A Simple Preoperative Talk With a Nurse Cuts Pain After Orthopedic Surgery, Trial Finds

Orthopedic surgery has a reputation that precedes it. Patients facing hip replacements, fracture repairs, or spinal procedures often arrive at the hospital braced for agony, and that dread is not merely an emotional footnote. Pain after orthopedic operations tends to be among the most intense of any surgical category, and how patients think about that pain, before the first incision is ever made, appears to shape how much of it they ultimately feel. A new randomized controlled trial from Türkiye suggests that a structured, nurse-led education session delivered before surgery can meaningfully reduce postoperative pain intensity while reshaping the beliefs patients carry about what pain means. The findings, published in BMC Nursing, point to a remarkably low-cost intervention that could be folded into routine perioperative care.

The study, conducted by İsmail Aşatır and Atiye Erbaş of Duzce University’s Department of Surgical Nursing, enrolled 122 patients at the orthopedic clinic of a tertiary university hospital between November 2023 and February 2024. Participants were randomly assigned in equal numbers to an intervention group and a control group, with 61 patients in each arm. Those in the intervention group received a structured preoperative pain education program delivered by nurses, while the control group received the standard care normally provided at the clinic. The trial was prospectively registered with ClinicalTrials.gov under identifier NCT06104254 on 23 October 2023, before participant enrollment began, a detail that strengthens confidence in the integrity of the randomization protocol.

The researchers tracked two primary outcomes: the intensity of pain patients reported after surgery, measured on the Numeric Rating Scale, and the patients’ pain beliefs, assessed with the Pain Beliefs Scale. The Pain Beliefs Scale distinguishes between two fundamentally different ways of thinking about pain. Psychological pain beliefs frame pain as something influenced by thoughts, emotions, and mental states, whereas organic pain beliefs attribute pain entirely to physical injury and tissue damage. This distinction matters because a growing body of pain science suggests that patients who understand pain as modifiable, rather than as a pure readout of bodily harm, tend to cope better and report less severe pain.

To analyze their data, the team used linear mixed-effects models, a statistical approach well suited to repeated measurements collected over time. Rather than comparing groups only at a single moment, mixed-effects models can capture how outcomes evolve across multiple postoperative time points and can test whether the two groups followed different trajectories. The key quantity in such analyses is the group-by-time interaction, which asks whether the change over time in one group differs statistically from the change over time in the other. A significant interaction is the signature of diverging paths, not merely a difference in a snapshot.

That is precisely what the researchers found for postoperative pain intensity. The linear mixed-effects model demonstrated a significant group-by-time interaction, indicating that pain followed genuinely different trajectories in the intervention and control groups. In practical terms, patients who had received structured preoperative pain education from nurses experienced a more favorable course of postoperative pain than those who received standard care alone. For a field in which postoperative pain management still relies heavily on escalating analgesic regimens, the idea that a conversation before surgery can bend the pain curve is striking.

The effects on pain beliefs were more nuanced. The analysis revealed a significant group-by-time interaction for psychological pain beliefs, meaning the education program produced measurable shifts in how patients conceptualized the psychological dimension of pain. Patients who had been educated came to view pain as something their thoughts and coping strategies could influence, a reframing that aligns with modern biopsychosocial models of pain. However, no significant intervention effect was found for organic pain beliefs. In other words, the program successfully updated patients’ understanding of the psychological side of pain but did not alter their conviction that pain fundamentally originates in physical injury, which the researchers suggest may be a more entrenched belief to shift.

The trial also examined several secondary factors. Pain intensity tended to be higher among women and among patients who reported fear of pain before their operations, although these differences did not reach statistical significance in the analysis. The directional pattern is nonetheless consistent with a wider literature linking preoperative pain catastrophizing and anxiety to worse postoperative outcomes, and it hints that patients who arrive frightened may be precisely those who benefit most from reassurance and preparation. Larger trials would be needed to determine whether these subgroup patterns are real effects or statistical noise.

What makes the findings compelling is the simplicity of the intervention relative to its reach. Preoperative education requires no new drugs, no additional hardware, and no change to surgical technique. It asks nurses to spend time before surgery explaining what patients should expect, how pain can be managed, and what role their own beliefs and behaviors play in recovery. Orthopedic wards are staffed by nurses who already interact with patients in the preoperative window, so embedding structured pain education into that existing contact represents a marginal cost for a potentially substantial gain in patient comfort, mobility, and possibly even length of stay.

The authors conclude that preoperative nursing education was associated with reduced postoperative pain intensity and favorable changes in psychological pain beliefs, though not in organic pain beliefs, and they suggest that structured preoperative pain education be considered as part of routine perioperative nursing care to improve postoperative pain management. The research received no specific grant from any funding agency and was approved by the Ethics Committee of the Faculty of Medicine at Duzce University, with the trial conducted in accordance with the Declaration of Helsinki.

Limitations and open questions remain. The study was conducted at a single tertiary center in one country, and the generalizability of the effect to other health systems, surgical populations, and cultural contexts will need to be tested. The incomplete shift in organic beliefs suggests that education programs might be strengthened by directly addressing the intuitive but incomplete equation of pain with tissue damage. Still, the trial adds to mounting evidence that the mind’s framing of pain is not a passive bystander in recovery. As health systems search for affordable ways to improve surgical outcomes, this study suggests one of the most powerful tools available may be a well-informed nurse and a few crucial minutes before the operation begins.

Subject of Research: Effect of preoperative nurse-led pain education on postoperative pain and pain beliefs in orthopedic surgical patients

Article Title: The effect of preoperative nursing education on postoperative pain intensity and pain beliefs in orthopedic surgical patients: randomized controlled trial

Article References: The effect of preoperative nursing education on postoperative pain intensity and pain beliefs in orthopedic surgical patients: randomized controlled trial. (n.d.). https://doi.org/10.1186/s12912-026-05422-0

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05422-0

Keywords: preoperative education, postoperative pain, orthopedic surgery, pain beliefs, nursing, randomized controlled trial, pain management, pain intensity, perioperative care, Turkey, BMC Nursing, biopsychosocial model