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A Prospective Study of Cognitive Intervention in the Reduction of Postoperative Pain and Narcotic Demand

Mike C Gavin, Mark Litt, Ahmed Khan, Hilary Onyiuke, Robert A Kozol
UConn Health Center, Farmington, CT

Objective: Determine if perioperative relaxation training will decrease pain and narcotic demand postoperatively.
Design: Single-blinded randomized prospective trial.
Setting: University Hospital.
Participants: Randomized sample of patients undergoing lumbar and cervical spine surgery. (n=49) patients completed the study with (n=22) in the control and (n=27) in the experimental group.
Intervention: The experimental group was given instruction on relaxation techniques in the preoperative period and postoperative periods. The control group received routine pre-op information.
MAIN OUTCOME MEASURES: Primary measures, pain scores and narcotic use were recorded in the first 48 hours after surgery. Patients completed a log to record data in the first four days at home. Secondary outcome measures, respiratory function and sedation were assessed for the inpatient period.
Results: Pain scores were higher in the experimental (4.8 +/- 1.7) vs. the controls (3.9 +/- 1.7) on POD 1, but lower on POD 2 (3.9 +/- 1.9 vs. 4.1 +/- 1.9). Narcotic use was also higher in the experimental group on POD 1 (11.1 +/- 7.2 vs. 6.8 +/- 5.2) and POD 2 (6.4 +/- 3.0 vs. 5.3 +/- 4.1). There is no significant difference in pain (p=0.941) or narcotic demand (p=0.114) over the first two days after surgery. Examining the change in pain and narcotic demand from day one to day two, the experimental group shows a greater drop in pain (p=0.016 vs. controls), but the trend is not significant for narcotic demand (p=0.113). There were no significant differences in the home log data or secondary outcome measures.
Conclusions: Cognitive intervention is not associated with an overall decrease in pain or narcotic demand in the early postoperative period.

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