The effect of mindfulness-based preoperative education on postoperative pain: a Solomon four-group randomized controlled trial

This study aimed to evaluate the effectiveness of mindfulness-based preoperative education on postoperative pain-related cognitive intrusion and fear of pain among patients undergoing elective inguinal hernia surgery. A Solomon four-group randomized controlled trial design was employed to control for potential pretest effects. A total of 68 patients scheduled for mesh-based inguinal hernia repair were randomly assigned to two experimental groups (EG1, EG2) and two control groups (CG1, CG2). Pretests were administered only to EG1 and CG1. The intervention consisted of awareness-based mindfulness education delivered preoperatively. Data were collected using the Sociodemographic Information Form, the Experience of Cognitive Intrusion of Pain Scale (ECIPS), and the Fear of Pain Questionnaire-III (FPQ-III). Statistical analyses were conducted with nonparametric tests, and a p-value < .05 was considered significant. Groups were homogeneous regarding sociodemographic and clinical characteristics (p > .05). Postoperative comparisons among the four groups revealed no statistically significant differences in cognitive intrusion of pain or fear-of-pain subdimensions. However, when pre–post changes were examined between EG1 and CG1, the mean ECIPS score decreased by 5.9 points in EG1 but increased by 10.2 points in CG1, a significant difference favoring the intervention group (p = 0.005, r = 0.49). No significant between-group differences were found for the FPQ-III subscales of severe, mild, or medical pain fear (p = 0.499, p = 0.690, p = 0.112). The findings indicate that mindfulness-based education may be associated with reductions in postoperative cognitive intrusion of pain in pretest–posttest comparisons, although most outcomes did not reach statistical significance. Although changes in pain-related fear were not significant, the findings indicate that mindfulness-informed education may enhance patients’ psychological readiness before surgery. Future studies with larger and more diverse samples are recommended to confirm these findings and explore long-term effects. NCT06449144 (Registry date: 07 July 2024).