Do Relaxation Exercises Decrease Postoperative Pain after Rotator Cuff Repair? A Randomized Controlled Trial

Abstract

Objectives: During the last decade, concern about opioid dependence and abuse has spurred an increasing interest within orthopedic surgery to decrease reliance on narcotics for pain management. Non-pharmacologic interventions, such as patient opioid education, can decrease narcotic consumption after arthroscopic rotator cuff repair (ARCR). Another non-pharmacologic intervention, the use of relaxation exercises, has been promoted for pain management following surgical procedures; however, its’ effect has not been investigated following ARCR. The purpose of this investigation was to evaluate the effects of relaxation exercises on post-operative pain and narcotics use after ARCR. Methods: This was a prospective, randomized, controlled trial evaluating 151 consecutive patients undergoing ARCR. The treatment group (n: 75) received and reviewed relaxation education materials including a 5 minute video explaining relaxation breathing techniques, while the control group (n: 75) received no relaxation education materials. Both groups received a standardized pre-operative interscalene nerve block as well as the same standardized post-op care, including oxycodone 5mg/acetaminophen 325 mg, and cryotherapy. Patients recorded a 5-day journal of their pain level and opioid consumption. Patients were then queried with the American Shoulder and Elbow Surgeons (ASES) Shoulder Score, Single Assessment Numerical Evaluation (SANE) score, and Visual Analog Score (VAS) for pain pre-operatively, and at 2, 6, 12, 18, and 24 weeks post-operatively. Additionally, patients were given a follow-up survey at 2 weeks post-operative to assess subjective pain relief efficacy of the relaxation techniques. T-test analyses were utilized to compare differences between the treatment group and the control group. Results: Ninety-five percent of patients completed the follow-up survey. Sixty-three percent (43/68) of study group patients reported that the relaxation techniques decreased their pain levels, while 37% said that it had no effect on their pain. There were no significant differences between the study and control groups in mean post-op VAS pain scores on post-op day 1 (treatment: 55.40, control: 59.5; p= 0.94), post-op day 2 (treatment: 56.15, control: 56.93; p= 0.88), post-op day 3 (treatment: 48.38, control: 47.07; p= 0.52), post-op day 4 (treatment: 40.03, control: 45.54; p= 0.79) and post-op day 5 (treatment: 38.57, control: 40.57; p= 0.71). At two weeks post-op the study group consumed significantly less narcotics than the control group (mean: 21.7 doses vs. 29.7; p= 0.016, Cohen’s d: 0.42), and 51% were still performing the relaxation techniques. There were no significant differences in ASES and SANE scores at each time point throughout the study period. Conclusion: Although nearly two-thirds of patients in the treatment group believed that the use of relaxation breathing techniques decreased their pain, there was no difference in pain measures between the treatment group and the control group. However, the treatment group did utilize less opioid medication than the control group. While the effect on post-op pain is uncertain, the use of relaxation techniques can provide an easy to implement, non-pharmacologic strategy to significantly decrease narcotics consumption after ARCR.