Reduce Opioid Use after Surgery for Orthopedic Trauma with Mindfulness

Reduce Opioid Use after Surgery for Orthopedic Trauma with Mindfulness

 

By John M. de Castro, Ph.D.

 

mindfulness-based interventions could help people dependent on opioids increase their self-awareness and self-control over cravings and be less reactive to emotional and physical pain.” – Pain Week

 

Substance abuse and addiction is a terrible problem, especially opioid pain relievers. Opioid addiction has become epidemic and is rapidly increasing affecting more than 2 million Americans and an estimated 15 million people worldwide. In the U.S more than 20,000 deaths yearly were attributed to an overdose of prescription opioids. An effective treatment for addiction has been elusive. Most programs and therapies to treat addictions have poor success rates.

 

An encouraging alternative is mindfulness training. It has been found to be effective in treating addictions. One way that mindfulness may produce these benefits is by reducing cravings for opioids. The vast majority of the mindfulness training techniques, however, require a trained therapist. This results in costs that many patients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules and at locations that may not be convenient. As an alternative, mindfulness training over the internet has been developed. This has the tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations.

 

Acceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT). ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes. Hence it would make sense to study ACT delivered over the internet to reduce opioid use with pain patients.

 

In today’s Research News article “Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use in Patients With Orthopedic Trauma: Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458063/ ) Anthony and colleagues recruited hospital patients who had a bone fracture requiring surgery and randomly assigned them to a treatment as usual control condition or to receive automated text based messages communicating a Acceptance and Commitment Therapy (ACT) message twice a day for the two weeks following surgery.

A day 1 example message was:

Maintaining focus on what you value most in life is sometimes difficult after surgery. Do not let the momentary discomforts due to surgery take away from what you want most in life. Pick 3 things that matter most to you in life. Remind yourself of these 3 things you value most during your recovery process.”

They were measured before and after the 2-week messaging period for opioid use, pain intensity, pain interference, and anxiety.

 

They found that although both groups were prescribed the same amount of opioids after surgery, the Acceptance and Commitment Therapy (ACT) message group consumed significantly fewer, 37% less, opioid pills during the 2 weeks following surgery than the control group. In addition, the ACT group reported significantly lower pain intensity and pain interference than the control group two weeks after surgery.

 

The ability of Acceptance and Commitment Therapy (ACT) to reduce perceived pain and to reduce opioid use have been previously documented. The important contribution of the present study is that it demonstrated that these benefits can be attained with ACT taught through automated text messages. This suggests that the benefits of the therapy can be provided routinely, inexpensively and conveniently to large numbers of patients. Although there was no long term follow up, it would be hoped that this treatment would result in lower likelihood of opioid addiction resulting from post-surgical use in these patients.

 

So, reduce opioid use after surgery for orthopedic trauma with mindfulness.

 

People suffering from opioid addiction and chronic pain may have fewer cravings and less pain if they use both mindfulness techniques and medication for opioid dependence.” – Science Daily

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Anthony, C. A., Rojas, E. O., Keffala, V., Glass, N. A., Shah, A. S., Miller, B. J., Hogue, M., Willey, M. C., Karam, M., & Marsh, J. L. (2020). Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use in Patients With Orthopedic Trauma: Randomized Controlled Trial. Journal of medical Internet research, 22(7), e17750. https://doi.org/10.2196/17750

 

Abstract

Background

Acceptance and commitment therapy (ACT) is a pragmatic approach to help individuals decrease avoidable pain.

Objective

This study aims to evaluate the effects of ACT delivered via an automated mobile messaging robot on postoperative opioid use and patient-reported outcomes (PROs) in patients with orthopedic trauma who underwent operative intervention for their injuries.

Methods

Adult patients presenting to a level 1 trauma center who underwent operative fixation of a traumatic upper or lower extremity fracture and who used mobile phone text messaging were eligible for the study. Patients were randomized in a 1:1 ratio to either the intervention group, who received twice-daily mobile phone messages communicating an ACT-based intervention for the first 2 weeks after surgery, or the control group, who received no messages. Baseline PROs were completed. Two weeks after the operative intervention, follow-up was performed in the form of an opioid medication pill count and postoperative administration of PROs. The mean number of opioid tablets used by patients was calculated and compared between groups. The mean PRO scores were also compared between the groups.

Results

A total of 82 subjects were enrolled in the study. Of the 82 participants, 76 (38 ACT and 38 controls) completed the study. No differences between groups in demographic factors were identified. The intervention group used an average of 26.1 (SD 21.4) opioid tablets, whereas the control group used 41.1 (SD 22.0) tablets, resulting in 36.5% ([41.1-26.1]/41.1) less tablets used by subjects receiving the mobile phone–based ACT intervention (P=.004). The intervention group subjects reported a lower postoperative Patient-Reported Outcome Measure Information System Pain Intensity score (mean 45.9, SD 7.2) than control group subjects (mean 49.7, SD 8.8; P=.04).

Conclusions

In this study, the delivery of an ACT-based intervention via an automated mobile messaging robot in the acute postoperative period decreased opioid use in selected patients with orthopedic trauma. Participants receiving the ACT-based intervention also reported lower pain intensity after 2 weeks, although this may not represent a clinically important difference.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458063/

 

Yoga Surgery2 Khan

Improve Surgery Recovery with Yoga

 

By John M. de Castro, Ph.D.

 

“Yoga is a holistic approach to wellness. We already know the many benefits of yoga. Apart from yoga, even intensive stretching may improve chronic lower back pain and reduce your dependence on medication drugs. Patients have shown to benefit immensely from yoga after their back surgery. Research shows that 12 weeks of yoga can actually improve back function and reduce symptoms in people with chronic back pain.” – Jasmine Bilimoria

 

Yoga practice has been shown to have a myriad of beneficial effects on physical and psychological well-being and it can help the individual heal from physical or mental illness or injury. In India, it is a common and acceptable practice to include yoga and other ayurvedic practices along with modern medical techniques in treating patients. This provides an opportunity to investigate the effects of these alternative practices on healing and recovery after a large array of medical interventions.

 

In today’s Research News article “From 200 BC to 2015 AD: an integration of robotic surgery and Ayurveda/Yoga”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1216640458359878/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756240/

Khan and colleagues investigate the effects of a package of alternative treatments including yoga, yogic breathing techniques, and massage on patients’ recovery after modern minimally invasive robotic thoracic surgery for a variety of conditions. They compared groups who received the additional treatments to those who did not. Yoga practices commenced shortly after surgery and were taught for as long as they were in the hospital (mean stay of 2.1 days). The patients were encouraged to continue practice at home after release from the hospital.

 

They found that the yoga practices group reported high satisfaction with the practices, less pain and use pain killing medications, less wound drainage, and less lung collapse. Hence, the yoga practices were effective in reducing pain and promoting recovery. These are interesting findings that these practices can improve recovery after surgery. This can have positive benefits for the patients and reduce hospital stays and overall treatment costs, making it attractive to the medical professions.

 

Since, this study was performed in India, where these practices are highly acceptable to the population, it remains to be demonstrated if they would be similarly effective in western countries. In addition, the yoga practices included a package of practices including postures, breathing, and massage. As a result, it cannot be determined which of these components, or which combinations of components, were required for effectiveness. Finally, since another active treatment or placebo control was not included in the study, it is impossible to determine if the effectiveness on recovery from surgery was due to the yogic practices or to a variety of contaminants including subject expectancy effects, demand characteristics, or experimenter bias. It remains for future research to verify the results under more controlled circumstances.

 

Regardless, the results are encouraging and provide the rationale to continue investigating the use of yogic practices to promote recovery after surgery.

 

“Yoga can be a great way to heal from surgery. However, as with any exercise after surgery, make sure you take it slow and do not push yourself. The best yoga for after surgery is Hatha yoga, which is very gentle and can be done very slowly. Hatha yoga focuses on a series of asanas done slowly and with deep breathing. If done properly, it is unlikely that it will do you any harm after the surgery.” – YogaWiz

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Study Summary

Khan, A. Z., & Pillai, G. G. (2016). From 200 BC to 2015 AD: an integration of robotic surgery and Ayurveda/Yoga. Journal of Thoracic Disease, 8(Suppl 1), S84–S92. http://doi.org/10.3978/j.issn.2072-1439.2016.01.74

 

Abstract

BACKGROUND: Among the traditional systems of medicine practiced all over the world, Ayurveda and Yoga has a documented history dating back to beyond 200 BC. Robotic and video assisted thoracic surgery (VATS) is an invention of the 21(st) century. We aim to quantify the effects of integration of Ayurveda and Yoga on patients undergoing minimally invasive robotic and VATS.

METHODS: Four hundred and fifty-four patients undergoing VATS and robotic thoracic surgery were introduced to a pre and postoperative protocol ofYoga therapy, mediation and oil massages. Yoga exercises included Pranayam, Anulom Vilom, and Oil Massages included Urotarpan. Preoperative and postoperative respiratory functions were recorded. Patient satisfaction questionnaire were noted. Statistical comparison was made to control group undergoing minimally invasive thoracic surgery without integrative medicine. Only one patient refused to undergo Ayurveda therapy and was deleted from the group.

RESULTS: Acceptability was high among all patients. Preoperative training led to implementation as early as 6 hours post surgery. Pulmonary function test showed significant improvement. All patients suggested an improvement in satisfaction score. Pain score were less in study patients. Quicker mobilization led to early discharge and drain removal. Chronic pain was prevented in patients having oil massages over the healed wound sites.

CONCLUSIONS: Integration of Ayurveda, Yoga and minimally invasive robotic and VATS is acceptable to Indian patients and gives better clinical results and higher patient satisfaction.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756240/