cohort study, the rate of pain postoperatively was moderate at 4 months of follow-up. Pain remained manageable when measured by the number of medications prescribed and the total daily doses of opioids provided to the patient.

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