TABLE 1.

Summary of Included Studies

				Results
Author/Year/Country	Study Design	Participants and Setting	Intervention	Pain (VAS/VRS)	Time of Measurement	Opioid Utilization	Quality*
McCarthy et al[19] 2019, the United States	RCT	Emergency department (n = 6520	Written and spoken explanation of information sheet about hydrocodone–acetaminophen + daily educational text messages: side effects, dangers of combination with medication and substances, mechanism of action.	Not applicable	Phone call 7–14 days after emergency department visit	Safe use	Good
			Intervention included provider-targeted measures: alert to counsel patient about safe use, reminder to primary care/outpatient provider to counsel patient about safe use of new prescription, request dispensing pharmacist on counsel about safe use.			Intervention arms demonstrated safe use compared with control P < 0.025, OR 2.46 (1.19–5.06)
						Knowledge
						Intervention (education + SMS) demonstrated increased knowledge compared with control P < 0.025 OR 0. 57 95% CI: (0.09–1.06)
Mears et al[24] 2019, the United States	Retrospective cohort study	Orthopaedic surgery department (n = 2654)	Preoperative patient education on pain and opioid utilization	Not applicable	30 days postdischarge	Tablets per prescription (Percocet): 47.2 (pre) versus 39.2 (post) P < 0.0001	Good
			Part of policy implementation which also included procedure-based narcotic prescription allocation (small procedure 20 tablets, moderate procedure 40 tablets, large procedure 60 tablets) and only 1 narcotic per prescription.			Mean MME prescribed: 354 (pre) versus 265 (post) P < 0.0001
						Avg. prescription: 1.76 (pre) versus 1.34 (post) no P value
						# Of refills 949 (pre) versus 404 (post) no P value
						30-day readmission rate 6.2% (pre) versus 4% (post) no P value
McCarthy et al[20] 2015, the United States	RCT	Emergency department (n = 220)	Written and spoken explanation of information sheet about hydrocodone–acetaminophen: side effects, dangers of combination with medication and substances, mechanism of action, risk of addiction.	4.7 (control) versus 5.1 (intervention)	Phone call 4–7 days after emergency department visit	Average number of tablets taken per day at home 2 (control) IQR 1–2 versus 2 (intervention) IQR 1–3, P = 0.83	Good
						Retained knowledge
						Precautions related to taking additional acetaminophen: 38%, 95% CI = 28.3%–47.7% (intervention) versus 18.2% (control) 95% CI = 10.9%–25.5%, P < 0.05
						Side effects: Median 2 (intervention) IQR 1–2 versus 1 (control) IQR 0–2, P < 0.001
						Driving within 6 h after taking hydrocodone: 3% (intervention) CI = −0.3%–6.3% versus 13.6% (control) 95% CI = 7.2%–20%, P < 0.05
Wong et al[25] 2014, China	Quasiexperimental	Orthopaedic surgery department (n = 152)	Preoperative 20-minute brief educational intervention: enhance knowledge on stress and anxiety coping	3.0 (control) versus 2.3 (intervention)	Days 2, 4, 7 (inpatient)	Not applicable	Good
			Reduce anxiety and gain self-efficacy.
Holman et al[23] 2014, the United States	Retrospective cohort study	Orthopaedic surgery department (n = 613)	Preoperative counseling by physician: length of the prescription (only 6 weeks), side effects of opiates and possibility of dependency, acknowledging the discomfort and pain they may experience.	Not applicable	6, 12 weeks	Patients who received counseling were more likely to stop opioid use by 6 weeks post operatively (73% vs. 64%) (P = 0.012); at 12 weeks, the likelihood that patients had stopped opioid use was equal (80% and 80%) (P = 0.90)	Good
Wong et al[26] 2010, China	Quasiexperimental	Orthopaedic surgery department (n = 125)	Preoperative 30-minute education: pain, coping strategies, breathing relaxation exercises.	Decreased throughout inpatient stay (intervention)	Inpatient, 1 month, 3 months	Increased analgesic request at day 2	Good
Oliveira et al[21] 2006, the United States	RCT	Emergency department (n = 126)	Psychoeducational video in ED: pathophysiology of whiplash, symptomatology within 48 h (including pain), medical treatment, symptomatology after 48 h (including pain), recovery time, nonmedical alternatives (including breathing techniques and relaxation).	5, 4.5, 4.80 (control) versus 1.5 1.25 0.57 (video), LR 15.6 at 6 months	Phone call at 1, 3, 6 months	Taking narcotics: 32%, 36%, 36% (control) versus 2%, 2%, 4% (video) < 0.001	Good
Ceccio et al[22] 1984, the United States	RCT	Orthopaedic surgery department (n = 20)	Perioperative Jacobson Relaxation technique: tongue and jaw exercises, coordinated rhythmic breathing, and a lack of attention to thoughts, words, and speech.	5.6 (control) versus 3.9 (intervention)	Within 24 h postoperatively (inpatient)	Intramuscular meperidine mg: 135.0 ± 39.441 (control) versus 87.5 ± 44.488 (intervention) P < 0.05	Fair

^*Quality assessment based on Cochrane Risk of Bias Tool for risk of bias in RCTs and Risk Of Bias In Nonrandomized Studies of Interventions (ROBINS-I0).

CI, confidence interval; IQR, interquartile range; LR, likelihood ratio; MME, morphine milligram equivalent; VAS, visual analog scale; VRS, visual rating scale.