The Effectiveness Of Acceptance And Commitment Therapy For Women At High Risk Of Chronic Postsurgical Pain After Hysterectomy

Objective:This study applied a single session of Acceptance and Commitment Therapy(ACT)to benign hysterectomy patients at high risk of chronic postsurgical pain(CPSP)to investigate the effect of the ACT on CPSP,pain interference,and health related quality of life in such patients,and to provide evidence for clinical application of perioperative psychological interventions for chronic postsurgical pain.Methods:Randomized controlled trial.Patients planned for benign hysterectomy were randomly assigned to an intervention group and a control group in a gynecological ward at a tertiary hospital in southwest China.Patients at high risk of chronic postsurgical pain were screened with history of cesarean section,the Numerical Rating Scales(NRS),the Pain Catastrophizing Scale(PCS),and the Hospital Anxiety and Depression Scale(HADS).Baseline data were collected via a general information questionnaire.Patients in the intervention group underwent a single-session preoperative ACT intervention with a duration of about 90 minutes,and the control group received usual care.The NRS pain score and the number of compressions of the patient-controlled analgesia pump were collected 24 hours after surgery.The NRS pain score,the incidence of chronic postsurgical pain,and health related quality of life(using the 12-Item Short-Form Health Survey,SF-12)and pain interference(using the Brief pain inventory,BPI)were assessed through telephone at 3 months after surgery.Intention-to-treat(ITT)and Perprotocol analysis(PP)were performed,and missing data were interpolated using the medians.Results:A total of 216 patients were included,with 108 in the intervention group and 108 in the control group.At 3 months after surgery,14 patients in the intervention group were lost,with a dropout rate of 12.9%;8 in the control group were lost,with a dropout rate of7.4%.The baseline data of the two groups were not statistically different(p>0.05).There were no significant differences in pain score and number of PCA compressions between groups at 24 hours after surgery(p > 0.05).At 3 months after surgery,30 out of 194 patients had pain,and the incidence of CPSP was 15.5%.Both ITT analysis and PP analysis showed that the total SF-12 score,the score of mental health domain,and the vitality score,mental health score,and social functioning score in the mental health domain were better in the intervention group than those in the control group(p < 0.05).The intervention group performed better in the mood and interest in life dimensions of pain interference(p < 0.05).