Surgical patients’ preoperative cognitive-emotional states may influence postoperative recovery and pain-related distress. Fear of pain and rumination about potential pain can interfere with successful postsurgical recovery. Mindfulness-based preoperative education may help reduce catastrophizing and rumination and, in turn, support recovery.  

Kılıç et al. [BMC Psychology] conducted a randomized controlled study examining whether mindfulness-based preoperative education reduces postoperative fear of pain and pain-related cognitive intrusion in patients undergoing elective inguinal hernia surgery.

The researchers randomly assigned 68 Turkish patients (average age 55 years; 91% male) scheduled for mesh-based inguinal hernia surgery to one of four groups: (1) a mindfulness group with pretesting; (2) a mindfulness group without pretesting, (3) a control group with pretesting; and (4) a control group without pretesting. This experimental design was intended to help distinguish effects due to pretesting from those due to mindfulness training itself. 

The mindfulness training education was delivered individually in a single face-to-face session lasting approximately 45-minutes and focused on present-moment awareness, attentional regulation, and cognitive coping with pain. One brief mindfulness exercise was completed during the session and a mindful eating activity was assigned as homework prior to surgery. Control groups received standard care at the clinic site. Preoperative self-report measures (administered only to the pretested experimental and control groups) and postoperative measures (administered to all groups) included the Experience of Cognitive Intrusion of Pain Scale (ECIPS) and the Fear of Pain Questionnaire-III (FPQ-III).

The results showed no significant postoperative differences between assigned groups. However, comparisons of pre-post change scores revealed a significant group difference within the pretested groups: the mindfulness group decreased average pain-related cognitive intrusion scores by 5.9 points, whereas the control group increased by 10.2 points (a reported medium-to-large effect). There were no significant between-groups differences on fear-of-pain scores.

The study suggests that a single session of preoperative mindfulness training education can reduce postoperative intrusive pain-related thoughts. The study is limited by the absence of significant postoperative between-group differences and, given the Solomon four-group design, by the possibility that pretesting produced differential responding to the intervention. Further, the single-session format is brief considering typical mindfulness programs (often 8 weeks), and it remains unclear whether changes in pain cognitions translate to improvements in postoperative pain or tissue recovery. 

Reference:

Saray Kılıç, H., İbrahimoğlu, Ö., Mercan, N., & Güneri, G. (2026). The effect of mindfulness-based preoperative education on postoperative pain: A Solomon four-group randomized controlled trial. BMC Psychology. 

Link to study