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Acute Pain | Chronic Pain | General

Preoperative information-giving interventions and pain

Clinical bottom line:

Preoperative interventions which combine sensory and procedural information significantly reduce postoperative pain, distress and negative affect. This is also true for sensory information given alone, although the effect is not as great.

Preoperatively, patients should be offered information-giving interventions with include explanations of what will be happening to them, and how they can expect to feel.

Preoperative information-giving interventions

A number of reviews have been carried out to consider whether giving a patient information before his or her operation is useful in helping that individual to deal with the pain and discomfort they will experience after the procedure. Preoperative information can be procedural (what will happen) and sensory (what you will feel). Reviews have produced mixed findings, and have not answered the question of which kinds of information are beneficial, and for which outcomes.

Systematic review

Suls J, Wan CK. Effects of sensory and procedural information on coping with stressful medical procedures and pain: a meta-analysis. J Consult Clin Psychol 1989; 57:372-9.

Inclusion criteria were controlled trials of sensory and/or procedural information-giving vs. no instruction; sufficient data to calculate the effect size or to determine statistical significance and/or direction of effects.

Effect sizes (with 95% confidence intervals) were calculated from the difference between group means divided by pooled within-group standard deviations. When this could not be calculated, trials reporting non-significant effects were assigned a value of zero. Values were corrected for small sample bias, and weighted according to reliability of result.

Findings

Two included trials used non-adult samples, five trials looked at experimental pain.

Although the review included 'other effects' (see main outcomes above), these findings have not been included here because of the lack of comparability between measures).

Procedural preparation vs. control

Procedural information alone does not provide significant benefit over control on any of the measures (negative affect, self-rated pain, other-rated pain/distress).

Sensory preparation vs. control

Sensory preparation is more effective than control on all measures (negative affect, self-rated pain, other-rated pain/distress).

Procedural vs. sensory preparation

Sensory preparation alone is more effective than procedural information alone, on self-ratings of pain. This is not true for either of the other measures.

Procedural and sensory preparation combined vs. control

A combination of procedural and sensory preparation was significantly better than control on all measures (negative affect, self-rated pain, other-rated pain/distress). Effect sizes were larger than either sensory or procedural information alone, suggesting that this is the most powerful intervention.

Because some of the effect sizes were heterogeneous, reviewers examined whether variability came from sex or age of samples, trial setting (experimental vs. medical), inclusion of a pain warning, and control conditions which did/did not control for experimenter attention/contact. None of these accounted for the variability in the data.

Adverse effects

Review did not report on adverse effects.

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