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(314) Is there a role for biofeedback in the management of acute postopoerative pain?
P54
Abstracts
(312) Anxiety sensitivity, experiential avoidance, and chronic pain
(314) Is there a role for biofeedback in the management of acute postopoerative pain?
L McCracken, E Keogh, K Vowles; Pain Management Unit, Royal National Hospital for Rheumatic Diseases & University of Bath, Bath, UK People often learn to respond with distress and avoidance to their own experiences of depression and anxiety. When people with chronic pain respond this way their overall level of distress may increase, they may struggle to avoid these emotional experiences, and their daily functioning may decrease. The purpose of this study was to examine the role of anxiety sensitivity (AS), or “fear of anxiety,” in relation to these processes. It was predicted that those persons with chronic pain who report higher AS would also report higher emotional distress overall and greater disability due to chronic pain. A second purpose was to examine whether therapeutic processes designed to reduce emotional avoidance could be demonstrated to reduce the role of AS in relation to this distress and disability. Subjects were 125 consecutive adult patients (64.8% women) seeking services from a specialty pain service in the UK. All patients completed a standard set of measures of AS, acceptance of pain, mindfulness, and values-based action, as well as measures of pain, disability, emotional functioning. In correlation and regression analyses AS was associated with greater pain, disability, and distress, for example, for the AS total score: r ⫽ .22, p ⬍ .05, r ⫽ .55, p ⬍ .001, r ⫽ .55, p ⬍ .001, respectively. In regression analyses the three proposed therapeutic processes (acceptance, mindfulness, and values), reduced the average variance accounted for by AS in patient functioning from ⌬R2 ⫽ .18 to ⌬R2 ⫽ .042. These results suggest that AS amplifies the impact of emotional distress on patient functioning in chronic pain and that processes of acceptance, mindfulness, and values-based action reduce this effect. Further investigation of these processes of emotional avoidance, and of the therapeutic processes of acceptance, mindfulness, and values, may lead to important treatment developments.
S Cheema, A Lebovits, M Dubois; NYU Pain Center, NYU School of Medicine, New York, NY Despite advances in postoperative pain control, patients often continue to report intense pain levels and unacceptable side effects post-surgically. Alternative methods of pain control, such as biofeedback have been demonstrated to be effective in the chronic pain setting, but have been rarely studied in the post-surgical setting. A new computer-based biofeedback program (The Wild Divine Project (TWDP)) offers a portable, biofeedback interface which may be useful in treating acute postoperative pain. The goal of the proposed study was to examine whether biofeedback can reduce pain, anxiety and pain medication consumption in the post-operative period after abdominal surgery. Thirty one women undergoing pelvic surgery (mean age⫽40; 52%Caucasian, 26%Black) were enrolled in a prospective, randomized study. Patients were started on a standardized dose of opioid given via IV PCA during the postoperative period, and were evaluated on the day after surgery for 24 hours. Patients randomized to the experimental group were provided with a laptop computer with a biofeedback videogame (TWDP) that teaches meditational, relaxation and breathing techniques which enables patients to modulate their heart rate, heart rate variability and skin conductance levels (SCL). Analyses to-date show that the biofeedback group (using it on average for over 2 hours) had consistently lower pain scores at each assessment than the comparison group (although not statistically different). Although 92% of the intervention group were glad they used it there were no differences between the groups in total opioid consumption, side effects experienced, or levels of anxiety. Higher pain scores at the second assessment point were significantly correlated with increased biofeedback use at the third evaluation. This ongoing study offers promising preliminary data that a portable biofeedback intervention brought to the patient’s bedside post-surgically may be of benefit in managing acute post-operative pelvic pain. A larger sample size may delineate additional positive effects.
(313) Confirmatory factor analysis of pain beliefs in significant others
(315) Effects of relaxation/music and patient teaching for pain management on salivary cortisol
A Loree, A Cano, L Miller; Wayne State University, Detroit, MI The Survey of Pain Attitudes (SOPA; Jensen et al., 1994) is one of the most commonly used measures of pain beliefs. Several subscales of the SOPA are related to pain adjustment and are modifiable by in behavioral treatments for pain. It is also possible that pain beliefs of family members may play an important role in support provision and treatment. For instance, family members’ attitudes about the extent to which they should be solicitous toward patients may contribute to healthrelated support. To our knowledge, family members’ pain beliefs have not yet been measured in the pain literature. To address this gap in the literature, we test a significant other version of the SOPA (SOPA-S) that assesses beliefs about a significant other’s pain. The sample consists of 200 undergraduates attending a large urban university in the Midwest. All completed an online version of the 57-item SOPA along with demographic questions. Confirmatory Factor Analysis using AMOS 7.0 demonstrated that the measurement models for the 7 subscales using the complete SOPA-S did not fit the data sufficiently; however, when the measurement models were restricted to SOPA-Brief items (30 items; Tait & Chibnall, 1997), 5 of the 7 scales exhibited a good fit. The structural model, in which all the scales were correlated with one another, did not fit the data well, suggesting that the subscales tap domains of pain beliefs that may not be correlated with one another. The results of this study provide some preliminary evidence for the validity of a significant other version of the SOPA. Continued research examining the correlates of SOPA-S will determine the extent to which the pain beliefs of significant others relates to pain adjustment in patients with pain as well as the quality of life of their significant others.
M Good, G Anderson, S Wotman, J Albert, X Cong, L Chiang, E Bernhofer; Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH Postoperative pain is a major physiological and psychological stressor. Studies have shown that stress and pain leave patients more susceptible to infection and complications. The purpose of this study was to determine whether two interventions, relaxation/music (RM) and patient teaching (PT) for pain management, reduce stress in postoperative abdominal patients. Abdominal surgery patients (N⫽517) (18-75 yrs) were randomly assigned to receive RM, PT, combination of RM and PT, or control. A 2x2 factorial design with pre and posttests was used to study the overall RM-Effect and PT-Effect on salivary cortisol. The interventions were tested at two 20-minute tests on postoperative day 2, morning and afternoon. Parotid saliva was stimulated with diluted lemon juice, collected in intra-oral cups, timed with a stopwatch, and flow rate was calculated as milliliters per minute. Analysis of obtained samples (N⫽ 164) was with High Sensitivity Salivary Cortisol Enzyme Immunoassay (Salimetrics, LLC). Higher cortisol was significantly related to GI/GU surgery (vs GYN) and male gender, r ⫽ .24 to .33. Lower cortisol was significantly related to greater postoperative activity, r ⫽ -.20 to -.29. Because pretest cortisol was strongly correlated with posttest cortisol in the morning, r ⫽ .82, p ⬍ .001 and afternoon, r ⫽ .86, p ⬍ .001, the pretests were used as covariates. Comparisons using ANCOVA showed that there was no RM-Effect or PT-Effect at either test. Post-hoc ANCOVA, controlling for pretests, indicated no significant effects when each intervention group was compared to the control group. There was no RM effect on pain or cortisol in the afternoon. Although the RMEffect reduced pain in the morning, it did not reduce cortisol. This may have been because pain was mild by day 2. Further analyses will be conducted to identify subgroups that may have benefited by lower cortisol. Funded by the National Institute of Nursing Research to Marion Good, RO1-NR3933 and the General Clinical Research Center, Case Western Reserve University. (Good, J Pain, 2006).
Abstracts
(312) Anxiety sensitivity, experiential avoidance, and chronic pain
(314) Is there a role for biofeedback in the management of acute postopoerative pain?
L McCracken, E Keogh, K Vowles; Pain Management Unit, Royal National Hospital for Rheumatic Diseases & University of Bath, Bath, UK People often learn to respond with distress and avoidance to their own experiences of depression and anxiety. When people with chronic pain respond this way their overall level of distress may increase, they may struggle to avoid these emotional experiences, and their daily functioning may decrease. The purpose of this study was to examine the role of anxiety sensitivity (AS), or “fear of anxiety,” in relation to these processes. It was predicted that those persons with chronic pain who report higher AS would also report higher emotional distress overall and greater disability due to chronic pain. A second purpose was to examine whether therapeutic processes designed to reduce emotional avoidance could be demonstrated to reduce the role of AS in relation to this distress and disability. Subjects were 125 consecutive adult patients (64.8% women) seeking services from a specialty pain service in the UK. All patients completed a standard set of measures of AS, acceptance of pain, mindfulness, and values-based action, as well as measures of pain, disability, emotional functioning. In correlation and regression analyses AS was associated with greater pain, disability, and distress, for example, for the AS total score: r ⫽ .22, p ⬍ .05, r ⫽ .55, p ⬍ .001, r ⫽ .55, p ⬍ .001, respectively. In regression analyses the three proposed therapeutic processes (acceptance, mindfulness, and values), reduced the average variance accounted for by AS in patient functioning from ⌬R2 ⫽ .18 to ⌬R2 ⫽ .042. These results suggest that AS amplifies the impact of emotional distress on patient functioning in chronic pain and that processes of acceptance, mindfulness, and values-based action reduce this effect. Further investigation of these processes of emotional avoidance, and of the therapeutic processes of acceptance, mindfulness, and values, may lead to important treatment developments.
S Cheema, A Lebovits, M Dubois; NYU Pain Center, NYU School of Medicine, New York, NY Despite advances in postoperative pain control, patients often continue to report intense pain levels and unacceptable side effects post-surgically. Alternative methods of pain control, such as biofeedback have been demonstrated to be effective in the chronic pain setting, but have been rarely studied in the post-surgical setting. A new computer-based biofeedback program (The Wild Divine Project (TWDP)) offers a portable, biofeedback interface which may be useful in treating acute postoperative pain. The goal of the proposed study was to examine whether biofeedback can reduce pain, anxiety and pain medication consumption in the post-operative period after abdominal surgery. Thirty one women undergoing pelvic surgery (mean age⫽40; 52%Caucasian, 26%Black) were enrolled in a prospective, randomized study. Patients were started on a standardized dose of opioid given via IV PCA during the postoperative period, and were evaluated on the day after surgery for 24 hours. Patients randomized to the experimental group were provided with a laptop computer with a biofeedback videogame (TWDP) that teaches meditational, relaxation and breathing techniques which enables patients to modulate their heart rate, heart rate variability and skin conductance levels (SCL). Analyses to-date show that the biofeedback group (using it on average for over 2 hours) had consistently lower pain scores at each assessment than the comparison group (although not statistically different). Although 92% of the intervention group were glad they used it there were no differences between the groups in total opioid consumption, side effects experienced, or levels of anxiety. Higher pain scores at the second assessment point were significantly correlated with increased biofeedback use at the third evaluation. This ongoing study offers promising preliminary data that a portable biofeedback intervention brought to the patient’s bedside post-surgically may be of benefit in managing acute post-operative pelvic pain. A larger sample size may delineate additional positive effects.
(313) Confirmatory factor analysis of pain beliefs in significant others
(315) Effects of relaxation/music and patient teaching for pain management on salivary cortisol
A Loree, A Cano, L Miller; Wayne State University, Detroit, MI The Survey of Pain Attitudes (SOPA; Jensen et al., 1994) is one of the most commonly used measures of pain beliefs. Several subscales of the SOPA are related to pain adjustment and are modifiable by in behavioral treatments for pain. It is also possible that pain beliefs of family members may play an important role in support provision and treatment. For instance, family members’ attitudes about the extent to which they should be solicitous toward patients may contribute to healthrelated support. To our knowledge, family members’ pain beliefs have not yet been measured in the pain literature. To address this gap in the literature, we test a significant other version of the SOPA (SOPA-S) that assesses beliefs about a significant other’s pain. The sample consists of 200 undergraduates attending a large urban university in the Midwest. All completed an online version of the 57-item SOPA along with demographic questions. Confirmatory Factor Analysis using AMOS 7.0 demonstrated that the measurement models for the 7 subscales using the complete SOPA-S did not fit the data sufficiently; however, when the measurement models were restricted to SOPA-Brief items (30 items; Tait & Chibnall, 1997), 5 of the 7 scales exhibited a good fit. The structural model, in which all the scales were correlated with one another, did not fit the data well, suggesting that the subscales tap domains of pain beliefs that may not be correlated with one another. The results of this study provide some preliminary evidence for the validity of a significant other version of the SOPA. Continued research examining the correlates of SOPA-S will determine the extent to which the pain beliefs of significant others relates to pain adjustment in patients with pain as well as the quality of life of their significant others.
M Good, G Anderson, S Wotman, J Albert, X Cong, L Chiang, E Bernhofer; Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH Postoperative pain is a major physiological and psychological stressor. Studies have shown that stress and pain leave patients more susceptible to infection and complications. The purpose of this study was to determine whether two interventions, relaxation/music (RM) and patient teaching (PT) for pain management, reduce stress in postoperative abdominal patients. Abdominal surgery patients (N⫽517) (18-75 yrs) were randomly assigned to receive RM, PT, combination of RM and PT, or control. A 2x2 factorial design with pre and posttests was used to study the overall RM-Effect and PT-Effect on salivary cortisol. The interventions were tested at two 20-minute tests on postoperative day 2, morning and afternoon. Parotid saliva was stimulated with diluted lemon juice, collected in intra-oral cups, timed with a stopwatch, and flow rate was calculated as milliliters per minute. Analysis of obtained samples (N⫽ 164) was with High Sensitivity Salivary Cortisol Enzyme Immunoassay (Salimetrics, LLC). Higher cortisol was significantly related to GI/GU surgery (vs GYN) and male gender, r ⫽ .24 to .33. Lower cortisol was significantly related to greater postoperative activity, r ⫽ -.20 to -.29. Because pretest cortisol was strongly correlated with posttest cortisol in the morning, r ⫽ .82, p ⬍ .001 and afternoon, r ⫽ .86, p ⬍ .001, the pretests were used as covariates. Comparisons using ANCOVA showed that there was no RM-Effect or PT-Effect at either test. Post-hoc ANCOVA, controlling for pretests, indicated no significant effects when each intervention group was compared to the control group. There was no RM effect on pain or cortisol in the afternoon. Although the RMEffect reduced pain in the morning, it did not reduce cortisol. This may have been because pain was mild by day 2. Further analyses will be conducted to identify subgroups that may have benefited by lower cortisol. Funded by the National Institute of Nursing Research to Marion Good, RO1-NR3933 and the General Clinical Research Center, Case Western Reserve University. (Good, J Pain, 2006).