How can expectation effects help to reduce pain after a hip operation?

Many older people require an artificial hip. Therefore, a total hip replacement (THR) is one of the most frequently performed major orthopaedic operations. Patients opt for this procedure because they are suffering from pain and because their movement is substantially restricted. However, the period before the upcoming operation is often one of emotional stress. Moreover, as with any surgery, patients initially suffer from acute pain after their operation, and strong postoperative pain poses a risk of chronic pain and pain-related disability.

In patients who enter into their operation with negative expectations, it tends to be more likely that the pain and impairments will be maintained after the operation. And this is precisely where intervention is crucial, namely by positively influencing patients’ expectations. In Project A13, we are researching how patients’ treatment expectations before an operation can be positively influenced in order to alleviate pain and impairment by means of an optimistic and confident outlook.

Practitioner communication and observing others influence the perception of pain

During the first funding period of our Collaborative Research Centre, we demonstrated in Project A13 that negative treatment expectations before a total knee replacement (TKR) operation led to stronger postoperative pain, and that optimized practitioner communication had a positive influence on pain. We also found that in people with chronic back pain, positive expectations induced by observing other sufferers improved the treatment with pain medication or with open-label placebos: When patients experience positive treatment outcomes in others, they enter into their own operation with a more optimistic attitude – and, on average, go on to have less pain themselves.

Concrete concepts for clinical routine

In the second funding period, we are extending our research to include expectation effects in the case of hip operations and subsequent postoperative pain. Our goal is to develop concrete concepts to optimize treatment expectations, which can be used in everyday clinical routine and help patients following hip replacement surgery. For this purpose, we are again building on the two pillars of expectation modulation: doctor-patient communication and observational learning, as well as a combination of both.

How can doctors communicate with patients in a way that improves their expectations and consequently increases the likelihood of treatment success and of less postoperative pain? Is it possible to design positive social observations, for instance through videos of patients, that can be efficiently used in everyday clinical routine? Are potentially positive treatment effects of these interventions also reflected in objective, physiological parameters of the patients? By answering these questions, Project A13 hopes to further improve what is already a helpful treatment, and above all increase patients’ satisfaction.