JMIR Publications

ABSTRACT

Background:

Important levels of pain are reported upon discharge from major surgery with a risk of becoming chronic. Further, individuals express the need for support in managing pain after discharge. However, very few studies address pain management interventions in the post-discharge phase after surgery including for individuals undergoing total joint arthroplasty. We have conducted a pilot randomized controlled trial testing a brief mindfulness intervention targeting people at risk for chronic post-surgical pain 2 weeks after surgery. Although the intervention we proposed was judged as acceptable based on ratings obtained through a questionnaire, the nuanced perceptions of why and how it is considered acceptable are critical in refining the intervention. Moreover, the acceptability of mindfulness interventions in the perioperative context remains generally unknown and even more in the post-discharge setting.

Objective:

The purpose of this study was to use qualitative data to explore the individual perception of acceptability of a brief 4-week MBI for pain following discharge after a total joint arthroplasty.

Methods:

A qualitative description was used to assess patients’ perception of the preliminary version of the intervention for pain management following discharge after surgery. The qualitative assessment was done at the end of the 4-week intervention (6 weeks after surgery). Semi-structured interviews with open-ended questions were used to encourage free expression from participants (n=16) before proceeding to content analysis.

Results:

When reflecting on the benefits of the intervention, the main themes that emerged were: mindfulness, pain acceptance, and supplementary relief. Overall, the intervention was perceived as relevant and suitable during recovery although participants experienced a few challenges related to the novelty of mindfulness practice. Engagement and readiness were discussed in relation to adherence to the intervention. Addressing expectations and personal beliefs before the intervention could improve participant’s adherence. Offering additional support when spikes of pain occur could help overcome some challenges related to mindfulness practice during postoperative recovery.

Conclusions:

Given the increasing number of total joint arthroplasty surgeries performed each year and the ability of non-pharmacological interventions, such as mindfulness-based approaches, to support recovery and well-being, efforts should be made to increase patient access to these promising adjunctive treatments. Combining non-pharmacological interventions before and after surgery may be an interesting avenue to optimize pain relief and recovery as well as prevent complications. Finally, the use of technology could improve the accessibility as well as the scalability and adoption of these promising approaches for individuals with limited resources and mobility. Clinical Trial: NCT04848428