Enhancing the Biopsychosocial Approach to Perioperative Care: A Pilot Randomized Trial of the Perioperative Pain Self-management (PePS) Intervention

Ann Surg. 2022 Jan 1;275(1):e8-e14. doi: 10.1097/SLA.0000000000004671.


Objective: The current study aimed to pilot the PePS intervention, based on principles of cognitive behavioral therapy (CBT), to determine feasibility and preliminary efficacy for preventing chronic pain and long-term opioid use.

Summary background data: Surgery can precipitate the development of both chronic pain and long-term opioid use. CBT can reduce distress and improve functioning among patients with chronic pain. Adapting CBT to target acute pain management in the postoperative period may impact longer-term postoperative outcomes.

Methods: This was a mixed-methods randomized controlled trial in a mixed surgical sample with assignment to standard care or PePS, with primary outcomes at 3-months postsurgery. The sample consisted of rural-dwelling United States Military Veterans.

Results: Logistic regression analyses found a significant effect of PePS on odds of moderate-severe pain (on average over the last week) at 3-months postsurgery, controlling for preoperative moderate-severe pain: Adjusted odds ratio = 0.25 (95% CI: 0.07-0.95, P < 0.05). At 3-months postsurgery, 15% (6/39) of standard care participants and 2% (1/45) of PePS participants used opioids in the prior seven days: Adjusted Odds ratio = 0.10 (95% CI: 0.01-1.29, P = .08). Changes in depression, anxiety, and pain catastrophizing were not significantly different between arms.

Conclusions: The findings from this study support the feasibility and preliminary efficacy of the PePS intervention.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Chronic Pain / prevention & control*
  • Cognitive Behavioral Therapy / standards*
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Models, Biopsychosocial
  • Pain Management / methods
  • Pain Management / trends*
  • Pain, Postoperative / prevention & control*
  • Perioperative Care / methods
  • Perioperative Care / trends*
  • Pilot Projects
  • Retrospective Studies
  • Rural Population
  • Self-Management / methods
  • Self-Management / trends*
  • Time Factors
  • Veterans