Online Brief Mindfulness-Based Intervention for Subacute Pain After Total Hip or Knee Replacement: A Pilot Randomized Controlled Trial

Recent brief mindfulness-based interventions (MBI) provided before surgery have shown promising results in improving clinical outcomes in patients undergoing total joint arthroplasty (TJA). However, they have not been delivered in the subacute phase after surgery to target patients at risk for chronic postsurgical pain (CPSP). The use of technologies allowing remote and online delivery can help increase the accessibility of these interventions.

We conducted a single site, two-arm pilot randomized controlled trial to evaluate the feasibility, acceptability, and preliminary effects of online Mini More (i.e., a condensed, 4-week mindfulness-based program) promoting pain self-management during the subacute postoperative phase. We randomized 36 patients into two groups (Mini MORE, n = 18 and Pain Coping Education, n = 18). Postoperative outcomes were: pain intensity, pain interference, analgesic medication use, pain catastrophizing, pain acceptance and mindfulness.

Results indicated that Mini MORE was highly feasible and well received. Further, results indicated that pain intensity (d = 1.47, p < 0.001) as well as pain interference levels (d = 1.04, p = 0.005) and medication use (Cliff’s Delta=-0.56, p = 0.02) were significantly different between groups after treatment. Statistically significant group by time interactions were found for both pain intensity (p < 0.001) and pain interference (p = 0.003), and a trend toward a decrease in pain medication use (p = 0.05) was observed in favor of the Mini MORE group. No statistically significant differences were found between groups for pain acceptance (d = -0.58), pain catastrophizing (d = 0.01) and mindfulness (d = -0.23).

Our results suggest Mini MORE is a feasible and acceptable brief, online MBI potentially capable of decreasing pain intensity and pain interference in the subacute period after TJA, thus Mini MORE may be a promising tool for preventing CPSP.

NCT04848428