In a groundbreaking study published in BMC Psychology in 2026, researchers led by Saray Kılıç and colleagues have explored the transformative potential of mindfulness-based preoperative education in managing postoperative pain. Employing a Solomon four-group randomized controlled trial design, the investigation delves deeply into how psychological preparation can influence a patient’s perception and experience of pain following surgery. This study comes at a critical time when the need for non-pharmacological approaches to pain management is increasing globally due to the opioid crisis and the limitations of conventional analgesics.
Postoperative pain remains one of the most challenging complications following surgical procedures. While advancements in surgical techniques have reduced many physical risks, pain control continues to be an unresolved issue, often leading to prolonged hospital stays, delayed recovery, and increased healthcare costs. The traditional reliance on opioids and other pain medications, though effective in many cases, carries significant risks including addiction, tolerance, and adverse side effects. Mindfulness-based interventions offer a promising alternative by targeting the cognitive and emotional aspects of pain, rather than merely its physiological basis.
The study’s innovative use of the Solomon four-group design allowed the researchers to isolate and quantify the effects of mindfulness-based preoperative education from confounding psychological and procedural variables. By comparing multiple groups—some receiving the mindfulness intervention before surgery, some after, and others as control groups—the trial meticulously distinguished the timing and efficacy of mindfulness training on postoperative outcomes. This rigorous methodological approach enhances the reliability and generalizability of the findings to diverse surgical contexts.
Mindfulness, broadly defined, involves cultivating moment-to-moment focused attention and awareness with an attitude of nonjudgmental acceptance. In the context of preoperative education, mindfulness training equips patients with strategies to regulate physiological stress responses and alter pain perception pathways before the trauma of surgery occurs. Patients learn techniques such as controlled breathing, body scanning, and cognitive reframing, which empower them to maintain psychological equilibrium despite postoperative discomfort.
One pivotal finding of the research was that patients who underwent mindfulness education prior to their surgical procedures reported significantly lower pain intensity scores in the immediate postoperative period when compared to controls. These patients also showed reduced levels of anxiety and improved emotional resilience, factors known to correlate closely with more favorable pain outcomes. The reduction in anxiety may itself act as a mediator in modulating the nociceptive processing amplified by stress.
The neurobiological underpinnings of mindfulness’s analgesic effects are increasingly illuminated by functional neuroimaging studies, which complement the current clinical findings. Mindfulness practices engage brain regions implicated in pain modulation such as the anterior cingulate cortex, prefrontal cortex, and insula. These areas contribute to top-down regulation, effectively dampening pain signal amplification in the central nervous system. The clinical trial’s results align with these mechanistic insights, suggesting that preoperative mindfulness reshapes patients’ neural pain pathways before surgical insult.
Beyond the subjective reduction in pain scores, the study also reported secondary benefits including decreased analgesic consumption and shorter hospital stays among mindfulness-trained patients. The cumulative effect of these improvements not only enhances individual patient outcomes but also has significant implications for healthcare systems striving to optimize resource allocation and patient throughput. Cost-benefit analyses are likely to favor incorporating such psychological interventions as adjuncts within standard preoperative care protocols.
Importantly, the simplicity and adaptability of mindfulness-based preoperative education make it a scalable intervention. Unlike pharmacological regimens, mindfulness does not require specialized infrastructure or complex dosing schedules. With growing telehealth capabilities, mindfulness programs can be delivered efficiently even in remote or underserved settings. This expands the potential reach of non-pharmacologic pain management strategies to populations that may otherwise lack comprehensive perioperative support.
The researchers meticulously controlled for confounding factors such as age, gender, type of surgery, and baseline psychological status, ensuring that the observed effects were attributable to the mindfulness intervention itself. This careful design reinforces the robustness of the conclusions, highlighting mindfulness as an independent contributor to postoperative pain mitigation. Future research could expand on these findings by exploring differential effects across various surgery types and patient demographics.
While the study’s timeline extended to the immediate and short-term postoperative phases, the potential for mindfulness interventions to impact long-term outcomes such as chronic post-surgical pain (CPSP) remains an exciting avenue for exploration. Chronic pain after surgery affects a substantial fraction of patients and is often refractory to conventional treatments. Early psychological modulation via mindfulness could interrupt the transition from acute to chronic pain, ultimately improving quality of life and reducing healthcare burden.
The success of this trial underscores the intersection of psychology, neurology, and surgery, advocating for an integrative biopsychosocial model in perioperative care. The prominence of patient mental health is increasingly recognized as vital to surgical recovery trajectories. Mindfulness-based preoperative education exemplifies how psychosocial interventions can be translated into clinical practice, providing holistic patient-centered care that transcends traditional biomedical approaches.
Critics may argue that mindfulness requires patient motivation and cognitive engagement, which could limit applicability in populations with cognitive impairments or severe psychological disorders. However, tailored adaptations and adjunctive support mechanisms could maximize accessibility. Implementation research is needed to determine best practices for integrating mindfulness education into diverse surgical workflows, from preadmission clinics to inpatient settings.
In conclusion, the findings from Kılıç, İbrahimoğlu, Mercan, and colleagues’ study pave the way for mindfulness-based interventions to be embraced as a standard facet of preoperative preparation. By harnessing the mind’s capacity to modulate pain perception, healthcare providers can offer safer, more effective, and more humane surgical experiences. This pioneering research invites clinicians, health systems, and policymakers to rethink pain management paradigms and prioritize psychological resilience as a cornerstone of perioperative care.
As the global healthcare community continues to grapple with opioid overuse and escalating surgical demand, innovations like mindfulness-based education promise a crucial shift toward sustainable, multidisciplinary approaches. Given the compelling evidence provided by this Solomon four-group randomized controlled trial, mindfulness training stands poised to revolutionize postoperative pain management and enhance recovery outcomes across a broad spectrum of surgical patients.
Subject of Research: The effect of mindfulness-based preoperative education on postoperative pain.
Article Title: The effect of mindfulness-based preoperative education on postoperative pain: a Solomon four-group randomized controlled trial.
Article References: Saray Kılıç, H., İbrahimoğlu, Ö., Mercan, N. et al. The effect of mindfulness-based preoperative education on postoperative pain: a Solomon four-group randomized controlled trial. BMC Psychol (2026). https://doi.org/10.1186/s40359-026-04056-w
Image Credits: AI Generated
