The Perioperative Pain Self-Management Program Trial (PePS)

Preventing Chronic Post-Surgical Pain and Prolonged Opioid Use: The Perioperative Pain Self-Management Program

This study will trial the impact of teaching surgical patients a pain self-management approach to compliment medical post-surgical pain management.

Surgery can precipitate the development of both chronic pain and long-term opioid use. There is a need for strategies to augment perioperative pharmacotherapeutic management of pain with non-pharmacologic strategies to prevent long-term sequelae. Psychological interventions such as cognitive behavioral therapy (CBT) can effectively reduce distress and improve functioning among patients with chronic pain. While CBT has been used extensively in patients with established chronic pain, it has not been used as a preventive intervention targeting the transition from acute to chronic postsurgical pain. The Perioperative Pain Self-management (PePS) program has the potential to reduce the incidence of chronic post-surgical pain and long-term opioid use among Veterans. This study will: Examine the efficacy of PePS compared to standard care on 6-month pain (primary outcome), mood and functioning outcomes as well as time to post-surgical opioid and other analgesic use cessation.

Participants will be randomized to either receive the pain self-management sessions (PePS) or standard care (SC).

Time to opioid cessation following surgery: daily opioid use will be collected via weekly phone calls for the first 6 weeks post-surgery.

A measure of depressive symptoms. Scores range from 0-24 with higher scores indicating more depressive symptoms.

A measure of anxious symptoms. Scores range from 0-21 with higher scores indicating more anxious symptoms.

A measure of pain-related functioning. Scores range from 0-70 with higher scores indicating greater pain-related disability.

Generalized body pain intensity and pain interference. Scores range from 0-10 with higher scores indicating more pain severity and interference.

Time to cessation of other analgesics following surgery: daily analgesic use will be collected via weekly phone calls for the first 6 weeks post-surgery.

Inclusion Criteria: scheduled for total hip, knee, or shoulder joint arthroplasty through the Iowa City, IA, Des Moines, IA, Minneapolis, IA, or Milwaukee WI, VA medical centers Exclusion Criteria: inability to complete study forms/procedures because of a language/literacy barrier active bipolar or psychotic disorder history of brain injury dementia CBT therapy within the past year lack of access to a telephone for PePS sessions

Hadlandsmyth K, Burgess DJ, Leparski RF, Odom AS, Campbell EJ, Obrecht AA, Adamowicz JL, Cho H, Steffensmeier KS, Johnson NL, Richards CC, Vander Weg MW, Lund BC, Yoon P, Mosher HJ. The Perioperative Pain Self-Management (PePS) randomized controlled trial protocol: Preventing chronic post-surgical pain and prolonged opioid use. Contemp Clin Trials. 2022 Jul;118:106810. doi: 10.1016/j.cct.2022.106810. Epub 2022 May 31.