Psychological management of postsurgical pain and patient adherence

The advantages of proper management of postsurgical pain include fewer postoperative complications; increased early ambulation and mobilization; decreased opportunity for chronic pain syndromes to occur; shorter, less complicated rehabilitation; greater patient satisfaction; and increased patient adherence to prescribed regimens. In turn, greater adherence positively affects pain management and, therefore, patients, satisfaction with their surgeon. A variety of approaches may be used for the management of acute pain, and the "psychological preparation" of the patient prior to surgery plays a significant role. Specific approaches include (1) cognitive-behavioral (such as diaphragmatic breathing, positive visualization rehearsal, and autogenic training); (2) hypnosis; (3) biofeedback; and (4) microelectrostimulation. Some of these approaches to pain management apply during surgery and the recovery and rehabilitation periods. Many of the approaches can be carried out relatively easily by the physician and his or her staff; in some cases, specialists, such as psychologists trained in behavioral medicine, are needed. Variables that affect patient adherence, both positively and negatively, include patient motivations, the nature and chronicity of the disorder, treatment variables, and the quality of the patient-doctor relationship. Physician behaviors may encourage or discourage patient adherence.