Acceptability of a brief behavioral pain treatment to enhance recovery after surgery.

Background: Enhanced recovery after surgery (ERAS) protocols are standardized perioperative treatment guidelines designed to enhance surgery outcomes and patient experience. Behavioral interventions to support the perioperative period are notably missing from spine surgery ERAs. Methods: After a successful clinical implementation pilot of a brief behavioral intervention Empowered Relief for Surgery (ER-S), the intervention was applied broadly in a large multi-site health center as part of standard of care for all spine surgery patients. This paper highlights clinical implementation alongside patient engagement and satisfaction data. Results: A total of 2105 orders for ER-S were placed from November 2021-June 2025 for the class. Within this time frame 1134 completed the class (54%), 636 canceled (30%) and 335 no showed (16%). Completion rates remained consistent across the four-year period, while the number of orders increased by 99% (314/yr to 626/yr) demonstrating increased provider uptake of the clinical treatment pathway as part of standard of care. A sub-set of ER-S completers took the satisfaction survey. The majority (131/241, 58%) of ER-S completers ranked the class high (8, 9, or 10) in areas of satisfaction, relevance, and utility. Conclusions: Brief behavioral intervention is feasible and acceptable as part of the perioperative pathway in spine surgery and may be a valuable inclusion in the ERAs pathway.