Mindfulness-based intervention for non-farmacological pain control after Total Hip and Total Knee Arthroplasty: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background

Pain control after Total Hip and Total Knee Arthroplasty (THA and TKA) mainly relies on medications including nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid medications. Despite generally positive outcomes, a substantial subset of patients experiences chronic post-surgical pain and dissatisfaction. This systematic review and meta-analysis aimed to evaluate the effectiveness of mindfulness-based interventions (MBIs) in reducing postoperative pain in patients undergoing THA and TKA.

Methods

Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted across PubMed, Embase, and Cochrane databases, including manual searches. The eligibility criteria included randomized controlled trials (RCTs) that assessed explicit MBIs on postoperative pain in THA or TKA patients, with outcomes including pain intensity, opioid use, and physical function. Risk of bias was evaluated using the RoB2 tool. A meta-analysis was performed on the studies included in the review.

Results

Out of 324 unique results, 5 RCTs met the inclusion criteria, encompassing 778 patients. The interventions varied from single-session mindfulness practices to multi-week courses. The meta-analysis demonstrated a significant reduction in standardized pain scores (Hedge’s g −1.83, 95%CI: −2.70; −0.96, p = 0.002) for MBI groups compared to controls, with high heterogeneity (I² = 80.0 %). Influence analysis indicated no single study disproportionately influenced the results. The Correlated and Hierarchical Effects (CHE) model confirmed the robustness of these findings.

Conclusions

MBIs are associated with a significant reduction in postoperative pain following THA and TKA, representing a viable non-pharmacological option for pain management. Further research should focus on optimizing the timing and delivery of these interventions to enhance their efficacy.