Presentation on theme: "The effect of pain on postoperative adjustment in patients undergoing colposcopy Susanna Kola & Jane C. Walsh 1 School of Psychology, National University."— Presentation transcript:
The effect of pain on postoperative adjustment in patients undergoing colposcopy Susanna Kola & Jane C. Walsh 1 School of Psychology, National University of Ireland, Galway INTRODUCTION Invasive medical procedures are considered very stressful and anxiety evoking by patients. Anxiety in turn affects acute pain, such that heightened anxiety reduces pain threshold, which may limit a physician’s ability to complete a procedure. Anxiety and pain experienced by patients prior to and during medical procedures also impact negatively on postoperative outcomes, e.g., post- operative pain, poorer recovery, increased analgesic use, increased physical complaints, and reduced immune function (e.g., Kain et al., 2000; Kielcolt-Glaser et al., 1998; Osborn & Sandler, 2004). PURPOSE The results reported are from a distraction intervention study designed to reduce anxiety, pain and discomfort in a clinical setting with patients undergoing invasive cancer screening.METHOD Participants and design 164 first-time colposcopy patients, aged between 18-58 years (mean age 30.28, SD = 8.66) participated in a randomised controlled trial.Materials Anxiety prior to the procedure was measured by STAI (Spielberger et al., 1983) Experienced pain and discomfort intensity was measured by two 100 mm visual analogue scales Sensory, affective and evaluative pain measured by McGill Pain Questionnaire (Melzack, 1975) Positive and negative affect measured by PANAS (Watson et al., 1988) Procedure State anxiety, positive and negative affect were assessed before and after the procedure. During colposcopy, patients were assigned to one of four conditions: audiovisual relaxation (watching relaxing DVD using head-mounted display), distraction (playing computer game), sensory focus (focus on sensations experienced and view procedure), or control (standard care). Observational measures of anxiety were assessed during the procedure. Following colposcopy, patients were again assessed on anxiety, mood, and experienced pain and discomfort. Additionally, pulse and blood pressure readings were taken before, during and after the procedure.RESULTS Preliminary results are reported. Three pain intensity groups were created based on patients reports of experienced pain during the procedure: high, medium and low pain. A two-way factorial analysis of variance (ANOVA) revealed a significant main effect for condition on post-colposcopy state anxiety levels, F(3, 150) = 2.79, p<0.05. Pairwise comparisons showed that state anxiety levels were significantly lower for the sensory focus condition than for the distraction condition, and for the relaxation condition than for the distraction group. There was also a significant main effect for pain intensity experienced on post-colposcopy state anxiety, F(2, 150) = 19.20, p<0.05. Pairwise comparisons revealed that state anxiety was significantly lower for those patients who experienced low pain compared with the other two groups, which were also significantly different from one another. There was no significant interaction effect. A one-way ANOVA showed a significant effect of level of pain experienced on observations of distress during the procedure, F(2, 159) = 4.41, p=0.14. A one-way ANOVA revealed a significant effect of pain experienced on post-colposcopy positive affect, F(2, 157) = 12.24, p=0.00. A one-way ANOVA showed a significant effect of pain experienced on post-colposcopy negative affect, F(2, 157) = 7.78, p=0.01. DISCUSSION These findings show that patients undergoing colposcopy, a stressful invasive cancer screening procedure, benefited from sensory focus and relaxation during the procedure, whereas distraction led to higher post- colposcopy state anxiety levels. In other words, those women who focused on the objective sensory aspects of the experience while viewing the colposcopy screen and those that relaxed by watching a nature DVD through audio-visual glasses had lower state anxiety post- colposcopy, compared with patients who were actively distracted by a computer game during the procedure. In addition, high levels of pain experienced during the procedure were associated with poorer adjustment both during and following colposcopy. Patients in the high pain group were observed to engage in more distress-related behaviours, such as moaning and groaning and body movements during the procedure, compared with patients who experienced low or moderate pain. Finally, those patients who reported high levels of pain experienced higher state anxiety levels, lower positive affect, and greater negative affect following the procedure, compared with those that reported low or moderate pain. These results, while preliminary, suggests relaxation and sensory focus are beneficial interventions, and that pain during colposcopy is associated with poor adjustment at the time of colposcopy and following it. Contact Susanna Kola: S.Kola1@nuigalway.ie
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