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Review
. 2020 Dec 8;9(1):38.
doi: 10.1186/s13741-020-00169-x.

Effects of psychological interventions on anxiety and pain in patients undergoing major elective abdominal surgery: a systematic review

Gianluca Villa  1   2 , Iacopo Lanini  3 , Timothy Amass  4 , Vittorio Bocciero  3 , Caterina Scirè Calabrisotto  3 , Cosimo Chelazzi  3   5 , Stefano Romagnoli  3   5 , A Raffaele De Gaudio  3   5 , Rosapia Lauro Grotto  6
Affiliations
Review

Effects of psychological interventions on anxiety and pain in patients undergoing major elective abdominal surgery: a systematic review

Gianluca Villa et al. Perioper Med (Lond). .

Abstract

A maladaptive response to surgical stress might lead to postoperative complications. A multidisciplinary approach aimed at controlling the surgical stress response may reduce procedural complications and improve patients' quality of life in the short and long term. Several studies suggest that psychological interventions may interact with the pathophysiology of surgical stress response, potentially influencing wound repair, innate and adaptive immunity, inflammation, perception of pain, and patients' mood. The aim of this systematic review is to summarise the effects of perioperative psychological interventions on surgical pain and/or anxiety in adult patients scheduled for elective general abdominal and/or urologic surgery.We conducted a systematic review of controlled clinical trials and observational studies involving psychological interventions for adult patients scheduled for elective general abdominal and/or urologic surgery. Only studies reporting pain and/or anxiety among outcome measures were included in the systematic review. The following psychological interventions were considered: (1) relaxation techniques, (2) cognitive-behavioural therapies, (3) mindfulness, (4) narrative medicine, (5) hypnosis and (6) coping strategies.We examined 2174 papers. Among these, 9 studies were considered eligible for inclusion in this systematic review (1126 patients cumulatively): 8 are randomised controlled trials and 1 is an observational prospective pre/post study.Psychological characteristics widely influence the pathophysiological mechanisms underlying the neuroendocrine and inflammatory response to surgical stress, potentially interfering with surgical outcomes. Psychological interventions are technically feasible and realistically applicable perioperatively during abdominal and/or urologic surgery; they influence the pathophysiological mechanisms underlying maladaptive surgical stress response and might have positive effects on patients' surgical outcomes, such as pain and anxiety.

Keywords: Cognitive behaviour therapy; Hypnosis; Metabolic stress response; Mindfulness; Narrative medicine; Perioperative care.

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Conflict of interest statement

The authors declare the following conflicts of interest. Dr Villa has received support for travel expenses, hotel accommodations, and registration to meetings from Baxter S.p.A. and Pall International. Dr Chelazzi has received honoraria for lectures by Orion Pharma; support for meetings (travels, hotel accommodations and/or registration) by BBraun, Astellas, MSD, Pfizer, Pall International, Baxter, and Orion Pharma. Prof. Romagnoli has received honoraria for lectures, grants for consultancy, and support for travel expenses, hotel accommodations, and registration to meetings from Baxter, Orion Pharma, Vygon, ICU Medical, MSD, Medtronic, Baxter, BBraun, and Pall International. Prof. De Gaudio has received research grants from MSD Italia, Baxter, and Pall international.

Figures

Fig 1.
Fig 1.
Flow chart of the screening process used to identify eligible studies. Exclusion criteria are not mutually exclusive and identified studies can fall into more than one category
See this image and copyright information in PMC

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