# Preventing Chronic Post-Surgical Pain and Prolonged Opioid Use: The Perioperative Pain Self-Management Program

> **NIH VA I01** · IOWA CITY VA MEDICAL CENTER · 2021 · —

## Abstract

Background: Surgery can precipitate the development of both chronic pain and long-term opioid use.
Preoperative psychological distress is a risk factor for poor post-surgical outcomes. Strategies are needed to
augment perioperative pharmacotherapeutic management of pain with non-pharmacologic strategies to
optimize post-operative outcomes. Psychological interventions such as cognitive behavioral therapy (CBT) can
effectively reduce distress and improve functioning among patients with chronic pain. While CBT has been
used extensively in patients with established chronic pain, it has not been used as a preventive intervention
targeting the transition from acute to chronic postsurgical pain.
 Significance/Impact: This proposal addresses the priority areas of chronic pain and opioid use. This study
enhances biopsychosocial pain care during the perioperative period and offers a model to prevent the
development of chronic pain and prolonged opioid use following surgery.
 Innovation: The proposed innovative approach to preventing, rather than managing, chronic postsurgical
pain among Veterans could incite a clinical paradigm shift from pain treatment to prevention.
 Specific Aims: Aim 1: Use a Hybrid Type 1 Randomized Controlled Trial design to examine the efficacy of
the Perioperative Pain Self-management (PePS) program versus Standard Care (SC) for preventing chronic
postoperative pain and prolonged opioid use. Exploratory analyses will examine whether substance use
disorders moderate treatment effects and whether changes in pain catastrophizing and self-efficacy relate to
postoperative pain at 6-months post-surgery. Aim 2: Determine the impact of the PePS program on secondary
outcomes: mood, functioning, and non-opioid analgesic prescriptions. Aim 3: Evaluate the context of
implementation by examining acceptability, feasibility, and appropriateness among Veterans and care team
members, and quantifying intervention-specific personnel-related costs. Based on the Implementation
Outcomes framework, the current study will use primarily qualitative methodology for aim 3.
 Methodology: The current study is a hybrid efficacy-implementation design to facilitate a more rapid move
toward broad-based dissemination and uptake of the PePS program. For Aim 1 and 2 we will utilize a single-
blind, two-arm, parallel, randomized control trial. Participants will include 400 Veterans scheduled at the Iowa
City or Minneapolis VAs for unilateral primary total joint arthroplasty. Participants will be randomized to PePS
or SC. The PePS program includes 4 telephone sessions: Session one will be preoperative and include an
introduction to relaxation and the importance of interpretation in the pain experience. Session two (two weeks
postoperative) will include: review of relaxation and the connection between thoughts/interpretation and pain,
and introduction to thought records. Session three will include review of thought records and relaxation and
introduction to goal-setting...

## Key facts

- **NIH application ID:** 10186447
- **Project number:** 1I01HX003225-01A1
- **Recipient organization:** IOWA CITY VA MEDICAL CENTER
- **Principal Investigator:** Katherine E. Hadlandsmyth
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-08-01 → 2025-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10186447

## Citation

> US National Institutes of Health, RePORTER application 10186447, Preventing Chronic Post-Surgical Pain and Prolonged Opioid Use: The Perioperative Pain Self-Management Program (1I01HX003225-01A1). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10186447. Licensed CC0.

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