# Integrating Pain Prehabilitation into Surgical Pathways: Current Modalities, Outcomes, and Research Gaps

## TL;DR

This review explores how prehabilitation can improve surgical outcomes by addressing pain-related risks before surgery.

## Contribution

The paper provides a synthesis of current prehabilitation strategies and identifies gaps in pain outcome reporting.

## Key findings

- Exercise-based prehabilitation was most commonly used across surgical specialties.
- Only 29.5% of studies included nutritional interventions as part of prehabilitation.
- Multimodal prehabilitation approaches were less common in cardiothoracic surgery compared to general surgery.

## Abstract

Prehabilitation constitutes a multidisciplinary strategy aimed at improving physiological and psychological readiness prior to surgery. Within pain medicine, prehabilitation provides an opportunity to address modifiable pain-related and functional risk factors prior to major procedures. This narrative review synthesizes contemporary evidence on prehabilitation modalities, their impact on surgical and pain-relevant outcomes, and persistent knowledge gaps limiting integration into perioperative pain pathways.

A targeted PubMed search was performed on June 25, 2025. Supplementary exploratory searches in Web of Science and Scopus did not identify unique eligible studies beyond those already captured in PubMed. After excluding non-original reports and studies lacking outcome data, 153 clinical studies were included. The most frequently represented surgical specialties were general surgery (43%), orthopedic surgery (21%), and cardiothoracic surgery (18%). Single-modality prehabilitation was reported in 43% of studies, whereas multimodal approaches varied by specialty, occurring in 36% of general surgery studies and 13% of cardiothoracic surgery studies. Five principal prehabilitation modalities were identified: exercise, nutrition, psychological intervention, substance cessation, and medical optimization. Exercise-based interventions were the most common, incorporated in 84.7% of studies, followed by nutritional interventions in 29.5%. Overall, 82% reported improvements in at least one postoperative or functional outcome, although pain-specific endpoints were inconsistently reported.

Prehabilitation appears beneficial across surgical specialties; however, pain outcomes remain underreported, and multimodal programs remain limited. Future work should standardize pain endpoints and evaluate multimodal interventions to guide integration of prehabilitation into perioperative pain management pathways.

The online version contains supplementary material available at 10.1007/s11916-025-01464-2.