The effect of peri-operative pain neuroscience education on post-operative pain and recovery in adult patients receiving laparoscopic inguinal hernia repair---A prospective randomized controlled trial

Abstract Background Peri-operative pain neuroscience education(PNE) is emerging as a peri-operative pain-specific cognitive therapy. To optimize the efficacy of analgesia for patients receiving laparoscopic inguinal hernia repair, PNE was incorporated into multi-modal analgesia. Materials and methods A randomized controlled trial was conducted to compare conventionally peri-operative multi-modal analgesia (group CA) and the addition of pain neuroscience education into it (group PNE). Setting: this study was designed and conducted in a tertiary teaching hospital in Southwest China.patients receiving laparoscopic hernia repair. The peri-operative pain trajectory were investigated. Characteristics of peri-operative pain was evaluated with Douleur Neuropathique 4 questionnaire (DN−4), central sensitization inventory (CSI) and pain catastrophizing scale (PCS) post-operatively. Pressure pain threshold was also compared between two groups .Post-operative quality of recovery was measured with EuroQol five dimensions questionnaire (EQ-5D-5L).The incidence of chronic post-operative pain at 3 months after surgery was also recorded. Results A total of 184 patients consented to participate in this study and finished follow-up.Compared with those receiving conventional analgesia (group CA,N = 91), patients in group PNE (N = 93) reported reduced intensity of acute pain from 12 till 72 hours after surgery and less dosages of opioid during hospitalization (p < 0.05). Catastrophizing, sensitization of peri-operative pain were reduced in group PNE (p < 0.05). Quality of recovery was improved till one month after surgery(p < 0.05). Conclusions The addition of pain neuroscience education into peri-operative multi-modal analgesia improved analgesic effect and quality of recovery for patients undergoing laparoscopic inguinal hernia repair. This psychological analgesic regimen also helped reduce sensitization and catastrophizing of acute surgical pain in these patients.