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Efficacy of Guided Imagery with Relaxation for Osteoarthritis Symptoms and Medication Intake
Abstract
Supporting safe self-management interventions for symptoms of osteoarthritis (OA) may reduce the personal and societal burden of this increasing health concern. Self-management interventions might be even more beneficial if symptom control were accompanied by decreased medication use, reducing cost and potential side effects. Guided imagery with relaxation (GIR) created especially for OA may be a useful self-management intervention, reducing both symptoms and medication use. A longitudinal randomized assignment experimental design was used to study the efficacy of GIR in reducing pain, improving mobility, and reducing medication use. Thirty older adults were randomly assigned to participate in the 4-month trial by using either GIR or a sham intervention, planned relaxation. Repeated-measures analysis of variance revealed that, compared with those who used the sham intervention, participants who used GIR had a significant reduction in pain from baseline to month 4 and significant improvement in mobility from baseline to month 2. Poisson technique indicated that, compared with those who used the sham intervention, participants who used GIR had a significant reduction in over-the-counter (OTC) medication use from baseline to month 4, prescribed analgesic use from baseline to month 4, and total medication (OTC, prescribed analgesic, and prescribed arthritis medication) use from baseline to month 2 and month 4. Results of this study support the efficacy of GIR in reducing symptoms, as well as in reducing medication use. Guided imagery with relaxation may be useful in the regimen of pain management for clinicians.
... By focusing with intention, the pain changes." Baird et al. [16] utilized the Guided Imagery Relaxation (GIR) method in a study of 30 patients designed to evaluate the effect of GI on pain and mobility. Response imagery (imagining oneself in a pleasant scene) with an end-state suggestion was the technique employed. ...
... Baird et al. [16] evaluated the effect of GIR exercises in an RCT of 30 patients with osteoarthritis. The results of this study support the efficacy of GIR in reducing symptoms. ...
... After examining the reviewed studies, we conclude that GI may be a helpful tool in managing pain, depression, stress, fatigue, anxiety, reducing medication use, improving general well-being, wellness, and quality of life [9,16,20,21] in patients with musculoskeletal disorders. Characteristics of GI significantly varied between studies. ...
Purpose of Review
Guided imagery (GI) is a non-pharmacological method used to reduce pain, stress, and anxiety. No comprehensive review has yet investigated the application of GI in musculoskeletal medicine, its various types, and potential mechanisms. The aim of this comprehensive narrative review was to examine the types of GI used in musculoskeletal medicine and GI effect on pain and health-related quality of life.
Recent Findings
A comprehensive narrative review of the English language scientific literature. PubMed, Google Scholar, ProQuest, and PEDro databases were searched from inception until August 2020 using keywords related to GI, musculoskeletal disorders, pain, and health-related quality of life. The search results generated 133 articles. After a critical analysis, 12 publications were included in this review. GI characteristics and protocols varied significantly between studies.
Summary
Based on the reviewed studies, we advocate GI as a safe, non-invasive technique that can assist in managing pain, depression, stress, fatigue, anxiety, reducing medication use, improving general well-being, wellness, and quality of life in patients with musculoskeletal disorders. We recommend further investigations of GI mechanisms.
... Pain intensity data were converted into numeric scores for comparisons between studies, and are shown in Additional file 2: Table S1. The studies covered the interventions of acupressure, acupuncture, guided imagery, periosteal stimulation, qigong, and Tai Chi [35][36][37][38][39][40][41][42][43][44]. The net change in pain intensity in the intervention group in the post-intervention assessment ranged from − 3.13 to − 0.65 after the conversion. ...
... After the study period, the older adults could continue to implement some of the non-pharmacological interventions. In the study, the older adults were taught to perform the following interventions by themselves: acupressure, guided imaginary, qigong, and Tai Chi [35,38,[40][41][42][43]. Acupuncture and periosteal stimulation required a therapist to perform the intervention. ...
... No follow-up assessment was conducted in the studies on acupressure, acupuncture, and guided imagery [35,37,38]. Details of the results are presented in Additional file 2: Table S1. ...
Background:
Pain is common in older adults. To maintain their quality of life and promote healthy ageing in the community, it is important to lower their pain levels. Pharmacological pain management has been shown to be effective in older adults. However, as drugs can have various side effects, non-pharmacological pain management is preferred for community-dwelling older adults. This systematic review evaluates the effectiveness, suitability, and sustainability of non-pharmacological pain management interventions for community-dwelling older adults.
Methods:
Five databases, namely, CINHAL, Journals@Ovid, Medline, PsycInfo, and PubMed, were searched for articles. The criteria for inclusion were: full-text articles published in English from 2005 to February 2019 on randomized controlled trials, with chronic non-cancer pain as the primary outcome, in which pain was rated by intensity, using non-pharmacological interventions, and with participants over 65 years old, community-dwelling, and mentally competent. A quality appraisal using the Jadad Scale was conducted on the included articles.
Results:
Ten articles were included. The mean age of the older adults was from 66.75 to 76. The interventions covered were acupressure, acupuncture, guided imagery, qigong, periosteal stimulation, and Tai Chi. The pain intensities of the participants decreased after the implementation of the intervention. The net changes in pain intensity ranged from - 3.13 to - 0.65 on a zero to ten numeric rating scale, in which zero indicates no pain and ten represents the worst pain.
Conclusions:
Non-pharmacological methods of managing pain were effective in lowering pain levels in community-dwelling older adults, and can be promoted widely in the community.
... These may include, but are not limited to, relaxation, mindfulness meditation, or hypnosis (Jensen, 2011). Guided imagery has been reported to have positive results, with respect to AORD-related outcomes, in randomized controlled trials (RCTs) (Baird, Murawski, & Wu, 2010;Baird & Sands, 2004Fors & Gotestamm, 2000;Fors, Sexton, & G€ otestam, 2002;Lewandowski, Good, & Draucker, 2005;Menzies, Taylor, & Bourguignon, 2006). Guided imagery can be defined as a quasi-perceptual, multisensory, and conscious experience that resembles the actual perception of some object, scene, or event but occurs in the absence of external stimuli (Thomas, 2014). ...
... Psychologists have long used guided imagery to help individuals cope with pain, anxiety, and trauma (Thomas, 2014). Guided imagery interventions with AORD patients often begin with breathing or progressive muscle relaxation exercises and then proceed to images of movement and physical activity free of pain and stiffness (Baird et al., 2010). Importantly, guided imagery is inexpensive, relatively easy to teach, and can be readily applied in both clinical and community-based settings (Baird et al., 2010;Giacobbi, Dreisbach, Thurlow, Anand, & Garcia, 2014). ...
... Guided imagery interventions with AORD patients often begin with breathing or progressive muscle relaxation exercises and then proceed to images of movement and physical activity free of pain and stiffness (Baird et al., 2010). Importantly, guided imagery is inexpensive, relatively easy to teach, and can be readily applied in both clinical and community-based settings (Baird et al., 2010;Giacobbi, Dreisbach, Thurlow, Anand, & Garcia, 2014). ...
Many individuals suffering from arthritis and other rheumatic diseases (AORD) supplement pharmacologic treatments with psychosocial interventions. One promising approach, guided imagery, has been reported to have positive results in randomized controlled trials (RCTs) and is a highly scalable treatment for those with AORD. The main purpose of this study was to conduct a systematic review of RCTs that have examined the effects of guided imagery on pain, function, and other outcomes such as anxiety, depression, and quality of life in adults with AORD. Ten electronic bibliographic databases were searched for reports of RCTs published between 1964 and 2013. Selection criteria included adults with AORD who participated in RCTs that used guided imagery as a partial or sole intervention strategy. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Instrument. Results were synthesized qualitatively. Seven studies representing 306 enrolled and 287 participants who completed the interventions met inclusion criteria. The average age of the participants was 62.9 years (standard deviation = 12.2). All interventions used guided imagery scripts that were delivered via audio technology. The interventions ranged from a one-time exposure to 16 weeks in duration. Risk of bias was low or unclear in all but one study. All studies reported statistically significant improvements in the observed outcomes. Guided imagery appears to be beneficial for adults with AORD. Future theory-based studies with cost-benefit analyses are warranted.
Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
... Even though there have been a few studies which have shown that relaxation therapy with guided imagery may be beneficial as alternative or adjunct treatment for osteoarthritis, these studies were mainly done in the western countries and there is insufficient data regarding the use of the treatment in Asian community. [6][7][8][9][10] This study would provide information about the acceptance of this treatment in the Malaysian context which might be different due to different cultural and social values. Therefore this study not only attempt to look into the efficacy of the treatment in Asian patient but also seek to determine the acceptance of the treatment among this group of patient. ...
... A power analysis using standard deviation of 11 and detectable difference of 13 for guided imagery and knee osteoarthritis symptom score, and considering 10% drop out rate indicated that a total sample size of 60 was needed for power greater than 0.90. 9 The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to assess the patients' opinions regarding their knee pain and associated problems. 12 It is a valid, reliable, and responsive self-administered instrument in the follow-up of short-term and long-term osteoarthritis and knee injuries. ...
... There are many studies which have reported the use of relaxation therapy in reducing pain, particularly in musculoskeletal pain such as osteoarthritis, anterior cruciate ligament reconstructions and others. [6][7][8][9][10]20 The result of our study is supported by the finding in a study by Baird and Sands. 8 Their study compared intervention using GI with sham intervention (an audio without GI). ...
Introduction: There is limited data regarding the use of relaxation technique in managing knee osteoarthritis in Asian population.
... These may include, but are not limited to, relaxation, mindfulness meditation, or hypnosis (Jensen, 2011). Guided imagery has been reported to have positive results, with respect to AORD-related outcomes, in randomized controlled trials (RCTs) (Baird, Murawski, & Wu, 2010;Baird & Sands, 2004Fors & Gotestamm, 2000;Fors, Sexton, & G€ otestam, 2002;Lewandowski, Good, & Draucker, 2005;Menzies, Taylor, & Bourguignon, 2006). Guided imagery can be defined as a quasi-perceptual, multisensory, and conscious experience that resembles the actual perception of some object, scene, or event but occurs in the absence of external stimuli (Thomas, 2014). ...
... Psychologists have long used guided imagery to help individuals cope with pain, anxiety, and trauma (Thomas, 2014). Guided imagery interventions with AORD patients often begin with breathing or progressive muscle relaxation exercises and then proceed to images of movement and physical activity free of pain and stiffness (Baird et al., 2010). Importantly, guided imagery is inexpensive, relatively easy to teach, and can be readily applied in both clinical and community-based settings (Baird et al., 2010;Giacobbi, Dreisbach, Thurlow, Anand, & Garcia, 2014). ...
... Guided imagery interventions with AORD patients often begin with breathing or progressive muscle relaxation exercises and then proceed to images of movement and physical activity free of pain and stiffness (Baird et al., 2010). Importantly, guided imagery is inexpensive, relatively easy to teach, and can be readily applied in both clinical and community-based settings (Baird et al., 2010;Giacobbi, Dreisbach, Thurlow, Anand, & Garcia, 2014). ...
Objectives:Arthritis and other rheumatic diseases (AORD), a leading cause of disability, are expected to reach more than 67 million US adults by the year 2030. Mental imagery (MI) is a non-pharmacological approach with potential for improving selected outcomes in adults with AORD. The purpose of this systematic review was to examine the impact of MI on reported outcomes in individuals with AORD.
Method:Nine electronic bibliographic databases were searched for reports of RCTs published between 1964 and 2013. Selection criteria included adult participants with AORD who participated in RCTs that used MI as a partial or sole intervention strategy. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Instrument. Additional variables included the length of the intervention, use of guided imagery scripts, delivery mechanisms, and reported outcomes. Results were synthesized qualitatively.
Results:Eight studies representing 347 enrolled and 319 participants who completed the interventions met the criteria for inclusion. The average age of the participants was 69.12 years (SD= 11.64). Seven interventions were delivered using audio technology while one relied on human interactions. The interventions ranged from 1 time exposure to 16 weeks in duration. Seven studies reported using guided imagery scripts. Risk of bias was low or unclear in all but two studies. All seven studies reported reduced pain and anxiety, increased mobility, and improved health-related quality of life in those who participated in MI.
Conclusions: Mental imagery appears to be beneficial for adults with AORD. Future theory-based studies with cost benefit analyses are warranted.
... Of the 146 studies that met the systematic review's inclusion criteria [12], 26 randomized controlled trials were categorized as multimodal integrative therapies (see Figure 1 for flow chart). These studies investigated the effects of multimodal therapies compared with a single self-care CIM modality [13][14][15][16][17][18][19], a nonself-care CIM modality [20], usual care/wait list/no treatment [14,17,[20][21][22][23][24][25][26][27][28][29][30][31][32], another multimodal program [20,33], or another control (i.e., exercise, support group) [19,26,27,31,[34][35][36][37] for the management of chronic pain symptoms. Nine of these studies [14,15,[17][18][19][20]26,27,31] compared a multimodal therapy with more than one of these controls. ...
... The most popular modality included in the multimodal approaches was relaxation, with 13 studies pairing some type of relaxation (e.g., relaxation training, progressive muscle relaxation) with cognitive therapy (cognitive behavioral therapy [CBT]) [19,20,26], imagery [24,28,33,37], flexibility [35], biofeedback [14,17,21], or autogenic training [18,27]. In addition to relaxation, autogenic training was also paired with education [29]. ...
... For the most part, integrative, relaxation-based approaches were found to be either more effective [19,33], or as effective [14,20], for the self-management of chronic pain symptoms than another single self-care CIM approach as only two studies found unfavorable results [17,18]. Similarly, compared with passive controls (i.e., usual care, wait list control, no treatment), relaxationbased approaches were generally either more effective [14,21,24,28,37], or as effective [20], with three studies [17,26,27] showing neither the multimodal therapy nor control was effective. Results were mixed when comparing these relaxation-based approaches to other active controls (i.e., exercise, headache monitoring, cognitive therapy) as some studies showed positive effects [19,20,35], whereas others showed none at all [26,27]. ...
Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures which are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM therapies (ACT-CIM) allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. To date, there are no systematic reviews examining the full range of ACT-CIM used for chronic pain symptom management.
A systematic review was conducted, using Samueli Institute's rapid evidence assessment of the literature methodology, to rigorously assess both the quality of the research on ACT-CIM modalities and the evidence for their efficacy and effectiveness in treating chronic pain symptoms. A working group of subject matter experts was also convened to evaluate the overall literature pool and develop recommendations for the use and implementation of these modalities.
Following key database searches, 146 randomized controlled trials were included in the review, 26 of which investigated multimodal, integrative therapies, as defined by the authors.
This article summarizes the current evidence, quality, and effectiveness of these modalities. Recommendations and next steps to move this field of research forward are also discussed. The entire scope of the review is detailed throughout the current Pain Medicine supplement.
... Quanto à natureza da intervenção, seis estudos avaliaram a utilização de Terapias Complementares tais como toque terapêutico (TT) (10) , terapia espiritual (11) , fitoterapia (19) , musicoterapia (13) , estimulação elétrica neuromuscular (14) , e imagem guiada (20) . Quatro estudos testaram a efetividade do atendimento de enfermeira especializada em reumatologia comparado à equipe multiprofissional à curto (12) e longo prazo (5) , sobre o bem estar dos pacientes (15) , e sobre a educação para o controle da doença por meio de visita domiciliar (18) . ...
... Em um estudo (20) realizado para verificar a utilização de imagem guiada com relaxamento para redução da dor, do uso de medicamentos, e melhora da mobilidade de pacientes com osteoartrite foi realizada por meio da randomização de 30 sujeitos em um grupo experimental e outro controle. A intervenção consistia em seguir um roteiro de cinco passos, por meio da escuta de um audiotape, que deveria ser seguido pelos sujeitos por 12 minutos/duas vezes ao dia, durante 4 meses. ...
... Entre os estudos que se dedicaram à investigação da eficácia de intervenções para o tratamento da dor relacionada à artrite em idosos, as melhores evidências que encontramos foram: a utilização de musicoterapia para redução da dor de idosos na faixa etária dos 76 anos (13) , sendo recomendada uma sessão diária de 20 minutos de audição de músicas que tenham ente 60 a 80 bits/min; e a estimulação neuromuscular elétrica (14) , para idosos na faixa etária dos 70 anos, portadores de osteoartrite de joelho, sendo recomendadas sessões diárias de cerca de 15 minutos, inicialmente com uma intensidade que promova contração de 10 a 20% da contração isométrica máxima voluntária. Os demais estudos (10)(11)14,(19)(20) , embora os autores tenham considerado as intervenções eficazes, apresentaram pelo menos um dos problemas metodológicos: amostra insuficiente , controle não efetivo, falta de homogeneidade na amostra e utilização de instrumentos de avaliação inespecíficos; tais dados sugerem a necessidade da realização de novos estudos, com refinamento metodológico, antes que as intervenções posam ser adotadas no cuidado de pacientes com artrite, pelos enfermeiros. ...
This integrative review aimed to analyze the scientific literature related to nursing care for patients with arthritis. Twelve experimental studies were included, randomized and controlled, published in CINAHL, MEDLINE, SciELO and LILACS databases, using the controlled keywords "arthritis" and "nursing". The results indicated the effectiveness of music therapy, neuromuscular electrical stimulation, therapeutic touch and guided imagery associated with relaxation, for the treatment of pain. Being treated by a specialist nurse increased satisfaction with care, improved the impact of the disease and increased the demand for health services. Specific educational programs for people with arthritis stimulated the practice of physical exercises and those targeted to people with chronic conditions in general were effective to control pain and functional disability. We conclude that there is a set of interventions that can support the practice of evidence-based nursing for the elderly people with arthritis.
... A total of 17 clinical trials were retrieved for further evaluation, of which 9 involving 201 patients were eligible for inclusion (Fig. 1). The 9 studies originated from the United States, [18][19][20][21][22][23] Norway, 24,25 and Australia. 14 The patient populations were heterogeneous ranging from FMS middle-aged patients, [23][24][25] elderly OA populations, 19,20 and postoperative patients, 18,21 to chronic pain patients. ...
... The 9 studies originated from the United States, [18][19][20][21][22][23] Norway, 24,25 and Australia. 14 The patient populations were heterogeneous ranging from FMS middle-aged patients, [23][24][25] elderly OA populations, 19,20 and postoperative patients, 18,21 to chronic pain patients. 14, 22 The control groups received standard or usual care, 18,19,23 sham GI, 20 placebo and standard care, 21 painrelated counseling, 24,25 wait list, 14 or no intervention. ...
... Eight of 9 trials that met our eligibility criteria suggested that GI is effective for MSP. 14, [18][19][20][21][22]24,25 One RCT showed no effect on pain. 23 The evidence from RCTs of GI for treating MSP is thus encouraging but, for several reasons, inconclusive. ...
The objective of this systematic review was to assess the effectiveness of guided imagery (GI) as a treatment option for musculoskeletal pain (MSP).
Six databases were searched from their inception to May 2010. All controlled clinical trials were considered, if they investigated GI in patients with any MSP in any anatomic location and if they assessed pain as an outcome measure. Trials of motor imagery were excluded. The selection of studies, data extraction, and validation were performed independently by 2 reviewers.
Nine randomized clinical trials (RCTs) met the inclusion criteria. Their methodologic quality ranged between 1 and 3 on the Jadad scale. Eight RCTs suggested that GI leads to a significant reduction of MSP. One RCT indicated no change in MSP in comparison with usual care.
It is concluded that there are too few rigorous RCTs testing the effectiveness of GI in the management of MSP. Therefore, the evidence that GI alleviates MSP is encouraging but inconclusive.
... Several previous studies support the aforementioned results. 19,26,[30][31][32][33][34][35] The results confirmed our hypothesis, which is stated as follows: "GI intervention after open-heart surgery reduces postoperative pain." However, literature also includes studies that contradict the results of the present study. ...
... Previous literature includes several studies on GI, which is one of the disciplines in complementary medicine, with positive results that support the results of the current study. 19,[31][32][33][34][35]38,41 This result confirmed our hypothesis, which is stated as follows: "GI intervention after open-heart surgery increases postoperative comfort." Anxiety and pain, which are the physical and psychospiritual dimensions of the comfort theory, 9,10 are the most frequent constituents of scenarios wherein GI interventions are applied, yielding positive, statistically significant results supporting the use of GI in medicine. ...
Objective
The present study aims to evaluate the effects of neuro‐linguistic programming (NLP) and guided imagery on postoperative pain and comfort after open‐heart surgery.
Methods
In the current, prospective, randomized, single‐blind clinical study, the participants received NLP with a new behavior formation technique or the guided imagery relaxation technique using an audio compact disc for a duration of 30 min.
Results
The patients in the NLP group had significantly lower posttest pain levels, compared to the patients in the guided imagery and control groups. Moreover, the patients in the guided imagery group had significantly higher posttest comfort levels, compared to the patients in the NLP and control groups.
Conclusion
The application of both NLP and guided imagery interventions resulted in reduced postoperative pain and increased postoperative comfort levels after open‐heart surgery.
... Guided imagery has been used in a variety of patient populations including preoperative patients [19], antepartum patients [20], community-dwelling older adults [21], patients with cancer [22,23], cardiac patients [24][25][26], and patients with chronic pain [27,28]. Patients recovering from same day head and neck surgery had a significant reduction in anxiety and pain levels and postanesthesia care unit (PACU) length of stay was nine minutes less compared to the control group [19]. ...
... In addition, guided imagery has been shown to reduce musculoskeletal pain and medication usage, including analgesics, in osteoarthritis patients from baseline to four months [27]. Similarly, patients with fibromyalgia who received guided imagery as an intervention had lower pain and depression levels compared to usual care [28]. ...
The study purpose was to assess the effects of guided imagery on sedation levels, sedative and analgesic volume consumption, and physiological responses of patients being weaned from mechanical ventilation. Forty-two patients were selected from two community acute care hospitals. One hospital served as the comparison group and provided routine care (no intervention) while the other hospital provided the guided imagery intervention. The intervention included two sessions, each lasting 60 minutes, offered during morning weaning trials from mechanical ventilation. Measurements were recorded in groups at baseline and 30- and 60-minute intervals and included vital signs and Richmond Agitation-Sedation Scale (RASS) score. Sedative and analgesic medication volume consumption were recorded 24 hours prior to and after the intervention. The guided imagery group had significantly improved RASS scores and reduced sedative and analgesic volume consumption. During the second session, oxygen saturation levels significantly improved compared to the comparison group. Guided imagery group had 4.88 less days requiring mechanical ventilation and 1.4 reduction in hospital length of stay compared to the comparison group. Guided imagery may be complementary and alternative medicine (CAM) intervention to provide during mechanical ventilation weaning trials.
... Guided imagery has been used in a variety of patient populations including preoperative patients [19], antepartum patients [20], community-dwelling older adults [21], patients with cancer [22,23], cardiac patients [24][25][26], and patients with chronic pain [27,28]. Patients recovering from same day head and neck surgery had a significant reduction in anxiety and pain levels and postanesthesia care unit (PACU) length of stay was nine minutes less compared to the control group [19]. ...
... In addition, guided imagery has been shown to reduce musculoskeletal pain and medication usage, including analgesics, in osteoarthritis patients from baseline to four months [27]. Similarly, patients with fibromyalgia who received guided imagery as an intervention had lower pain and depression levels compared to usual care [28]. ...
The study purpose was to assess the effects of guided imagery on sedation levels, sedative and analgesic volume consumption, and physiological responses of patients being weaned from mechanical ventilation. Forty-two patients were selected from two community acute care hospitals. One hospital served as the comparison group and provided routine care (no intervention) while the other hospital provided the guided imagery intervention. The intervention included two sessions, each lasting 60 minutes, offered during morning weaning trials from mechanical ventilation. Measurements were recorded in groups at baseline and 30- and 60-minute intervals and included vital signs and Richmond Agitation-Sedation Scale (RASS) score. Sedative and analgesic medication volume consumption were recorded 24 hours prior to and after the intervention. The guided imagery group had significantly improved RASS scores and reduced sedative and analgesic volume consumption. During the second session, oxygen saturation levels significantly improved compared to the comparison group. Guided imagery group had 4.88 less days requiring mechanical ventilation and 1.4 reduction in hospital length of stay compared to the comparison group. Guided imagery may be complementary and alternative medicine (CAM) intervention to provide during mechanical ventilation weaning trials.
... Guided imagery has been used increasingly by healthcare providers in the medical field with impressive results. This is particularly true not only with cancer patients but also with patients who have other medical concerns such as stroke, recurrent abdominal pain, osteoarthritis, asthma, and chronic fatigue syndrome [9]. The techniques have been shown to reduce anxiety in surgical patients. ...
... Based on extensive review [8,9,15] an imagery-induced relaxation script for children in Bahasa Malaysia was developed. The initial script consist of sequence of deep breathing instructions, followed by imagination involving multiple senses such as touch, smell, sight, sound and taste, and at the end there was component of healing before the child is brought back to reality. ...
The study aims to develop, validate and evaluate a Guided Imagery and Relaxation (GIR) audio in Bahasa Malaysia, serving as one of the coping tools for children with cancer. Based on extensive review, GIR script was developed by a clinical psychologist. Panels of experts including pediatric oncologists and psychiatrists conducted initial assessment at multiple stages of hearing sessions. The final version of the audio was pre-recorded in MP3 player for evaluation. Face and content validation of 3 × approximately 5 minutes duration of GIR audio series were obtained via experts’ reports. Twenty-three participants (5 adults, 18 children with cancer) listened to the audio and completed evaluation form. All adult evaluators gave positive remarks on the script, narration and recording quality. As for the children, 100% completed audio-hearing and majority (66.7% - 88.9%) were able to imagine well without falling asleep and in some way were positively affected by the imagery-induced relaxation audio. Majority was not disturbed during the hearing sessions (66.7%), will hear it again (83.3%) and found it enjoyable (88.8%). This is the first known study developing GIR audio in Bahasa Malaysia which is feasible, enjoyable and beneficial for children that warrants efficacy study.
... 7). Experiments that use guided imagery for healing often include instruction for images that are or will lead to being fully normal, healed, and restored and that give a sense of well being (Baird, Murawski, & Wu, 2010; Ball et al., 2003; Carrico, Peters, & Diokno, 2008; Eremin et al., 2009; Fernros et al., 2008; Menzies & Kim, 2008; Menzies, Taylor, & Bourguignon, 2006; Nunes et al., 2007; Walker et al., 1999; Wells, 2010). The positive content of these images provides the conflict with the immune system information, which in contrast indicates something abnormal, such as a cancer cell. ...
... to pain, or is the " subjectivity " of pain a simpler and more fitting explanation? This is an important question to consider, because mind–body interventions of guided imagery and mindful meditation appear to be very successful with pain (e.g., Baird et al., 2010; Ball et al., 2003). It may appear both that the immune system is not relevant for pain and that visual imagery of pain (or its absence) isn't sensible. ...
A new theory of mind-body interaction in healing is proposed based on considerations from the field of perception. It is suggested that the combined effect of visual imagery and mindful meditation on physical healing is simply another example of cross-modal adaptation in perception, much like adaptation to prism-displaced vision. It is argued that psychological interventions produce a conflict between the perceptual modalities of the immune system and vision (or touch), which leads to change in the immune system in order to realign the modalities. It is argued that mind-body interactions do not exist because of higher-order cognitive thoughts or beliefs influencing the body, but instead result from ordinary interactions between lower-level perceptual modalities that function to detect when sensory systems have made an error. The theory helps explain why certain illnesses may be more amenable to mind-body interaction, such as autoimmune conditions in which a sensory system (the immune system) has made an error. It also renders sensible erroneous changes, such as those brought about by "faith healers," as conflicts between modalities that are resolved in favor of the wrong modality. The present view provides one of very few psychological theories of how guided imagery and mindfulness meditation bring about positive physical change. Also discussed are issues of self versus non-self, pain, cancer, body schema, attention, consciousness, and, importantly, developing the concept that the immune system is a rightful perceptual modality. Recognizing mind-body healing as perceptual cross-modal adaptation implies that a century of cross-modal perception research is applicable to the immune system.
... Relatedly, in a trial of guided imagery for pain relief [18], the patient's attention focus on the breath and away from the pain experience is an integral part of the treatment and will thus not be matched. As such, it is unclear whether an optimal control should direct attention to something else non-pain related (as would be the case in a general health education programme used as attention control) or not manipulate attention at all (as in the given example, using 'rest' as sham control). ...
Blinding is challenging in randomised controlled trials of physical, psychological, and self-management therapies for pain, mainly because of their complex and participatory nature. To develop standards for the design, implementation, and reporting of control interventions in efficacy and mechanistic trials, a systematic overview of currently used sham interventions and other blinding methods was required. Twelve databases were searched for placebo or sham-controlled randomised clinical trials of physical, psychological, and self-management treatments in a clinical pain population. Screening and data extraction were performed in duplicate, and trial features, description of control methods, and their similarity to the active intervention under investigation were extracted (protocol registration ID: CRD42020206590). The review included 198 unique control interventions, published between 2008 and December 2021. Most trials studied people with chronic pain, and more than half were manual therapy trials. The described control interventions ranged from clearly modelled based on the active treatment to largely dissimilar control interventions. Similarity between control and active interventions was more frequent for certain aspects (eg, duration and frequency of treatments) than others (eg, physical treatment procedures and patient sensory experiences). We also provide an overview of additional, potentially useful methods to enhance blinding, as well as the reporting of processes involved in developing control interventions. A comprehensive picture of prevalent blinding methods is provided, including a detailed assessment of the resemblance between active and control interventions. These findings can inform future developments of control interventions in efficacy and mechanistic trials and best-practice recommendations.
... 26 One study 26 found that 3% of participants in the relaxation group consumed ≥3 doses of Citodon (Paracetamol-Codeinphosp) compared to 28% in the usual care group one week post-dental surgery. Similarly, results from another study 6 showed that the average log rate of over-the-counter medication use (primarily paracetamol) in those who received a relaxation intervention decreased by 0.65 doses/day from baseline to four months compared to participants receiving in the control group receiving usual care (Tables 3 and 5). ...
Objective
To examine evidence on deprescribing paracetamol in pain conditions and inform future strategies for paracetamol deprescription.
Design
Scoping review.
Participants
Adults with pain conditions, taking paracetamol.
Results
After two independent teams of reviewers screening for titles, abstracts, and then full texts, 16 original articles were included. Deprescribing strategies were grouped into 5 categories: (1) Pharmacological, (2) Psychological, (3) Physiological, (4) Policy, and (5) Combination. We found strategies were predominately consumer-focused, conducted in community settings and involved individuals experiencing musculoskeletal pain (such as low back pain and osteoarthritis). A total of twelve studies investigated interventions targeting dose reduction and four studies examined interventions focusing on discontinuation of paracetamol. The most common strategies used to deprescribe paracetamol in pain conditions were physiological strategies, followed by psychological strategies. All included studies demonstrated some level of effectiveness to deprescribe paracetamol in a pain conditions through dose reduction or discontinuation, although the effectiveness of deprescribing strategies were highly variable, ranging from the majority of participants discontinuing their paracetamol use, to less than 10% reducing their paracetamol use upon the latest follow-up.
Conclusions
There are clear opportunities for prospective trials to be designed more purposely and primarily focused to influence reduction and cessation of paracetamol for specific pain conditions where deprescription is appropriate.
... 17 A phasic study was also done on GMI with PMR in patients with OA in which audio tapes were used for imagery and the effect on the use of pain medications, mobility, function and quality of life was assessed. In these studies, the investigators concluded that GMI and PMR was beneficial in patients with OA. 11,17,32 The findings of previous studies are in accordance with our findings, although in the above study GMI was used in conjunction with PMR, and we compared GMI and PMR treatment in our study. ...
Background:
Osteoarthritis (OA) is the most common musculoskeletal condition seen in aging. Joint destruction, chronic pain, change in proprioception, stability problems and decreased range of motion are the most common problems seen in OA. Complementary therapies like yoga, graded motor imagery (GMI), progressive muscle relaxation (PMR) and Tai Chi are more effective in chronic conditions such as knee OA.
Aims:
The purpose of this study was to evaluate and compare the effect of graded motor imagery and progressive muscle relaxation on mobility and function in patients with knee OA.
Methods:
This study was a randomized controlled pilot trial conducted in a tertiary health center in Belagavi, Karnataka, India.
Participants:
A total of 11 patients with unilateral knee pain persisting for more than 12 months were included in the study.
Interventions:
Patients were randomly assigned to 2 groups: the PMR group (n = 5) or the (GMI) group (n = 6). Patients in the PMR group practiced Jacobson's PMR and patients in the GMI group practiced explicit and mirror therapy. All patients were treated 5 times a week for 2 weeks.
Outcome measures:
The outcome measures in this study were range of motion and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score for assessing knee joint pain, function and stiffness.
Results:
Results demonstrated knee flexion range (P = .046) and function WOMAC scores (P = .0062) were significantly better in the GMI group than in the PMR group.
Conclusion:
GMI and PMR were both beneficial for knee mobility and function but GMI was better than PMR in chronic knee OA.
... As in common with most non-pharmacological pain management interventions, the evidence base for its efficacy in the elderly is limited. However available studies do suggest it may be of benefit, with early work by Baird and Sands (2004) indicating that guided imagery linked to progressive muscle relaxation could result in a significant reduction in pain in those suffering from osteoarthritis, with similar findings indicated in a 2010 follow-up study (Baird et al. 2010). Giacobbi et al. (2015) undertook a systematic review which identified seven previous RCTs that has used guided imagery and progressive relaxation on a range of arthritic conditions; although there was a high range of variation in the techniques used and length of exposure to participants, all studies reported statistically significant improvements in a range of outcomes including pain, anxiety, depression and quality of life. ...
There will be increased numbers of older adults in society in the next few decades. Older adults are more likely to have pain problems and other co-morbidities. Generally, pain is poorly managed in older adults, and this becomes worse when cognitive impairment exists. The impact of chronic pain on older adults will be greater than that of their younger counterparts in terms of social isolation. Attitudes and barriers to improved pain management exist in both the older adults themselves and their younger counterparts
... l Guided imagery can be used to decrease pain (Baird, Murawski, & Wu, 2010). l Distraction techniques, or directing attention away from pain, to decrease pain intensity and distress can be used. ...
Acute pain is a prevalent problem in a growing segment of the older adult population and is often ineffectively managed despite the accumulation of evidence to guide assessment and support interventions in managing pain. Improvements in acute pain management in older adults are needed to provide consistent and quality pain assessment techniques and treatment therapies consistent with patient and/or family preferences. The current article briefly discusses ways to improve the pain experience and outcomes for older patients and families. [Journal of Gerontological Nursing, 43(2), 18-27.].
... P= .04 Baird et al. 2010 To compare the effects of GI with a sham intervention for reducing reported pain levels, improving mobility and using less medication in 30 female older adult participants with osteoarthritis. ...
Psychological research has consistently demonstrated the importance of cognitions in the form of
thoughts and images on an individual’s wellbeing. Having pain-related verbal cognitions has been
shown to lead to poorer outcomes for patients (McCracken & Turk, 2002). Research in other
conditions has shown mental images have a more powerful impact on emotion than verbal
cognitions (Holmes & Matthews, 2005). To date however, little work has explored the role of
mental imagery in adjustment to chronic pain.
Methods
Fourteen semi-structured interviews were conducted with individuals with chronic pain. Interview
transcripts were analysed according to grounded theory methods to construct a substantive theory of
the impact spontaneously-invoked images of pain have on functioning.
Results
Eight participants reported pain-related imagery and three reported mental images associated with
related symptoms. In line with previous findings (Gillanders et al., 2012; Gosden, 2008) the
frequency and intensity of pain-related images influenced the degree of distress experienced. There
was a distinction made between intrusive mental images and visual descriptions or metaphors of
pain. The former being conceptualised as a visual cognition and playing a role in the aetiology and
maintenance of distress in chronic pain and therefore an adverse impact on functioning.
Conclusion
Enhancing our understanding of pain related imagery and its impact on functioning could inform
the design of interventions in clinical practice. Working systematically with patients’ idiosyncratic
pain related images and the beliefs that are associated with them could be a helpful specific target
for therapy.
... In particular, exercise alone may have a beneficial effect on depression symptoms that is comparable to that of antidepressant treatments [96]. It is also argued that because stress and depression are both associated with the development of later life medical comorbidities as well as the onset and worsening of osteoarthritis, pain, disability, and poor health, careful evaluation to tease out the presence of physical symptoms, versus emotional distress, followed by interventions such as relaxation, may be helpful in reducing osteoarthritis related disability, especially in over-anxious and/or chronically ill patients [44,[97][98][99][100]. In turn, therapies that foster feelings of efficacy and confidence and engage the mental and social capacities of the arthritis sufferer are expected to positively impact overall well-being, as well as mental health status [91,101]. ...
Osteoarthritis, a highly prevalent progressively disabling chronic health condition associated with aging, is frequently addressed from a physical standpoint, rather than a more holistic standpoint, even though psychological correlates are often prevalent co morbid determinants of this condition. This review briefly summarizes the literature on osteoarthritis and depression published over the last 30 years. From this review, it is concluded that depression is a frequent correlate of osteoarthritis disability, and where present heightens the prevailing disabling painful experience consistently and significantly. Since depression is amenable to treatment, it is recommended more attention to routinely screening for depression among osteoarthritis sufferers, rather than doing this sporadically, is strongly indicated for promoting optimal outcomes among this burgeoning population.
... (46) , 2010), hasta el punto de demostrar que es posible reducir la medicación con un buen control de los síntomas (Baird y cols. (47) , 2010). ...
... Jamani & Clyde, 2008;Pincus & Sheikh, 2009;Winterowd, Beck, & Gruener, 2003), yet to our knowledge, have not to date been assessed by systematic trials. The most studied technique in the context of pain is "guided imagery", which suggests a standard positive image to patients (Albright & Fischer, 1990;Baird, et al., 2010;Brown, 1984;Fors & Gotestam, 2000;Fors, et al., 2002;Kwekkeboom, et al., 2008;Lewandowski, 2004;Lewandowski, et al, 2011.;Mannix, et al., 1999;Menzies, et al., 2006;Morone & Greco, 2007;Posadzki & Ernst, 2011;Raft, et al., 1986). ...
Therapy with mental images is prevalent in the field of chronic pain, and this has been the case for centuries. Yet few of the recent advances in the cognitive behavioural understanding of spontaneous (i.e. intrusive) mental imagery have been translated to this field. Such advances include imagery as a component of a psychopathological process, as an emotional amplifier and as a cognitive therapeutic target in its own right. Hence very little is known about the contents, prevalence and emotional impact of spontaneous mental imagery in the context of chronic pain. This article discusses the evidence in favour of spontaneous imagery being a potentially important part of patients' pain experience, and makes a case, based on neurophysiological findings, for imagery having an impact on pain perception. Furthermore, it presents how mental imagery has been used in the treatment of chronic pain. A case report illustrates further how spontaneous negative imagery linked to pain can be distressing, and how this might be addressed in therapy. Additionally, the case report demonstrates the spontaneous use of coping imagery, and raises a discussion of how this might be enhanced.
... (46) , 2010), fi ns al punt de demostrar que és possible reduir la medicació amb un bon control dels símptomes (Baird i col. (47) , 2010). ...
... Consistent with our study results, researchers have indicated that some relaxation techniques decreased the sleep disturbance, 8,32 the use of sleep medication, 35,41 and daytime dysfunction 23,35 and improved the subjective sleep quality. 23,35 Moreover, relaxation technique reduced daytime dysfunction and enhanced daytime energy 35 as well as the mind's capacity to improve physical function and performance. ...
This study was performed to evaluate the effectiveness of Benson's relaxation technique in the quality of sleep of hemodialysis patients.
It was a randomized controlled trial with a pre-post-test design. A total of 86 hemodialysis patients referring to hemodialysis units were assigned to either the intervention (receiving Benson's relaxation technique) or the control group (routine care) through block randomization.
The study was performed in two hemodialysis units affiliated to Shiraz University of Medical Sciences, Shiraz, Iran.
The patients in the intervention group listened to the audiotape of Benson's relaxation technique twice a day each time for twenty minutes for eight weeks.
The global score of Pittsburgh Sleep Quality Index (PSQI) as well as its components was computed in both the intervention and the control group before and at the 8th week of the intervention.
The results of ANCOVA indicated significant differences between the two groups regarding the scores of Pittsburgh Sleep Quality Index subscales, such as sleep disturbance, daytime dysfunction, the use of sleep medication, and subjective sleep quality and as well as its global scores at the 8th week of the intervention (p<0.05).
This study highlighted the importance of Benson's relaxation technique in improvement of the sleep quality of the patients on hemodialysis. Thus, educational sessions are recommended to be planned on this cost effective and easy to use relaxation technique in order to improve hemodialysis patients' sleep quality. Further studies are needed to assess the effectiveness of this technique in other groups of patients.
... Clinical trials of mental imagery have shown benefits for patients with chronic pain [e.g. 3,8,18,49,50,87,91,92,96,102,124]. Nonetheless, there are methodological issues with many of the studies conducted in this field, as discussed in recent literature reviews [109,123]. ...
A large number of studies have provided evidence for the efficacy of psychological and other non-pharmacological interventions in the treatment of chronic pain. While these methods are increasingly used to treat pain, remarkably few studies focused on the exploration of their neural correlates. The aim of this article was to review the findings from neuroimaging studies that evaluated the neural response to distraction-based techniques, cognitive behavioral therapy (CBT), clinical hypnosis, mental imagery, physical therapy/exercise, biofeedback, and mirror therapy. To date, the results from studies that used neuroimaging to evaluate these methods have not been conclusive and the experimental methods have been suboptimal for assessing clinical pain. Still, several different psychological and non-pharmacological treatment modalities were associated with increased pain-related activations of executive cognitive brain regions, such as the ventral- and dorsolateral prefrontal cortex. There was also evidence for decreased pain-related activations in afferent pain regions and limbic structures. If future studies will address the technical and methodological challenges of today's experiments, neuroimaging might have the potential of segregating the neural mechanisms of different treatment interventions and elucidate predictive and mediating factors for successful treatment outcomes. Evaluations of treatment-related brain changes (functional and structural) might also allow for sub-grouping of patients and help to develop individualized treatments.
... Our search identified 117 unique publications on the nonpharmacologic management of OA over the study time period: eight general reviews of the non-pharmacologic management of OA 1e8 ; 14 studies of acupuncture 9e22 ; 10 studies of devices 23e32 (including seven of orthoses 23e26,28,29,32 , two of splints or braces 30,31 , and one of temporomandibular joint therapy 27 ); three studies evaluating education or self-management 33e35 ; 25 studies of exercise 36e60 ; 12 studies of nutraceuticals 61e72 , including five of glucosamine 62e65,69 ; 12 of physical therapy 73e84 ; one of manual therapy 85 ; 11 studies evaluating rehabilitation in the context of surgery 86e96 ; five of electrostimulation 97e101 , including two evaluating TENS 99,101 ; two of weight loss 102,103 ; one of thermal modalities 104 ; two of ultrasound 105,106 and 11 of other forms of nonpharmacologic management, including three of spa therapy 107e109 , two of mud-bath therapy 110,111 , and one each of: Castor oil/diclofenac sodium 112 ; magnetic and copper bracelets 113 ; stimulating massage 114 ; hydrotherapy 115 ; hyperthermia 116 ; guided imagery with relaxation 117 . The results of our search are summarized in Table I, by modality and study design. ...
To highlight seminal publications in the past year on the topic of non-pharmacologic management of osteoarthritis (OA).
A systematic search of the PUBMED and Cochrane databases from September 2009 to September 2010 was conducted to identify articles reporting on studies examining the safety or efficacy of non-pharmacologic therapies in the management of OA. Non-pharmacologic therapies were those considered in the 2008 OARSI OA guidelines. Identified articles were reviewed for quality; those of highest quality and deemed to have greatest potential impact on the management of OA were summarized.
The search identified 117 unique articles. Of these, four studies were chosen to highlight. A nested two-stage trial found that traditional Chinese acupuncture (TCA) was not superior to sham acupuncture, but that the providers' style affected both pain reduction and satisfaction with treatment, suggesting that the analgesic benefits of acupuncture may be partially mediated by the acupuncturists' behavior. A systematic review found little evidence of a significant effect for electrostimulation vs sham or no intervention on pain in knee OA. A single-blinded trial of Tai Chi vs attention controls found that 12 weeks of Tai Chi was associated with improvements in symptoms and disability in patients with knee OA. A randomized trial of early ACL reconstructive surgery and rehabilitation vs structured rehabilitation alone in subjects with acute anterior cruciate ligament tears found that, at 24 months following randomization, all study participants had improved, suggesting that a strategy of structured rehabilitation followed acute ACL injury may preclude the need for surgical reconstruction.
High quality studies of the safety and efficacy of non-pharmacologic agents in the management of OA remain challenging due to difficulties with adequate blinding and appropriate selection of attention controls. High quality studies suggest modest, if any, benefit of many non-pharmacologic therapies over attention control or placebo, but a significant impact of both over no intervention at all.
Background:
Guided imagery (GI) is a non-pharmacological method used to reduce pain, stress, and anxiety.
Aims:
This study aimed to evaluate the impact of brief GI on symptoms of chronic back pain in adults treated in the Rheumatology clinic.
Design:
A-B design study.
Settings & participants:
A sample of 35 women with chronic back pain were recruited at the Rheumatology Outpatient Clinic of Barzilai Medical Center in Ashkelon, Israel.
Methods:
All subjects completed questionnaires at recruitment (T1), and after 8-10 weeks, they completed questionnaires again before the first intervention (T2). The intervention included five brief GI group meetings every 2-3 weeks, one hour each (3-5 subjects per group). Participants learned 6 GI exercises and were asked to practice brief guided imagery exercises at least once daily. Then, questionnaires were completed the third time (T3).
Outcome measures:
MOQ - Modified Oswestry Low Back Pain Disability Questionnaire, STAI - State-Trait Anxiety Inventory, FABQ - Fear-Avoidance Beliefs Questionnaire, NPRS - Numerical Pain Rating Scale (average pain over the last week).
Results:
Compared with the period without intervention, NPRS (Δ = 2.53, standard error [SE] = 0.43, p < .001), STAI (Δ = 8.41, SE = 1.95, p < .001), and MOQ (Δ = 0.06, SE = 0.02, p = .019) reported significantly lower levels after brief guided imagery training. However, no statistically significant change was found in FABQ.
Conclusions:
The brief guided imagery intervention may help alleviate chronic back pain, help decrease anxiety, and improve daily activity in women who suffer from chronic low back pain.
Guided imagery distracts patients from disturbing feelings and thoughts, positively affects emotional well-being, and reduces pain by producing pleasing mental images. This study aimed to determine the effects of guided imagery on postoperative pain management in patients undergoing lower extremity surgery. This randomized controlled study was conducted between April 2018 and May 2019. This study included 60 patients who underwent lower extremity surgery. After using guided imagery, the posttest mean Visual Analog Scale score of patients in the intervention group was found to be 2.56 (1.00 ± 6.00), whereas the posttest mean score of patients in the control group was 4.10 (3.00 ± 6.00), and the difference between the groups was statistically significant (p <.001). Guided imagery reduces short-term postoperative pain after lower extremity surgery.
Background:
With the development of electronic geriatric assessment (GA), recommendations for self-management can be provided to patients without the presence of health care providers. Our research question was to identify what self-management interventions can be used by patients to address issues identified in GA and to determine their effect on patient-centered outcomes such as quality of life, health, mood, cognition, and functional status.
Methods:
Searches were conducted on July 13, 2021, by a health sciences librarian in Medline, Embase, CINAHL, PsycInfo, and the Cochrane Library. A combination of database-specific subject headings and text word searches was used such as self-management, a key word for each of the geriatric assessment domains and older adults. Two independent reviewers reviewed abstracts and full texts for inclusion and abstracted data. Narrative synthesis was used to summarize findings.
Results:
Among 28,520 abstracts reviewed, 34 randomized controlled trials were included. The most frequently studied geriatric domains were mood (n = 13 studies), mobility/falls (n = 12), quality of life (n = 11), and functional status (n = 7). The majority of studies demonstrated positive effects on mobility/falls (9 of 12), pain (3 of 5), comorbidity (4 of 4), and medication management (4 of 4). Most studies were of low to moderate quality. All geriatric domains were targeted in at least one study.
Conclusions:
Low- to moderate-quality studies show a variety of effective self-efficacy-targeted interventions exist for older adults to improve several important geriatric domains and related outcomes. However, long-term effects, validation, and scalability of these interventions remain largely unknown.
Pain in the elderly is an increasing problem with increasing life expectancy resulting in many people living for longer with a range of age-related debilitating and painful conditions. Management of pain in the elderly can be complex due to increasing fragility, cognitive impairment and the presence of comorbidities and polypharmacy. Non-pharmacological methods of pain relief would appear to offer a solution to many of these problems. Overall the evidence for the effective use of many non-pharmacological therapies in pain management for the elderly is limited. Most effective measures appear to be those which support self-help, those which provide distraction and promote exercise and the use of superficial heat/cold. There is limited evidence to support the use of most complementary and alternative medicines (CAMs) including dietary supplements, and the role of psychological therapy is limited to improvements in mood states such as anxiety and depression. However due to the low incidence of adverse events, any non-pharmacological therapy which is perceived as offering some relief from suffering by the individual may have personal value.
Management of persistent pain in older adults is challenging given the prevalence of multiple comorbid painful conditions, polypharmacy, age-related changes restricting pharmacological options, and socioeconomic factors. The influences of these factors along with current concern for the use of opioid analgesics highlight the importance of incorporating complementary and integrative medicine approaches. Evidence suggests efficacy and satisfaction with integrating complementary pain management strategies for older adults, especially yoga, massage, and natural products. Nurses and other providers, given their emphasis on holistic care, are in a unique position to lead the transformation of pain management to a patient-centered, self-management style that integrates complementary therapies. [Journal of Gerontological Nursing, 42(12), 40-48.].
Degenerative joint disease (DJD) of the hip is a common cause of atraumatic hip pain in the older patient. Diagnosis is made by history, physical exam, and radiography. Nonoperative nonpharmacologic management includes exercise, weight loss, patient education and self-management programs, assistive devices, and acupuncture. Nonoperative pharmacologic therapy includes acetaminophen, NSAIDs, tramadol, opioids, intra-articular injectable therapy, glucosamine and chondroitin, and diacerein. Surgical joint replacement is seen as a last resort.
The first part of the chapter introduces images, their characteristics, habitual contexts and cognitive functions. The following sections provide a review of studies that focus on guided imagery as a therapeutic option in the domain of medicine. The special themes dealt with include the effects of guided imagery on coping, on reducing stress, on symptoms due to different diseases and the administered treatments, on pain, on healing and on different parameters of the immune system. The final section deals with guided imagery in the clinical setting, describing in detail the Kreitler method of guided imagery, presenting its operational procedure and theoretical rationale. Concluding remarks refer to advantages and risks of applying guided imagery.
Sudden cardiac arrest remains the single most common cause of death for adults in the Western world. Sudden cardiac arrest (SCA) affects approximately 350,000 Americans annually and is a significant health concern and risk (The American Heart Association 2007). These potentially life-threatening arrhythmias often begin as ventricular tachycardia (VT), a dangerously fast heart rhythm that originates in one of the ventricles that may decompensate into ventricular fibrillation (VF). Treatment for VF usually includes high-energy defibrillation from either an automatic external defibrillator (AED) or an implantable cardioverter defibrillator (ICD) that restores proper heart rate and rhythm using high-energy electrical shock. Randomized controlled clinical trials have demonstrated superior mortality benefits of ICDs compared to medications for both primary and secondary prevention for patients at risk for VT/VF. The patient experiences of both spontaneous life-threatening arrhythmias and the treatment via high-energy shock from the ICD have prompted significant clinical and research attention to psychosocial factors (Stutts, Cross, Conti, & Sears, 2007). Biopsychosocial approaches to understanding and managing the risk of sudden cardiac arrest have included examination of psychosocial factors both as antecedents and as consequences to the experience of VF and the subsequent treatment by the ICD. The purpose of this chapter is to review the medical manifestation of ventricular fibrillation and the psychosocial factors of ventricular fibrillation and its treatment and suggest psychological intervention approaches for patients with VF/ICDs. © 2012 Springer Science+Business Media, LLC. All rights reserved.
A systematic review was conducted using Samueli Institute's rapid evidence assessment (REAL©) methodology, to rigorously assess both the quality of the research on active, self-care complementary and integrative medicine (ACT-CIM) modalities and the evidence for their efficacy and effectiveness in treating chronic pain symptoms. Each of the following articles will discuss a key aspect of the review, including an introduction and background to the review and its methodological processes; the current evidence, quality, effectiveness and safety of each ACT-CIM modality and; a summary of lessons learned from the review and recommendations for next steps in the field.
Despite advances in HIV treatment, pain continues to be a prevalent symptom experienced by persons living with HIV (PLWH) and is associated with sleep disturbance and lower quality of life. Ongoing assessments guide effective pain management. Substance abuse issues and concerns about diversion complicate pain treatment. We reviewed the evidence of current research related to pharmacological and nonpharmacological interventions for pain. A comprehensive review of the literature was conducted, including randomized controlled trials, meta-analyses, evidence-based clinical practice guidelines, and expert opinion; studies of HIV neuropathy and pediatric populations were excluded. We limited the search to English language and human studies. While pharmacology-based interventions are widespread, their efficacy over the long term is questionable. Nonpharmacological therapies are promising and require further study. Aberrant behaviors related to opiates are common in PLWH; expert guidelines to address them are presented. A case study is included to illustrate an application of evidence-based clinical practice.
Purpose:
To determine the effects of guided imagery techniques with tape and perceived happy memory on people with chronic tension-type headache (CTTH).
Methods:
Sixty people with CTTH completed the demographic questionnaire and headache diary 1 week before the treatment, that is, for 3 weeks during the treatment and 1 week immediately after that. The people were randomly assigned into one of three different treatment groups: a Guided imagery (GI) with tape group (n = 20), a GI with perceived happy memory group (n = 20) and a control group (n = 20). In addition to individualized headache therapy, subjects listened to a guided imagery audiocassette tape or imagined the happiest personal memory three times per week for 3 weeks. It should be noted that 20 control subjects received individualized therapy without guided imagery.
Results:
The guided imagery groups both tape and perceived happy memory had significantly more improvement than the controls in three of the outcome measures; headache intensity, headache frequency and headache duration. There were no other significant differences between the guided imagery groups (tape and perceived happy memory) at any time point.
Conclusions:
Guided imagery is an effective, available and affordable nonpharmacological therapy either with tape or with perceived happy memory for the management of the CTTH.
Osteoarthritis (OA) is a leading cause of pain and disability worldwide. Current treatment guidelines recommend nonpharmacological approaches such as yoga for firstline treatment of OA. Yoga is a promising mind-body practice that includes physical postures, breathing practices, and meditative mental focus. This article presents the current evidence, as well as a proposed conceptual model for future research. Current research on yoga for OA is scant but promising, showing some evidence of reduced pain, sleep disturbance, and disability. The conceptual model described here proposes musculoskeletal effects (strengthening, flexibility, relaxation), reduction of autonomic arousal, and therapeutic cognitive patterns (distraction, mindfulness) as potentially important mechanisms of yoga. This article also describes considerations for patients and health care providers when evaluating the potential usefulness and safety of yoga programs: yoga style, instructor qualifications, and amount of time spent in yoga practice.
Our previous review of the literature concluded that there is encouraging evidence that guided imagery alleviates musculoskeletal pain, but the value of guided imagery in the management of non-musculoskeletal pain remains uncertain.
The objective of this systematic review was to assess the effectiveness of guided imagery as a treatment option for non-musculoskeletal pain.
Six databases were searched from their inception to February 2011. Randomized clinical trials were considered if they investigated guided imagery in human patients with any type of non-musculoskeletal pain in any anatomical location and assessed pain as a primary outcome measure. Trials of motor imagery and hypnosis were excluded. The selection of studies, data extraction, and validation were performed independently by two reviewers.
Fifteen randomized clinical trials met the inclusion criteria. Their methodological quality was generally poor. Eleven trials found that guided imagery led to a significant reduction of non-musculoskeletal pain. Four studies found no change in non-musculoskeletal pain with guided imagery in comparison with progressive relaxation, standard care, or no treatment.
The evidence that guided imagery alleviates non-musculoskeletal pain is encouraging but remains inconclusive.
Comorbid conditions that pose risks for suicide, especially depression, are prevalent in people living with chronic pain. The true numbers of failed attempts and successful suicides are unknown and may never be determined. Yet, risk factors for suicidal ideation are so high in this population that it must be assumed that some proportion of those who die of drug overdoses might have intended to end their lives, not just temporarily relieve their pain. The purpose of this manuscript is to highlight to clinicians the important association between chronic pain and intentional self-harm. Contemporary understanding of the epidemiology of depression and suicide and the relationship to chronic pain will be reviewed. Recommendations for the use of validated and practical screening tools as part of a comprehensive clinical assessment and for approaches to suicide prevention and interventions as crucial components of chronic pain management are outlined.
Background: Total joint replacement is an accepted, cost-effective, and underutilized treatment for moderate-to-severe hip and knee arthritis. Yet, research has suggested that many patients with arthritis are unwilling to consider total joint replacement surgery. We sought to understand these patients' unwillingness by exploring the nature of their decision-making processes. Methods: In-depth interviews were conducted with seventeen individuals with moderate-to-severe arthritis who were appropriate candidates for, but unwilling to consider, total joint replacement. The interviews were analyzed with use of qualitative methods and content analysis techniques. Results: Symptoms and information sources were the two main factors influencing patient decision-making. Participants engaged in individualized processes of trading off perceived costs and benefits. Accommodation to pain and disability and minimization of the quality-of-life benefit, in view of decreasing life span, led to a process whereby the threshold at which the benefits compared with the risks would tilt in favor of total joint replacement was constantly shifting, a phenomenon we called "the moving target." Conclusions and Clinical Relevance: The moving-target. characterization sheds light on patients' conceptions of their arthritis and on their unwillingness to consider total joint replacement. This process needs to be considered when developing ways to aid decision-making.
Context
Evidence that rofecoxib increases the risk of myocardial infarction has led to scrutiny of other nonsteroidal anti-inflammatory drugs (NSAIDs). Regulatory agencies have provided variable advice regarding the cardiovascular risks with older nonselective NSAIDs.
Objective
To undertake a systematic review and meta-analysis of controlled observational studies to compare the risks of serious cardiovascular events with individual NSAIDs and cyclooxygenase 2 inhibitors.
Data Sources
Searches were conducted of electronic databases (1985-2006), scientific meeting proceedings, epidemiological research Web sites, and bibliographies of eligible studies.
Study Selection
Eligible studies were of case-control or cohort design, reported on cardiovascular events (predominantly myocardial infarction) with cyclooxygenase 2 inhibitor, NSAID use, or both with nonuse/remote use of the drugs as the reference exposure. Of 7086 potentially eligible titles, 17 case-control and 6 cohort studies were included. Thirteen studies reported on cyclooxygenase 2 inhibitors, 23 on NSAIDs, and 13 on both groups of drugs.
Data Extraction
Two people independently extracted data and assessed study quality with disagreements resolved by consensus.
Data Synthesis
Data were combined using a random-effects model. A dose-related risk was evident with rofecoxib, summary relative risk with 25 mg/d or less, 1.33 (95% confidence interval [CI], 1.00-1.79) and 2.19 (95% CI, 1.64-2.91) with more than 25 mg/d. The risk was elevated during the first month of treatment. Celecoxib was not associated with an elevated risk of vascular occlusion, summary relative risk 1.06 (95% CI, 0.91-1.23). Among older nonselective drugs, diclofenac had the highest risk with a summary relative risk of 1.40 (95% CI, 1.16-1.70). The other drugs had summary relative risks close to 1: naproxen, 0.97 (95% CI, 0.87-1.07); piroxicam, 1.06 (95% CI, 0.70-1.59); and ibuprofen, 1.07 (95% CI, 0.97-1.18).
Conclusions
This review confirms the findings from randomized trials regarding the risk of cardiovascular events with rofecoxib and suggests that celecoxib in commonly used doses may not increase the risk, contradicts claims of a protective effect of naproxen, and raises serious questions about the safety of diclofenac, an older drug.
Conclusions
Published online September 12, 2006 (doi:10.1001/jama.296.13.jrv60011).
Objectives. This study is designed to test the effects of a 6-week trial of mental practice of motor imagery (MP) on balance and gait in community-dwelling elderly.Methods. Six elderly females were recruited from a community-assisted living center and randomly assigned 2 groups. The experimental group received 20 minutes of mental practice of motor imagery, while the control group received 20 minutes of health education, before assembling together for 20 minutes of physical exercise. The study lasted for 6 weeks, 12 intervention sessions, with each intervention session lasting for 1 hour. Pretest-Posttest outcome measures included the Berg Balance Scale (BBS), Timed Up and Go (TUG), and Activities-specific Balance Confidence Scale (ABC).Results. Compliance was excellent. Wilcoxon Signed-Ranks test for the TUG were significant (Z = 2.2, p = .02) for increases in gait speed for the group as a whole. Improvements were measured in dynamic measures of balance on the BBS, but all outcome measures were not statistically significant at the .05 level for either the mental practice or education group. A net trend towards decline in balance confidence was observed.Discussion. Movement efficiency as measured by gait speed, improves after a short trial of physical practice, regardless of mental practice involvement. Posttest declines in balance confidence may imply increased body awareness and realistic awareness of functional deficits.Conclusion. Further research is warranted to determine the effect of MP on balance in this population. Longer interventions, further validation of mental imagery for this population and quantification of tests of balance are recommended.
Successful control of affect partly depends on the capacity to modulate negative emotional responses through the use of cognitive
strategies (i.e., reappraisal). Recent studies suggest the involvement of frontal cortical regions in the modulation of amygdala
reactivity and the mediation of effective emotion regulation. However, within-subject inter-regional connectivity between
amygdala and prefrontal cortex in the context of affect regulation is unknown. Here, using psychophysiological interaction
analyses of functional magnetic resonance imaging data, we show that activity in specific areas of the frontal cortex (dorsolateral,
dorsal medial, anterior cingulate, orbital) covaries with amygdala activity and that this functional connectivity is dependent
on the reappraisal task. Moreover, strength of amygdala coupling with orbitofrontal cortex and dorsal medial prefrontal cortex
predicts the extent of attenuation of negative affect following reappraisal. These findings highlight the importance of functional
connectivity within limbic-frontal circuitry during emotion regulation.
The present study investigates the effectiveness of Erikson hypnosis and Jacobson relaxation for the reduction of osteoarthritis pain. Participants reporting pain from hip or knee osteoarthritis were randomly assigned to one of the following conditions: (a) hypnosis (i.e. standardized eight-session hypnosis treatment); (b) relaxation (i.e. standardized eight sessions of Jacobson's relaxation treatment); (c) control (i.e. waiting list). Overall, results show that the two experimental groups had a lower level of subjective pain than the control group and that the level of subjective pain decreased with time. An interaction effect between group treatment and time measurement was also observed in which beneficial effects of treatment appeared more rapidly for the hypnosis group. Results also show that hypnosis and relaxation are effective in reducing the amount of analgesic medication taken by participants. Finally, the present results suggest that individual differences in imagery moderate the effect of the psychological treatment at the 6 month follow-up but not at previous times of measurement (i.e. after 4 weeks of treatment, after 8 weeks of treatment and at the 3 month follow-up). The results are interpreted in terms of psychological processes underlying hypnosis, and their implications for the psychological treatment of pain are discussed.
Long-term exercise participation among older adults will result in healthier lifestyles and reduced need for health care. A better understanding, therefore, of what influences older individuals to start and maintain exercise plans would be beneficial. The twofold purpose of this study was (1) to create a knowledge base of determinants that influence exercise behavior in older adults and (2) to have health professionals prioritize determinants that affect exercise initiation and adherence in older adults. The expert panel examined nine determinants within the category of personal characteristics: age, gender, ethnicity, occupation, educational level, socioeconomic status, biomedical status, smoking status, and past exercise participation. The experts rated the determinants on importance for influencing exercise behavior of older adults. This expert panel concluded that older adults who are in good health and have a history of exercise activity might be more likely to participate in long-term exercise programs.
Mental imagery involves rehearsing or practicing a task in the mind with no physical movement. The technique is commonly used, but the actual physical foundation of imagery has not been evaluated for the fast, complex, automatic motor movement of the golf swing. This study evaluated motor imagery of the golf swing, of golfers of various handicaps, by using functional MR imaging to assess whether areas of brain activation could be defined by this technique and to define any association between activated brain areas and golf skill.
Six golfers of various handicap levels were evaluated with functional MR imaging during a control condition and during mental imagery of their golf swing. Two control conditions were evaluated--"rest" and "wall"--and were then subtracted from the experimental condition to give the functional activation map. These control conditions were then tested against the golf imagery; the participants were told to mentally rehearse their golf swings from a first person perspective. The percentages of activated pixels in 137 defined regions of interest were calculated.
The "rest-versus-golf" paradigm showed activation in motor cortex, parietal cortex, frontal lobe, cerebellum, vermis, and action planning areas (frontal and parietal cortices, supplementary motor area, cerebellum) and areas involved with error detection (cerebellum). Vermis, supplementary motor area, cerebellum, and motor regions generally showed the greatest activation. Little activation was seen in the cingulate gyrus, right temporal lobe, deep gray matter, and brain stem. A correlation existed between increased number of areas of activation and increased handicap.
This study showed the feasibility of defining areas of brain activation during imagery of a complex, coordinated motor task. Decreased brain activation occurred with increased golf skill level for the supplementary motor area and cerebellum with little activation of basal ganglia.
Total joint replacement is an accepted, cost-effective, and underutilized treatment for moderate-to-severe hip and knee arthritis. Yet, research has suggested that many patients with arthritis are unwilling to consider total joint replacement surgery. We sought to understand these patients' unwillingness by exploring the nature of their decision-making processes.
In-depth interviews were conducted with seventeen individuals with moderate-to-severe arthritis who were appropriate candidates for, but unwilling to consider, total joint replacement. The interviews were analyzed with use of qualitative methods and content analysis techniques.
Symptoms and information sources were the two main factors influencing patient decision-making. Participants engaged in individualized processes of trading off perceived costs and benefits. Accommodation to pain and disability and minimization of the quality-of-life benefit, in view of decreasing life span, led to a process whereby the threshold at which the benefits compared with the risks would tilt in favor of total joint replacement was constantly shifting, a phenomenon we called "the moving target."
The moving-target characterization sheds light on patients' conceptions of their arthritis and on their unwillingness to consider total joint replacement. This process needs to be considered when developing ways to aid decision-making.
The aim of this study was to investigate whether brief psychologic interventions to reduce perioperative stress may improve the postoperative course of patients undergoing abdominal surgery.
We used a randomized, controlled, partially blinded trial to evaluate the differential effectiveness of two brief psychologic interventions (guided imagery and progressive muscle relaxation) on analgesic requirement, pain perception, pulmonary function, duration of postoperative ileus, and fatigue after conventional resection of colorectal carcinoma in elderly cancer patients.
Sixty patients (20 guided imagery, 22 relaxation, 18 control) were evaluated. Acceptance of the brief psychologic interventions was high and 90 percent of the patients indicated that they would recommend it to other patients. Analgesic consumption (P = 0.6) and subjective pain intensity at rest (P = 0.3) and while coughing (P = 0.3) were not different between groups. Recovery of pulmonary function, duration of postoperative ileus, and subjective postoperative fatigue were also not influenced. When the data from intervention groups were pooled, again no benefits were detected compared with the control group.
Brief psychologic interventions such as guided imagery and relaxation yielded a very positive patient response but did not show a clinically relevant influence on the postoperative physiologic course of elderly patients undergoing conventional resections of colorectal cancer.
The interpretation of available evidence on the relative efficacy of nonsteroidal antiinflammatory drugs (NSAID) and acetaminophen in osteoarthritis (OA) has recently been debated. This systematic review summarizes the available evidence on the efficacy of NSAID compared to acetaminophen, and compares the quality and content of clinical guidelines regarding the pharmacological treatment of OA.
Published reports of randomized controlled trials (RCT) and clinical guidelines were identified by a systematic search of bibliographic databases and relevant websites. The quality of RCT was assessed by 2 reviewers independently using a standardized checklist. Data from these RCT were used to calculate pooled differences between groups for pain and disability. The methodology of identified guidelines was appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) instrument.
The search strategy resulted in the identification of 5 RCT. Statistical pooling of data from 3 trials with adequate methods and sufficient data presentation resulted in a pooled standardized mean difference for general pain of 0.33 (95% CI 0.15 to 0.51), indicating a small effect in favor of NSAID. Pooled estimates for other outcome measures were smaller. Three of the 9 identified guidelines satisfied more AGREE criteria than others, particularly regarding rigor of development. Stakeholder involvement, applicability, and editorial independence were poorly described in most guidelines. The content of recommendations regarding the use of NSAID or acetaminophen was fairly consistent.
Acetaminophen is often effective in OA and is associated with fewer adverse reactions than NSAID. Available evidence supports the recommendations of recent guidelines to use acetaminophen as initial therapy for OA in addition to nonpharmacological interventions. Further research is needed to establish the efficacy of NSAID or acetaminophen in relevant subgroups of patients. We agree with guidelines that it is important that treatment is tailored to individual patients taking into account the severity of symptoms, previous use of acetaminophen, and the patient's knowledge, expectations, and preferences.
(1) To investigate the effects of a 6-week intervention of guided imagery on pain level, functional status, and self-efficacy in persons with fibromyalgia (FM); and (2) to explore the dose-response effect of imagery use on outcomes.
Longitudinal, prospective, two-group, randomized, controlled clinical trial.
The sample included 48 persons with FM recruited from physicians' offices and clinics in the mid-Atlantic region.
Participants randomized to Guided Imagery (GI) plus Usual Care intervention group received a set of three audiotaped guided imagery scripts and were instructed to use at least one tape daily for 6 weeks and report weekly frequency of use (dosage). Participants assigned to the Usual Care alone group submitted weekly report forms on usual care.
All participants completed the Short-Form McGill Pain Questionnaire (SF-MPQ), Arthritis Self- Efficacy Scale (ASES), and Fibromyalgia Impact Questionnaire (FIQ), at baseline, 6, and 10 weeks, and submitted frequency of use report forms.
FIQ scores decreased over time in the GI group compared to the Usual Care group (p = 0.03). Ratings of self-efficacy for managing pain (p = 0.03) and other symptoms of FM also increased significantly over time (p = < 0.01) in the GI group compared to the Usual Care group. Pain as measured by the SF-MPQ did not change over time or by group. Imagery dosage was not significant.
This study demonstrated the effectiveness of guided imagery in improving functional status and sense of self-efficacy for managing pain and other symptoms of FM. However, participants' reports of pain did not change. Further studies investigating the effects of mind-body interventions as adjunctive self-care modalities are warranted in the fibromyalgia patient population.
Osteoarthritis (OA) is the most prevalent health condition among seniors and it causes significant pain and disability. We assessed the influence of patient education and exercise regimens on the well-being of patients with knee OA.
A metaanalysis was conducted on 16 studies reporting exercise and/or self-management interventions for patients with knee OA. The effects on physical and psychological well-being were assessed immediately after the interventions.
Compared to control conditions, exercise regimens led to improvement in physical health (by self-report and direct measures) and in overall impact of OA. Perceived psychological health remained unchanged by the exercise programs. Although the effect sizes for the self-management programs were significant for psychological outcomes and for the overall effect of OA, there was a significant difference between self-management and control groups only in psychological outcomes.
Overall, both patient education and exercise regimens had a modest, yet clinically important, influence on patients' well-being.
This study aimed to ascertain perceived barriers and motivators to exercise in people age 74-85 and to clarify the meaning of these barriers and motivators by examining participant characteristics that relate to them. 324 community-dwelling participants age 74-85 completed a health questionnaire that included items on barriers and motivators to exercise, as well as questions on demographic variables, health, and exercise. Selected participants then completed a physical-performance battery to measure functional performance. Barriers and motivators were related internally, as well as to many other factors including pain and depressed affect on the Geriatric Depression Scale. The findings suggest a need for individualized and comprehensive approaches to the presentation of exercise programs. Health interventions are needed that will address both physical pain and depressed affect and explain the importance of exercise even in the presence of health problems. An understanding of the context of reported barriers and motivators is necessary for correct interpretation and program development.
Objective. To develop a short form of the Arthritis Impact Measurement Scales 2 (AIMS2) questionnaire, preserving content validity as the priority criterion.
Methods. A 2-step reduction procedure was used: 1) Delphi technique, with 1 panel of patients and 1 panel of experts each selecting 1 set of items independently; and 2) nominal group technique, where members of both panels reached consensus on the final selection of items, using information derived from item analysis. Psychometric properties of the AIMS2-Short Form (AIMS2-SF) and AIMS2 were compared using data from a cohort of 127 rheumatoid arthritis patients who completed the AIMS2 twice prior to the initiation of methotrexate (MTX) treatment and 3 months post-initiation of MTX treatment.
Results. The 2 panels reached consensus on a 26-item AIMS2-SF (54.4% reduction from the AIMS2). Factor analysis showed preservation of the 5-component structure. Convergent validity (Physical and Symptom components with clinical variables: r = 0.24-0.59), test-retest reproducibility (intraclass correlation coefficient >0.7), and sensitivity to change at 3 months (standardized response mean 0.36-0.8, except Social Interaction component [0.08]) were very close to the values for the original AIMS2.
Conclusion. The AIMS2-SF is a shorter version of the AIMS2 (i.e., available in 2-page format) and has psychometric properties similar to those of the AIMS2.
Objective: To validate the WOMAC Osteoarthritis Index for use in Sweden. Methods: Test-retest reliability, internal consistency, validity, and responsiveness was determined in 52 patients (mean age 48 (20-69)) with arthroscopically assessed cartilage damage of the tibio-femoral knee joint. Results: All WOMAC scales were internally consistent with Cronbach's alpha coefficients of 0.83, 0.87, and 0.96 pre-operatively. Test-retest reliability was satisfactory with intraclass correlation coefficients of 0.74, 0.58, and 0.92. As hypothesized worse post-operative but not pre-operative outcomes were associated with radiographic OA. In comparison with the SF-36 the expected correlations were found when comparing items measuring similar and dissimilar constructs, supporting the concepts of convergent and divergent construct validity. Three months after arthroscopy significant mean improvement was seen in all WOMAC scales (p<0.0004). Conclusion: The Swedish version of WOMAC is a reliable, valid, and responsive instrument with metric properties in agreement with the original widely used version.
Objective. To provide an indication of the economic, social, and psychological impact of musculoskeletal conditions in the United States.
Methods. Review of the literature combined with estimates of data concerning health care utilization and acute and chronic disability due to musculoskeletal conditions, from the 1990–1992 National Health Interview Survey.
Results. The cost of musculoskeletal conditions was $149.4 billion in 1992, of which 48% was due to direct medical care costs and the remainder was due to indirect costs resulting from wage losses. This amount translates to ˜2.5% of the Gross National Product, a sharp rise since the prior studies, even if part of the increase is an artifact of improved accounting methods. Each year, persons with musculoskeletal conditions make 315 million physician visits, have more than 8 million hospital admissions, and experience ˜1.5 billion days of restricted activity. Approximately 42% of persons with musculoskeletal conditions–more than 17 million in all–are limited in their activities.
Conclusion. The economic and social costs of musculoskeletal conditions are substantial. These conditions are responsible for a sizable amount of health care use and disability, and they significantly affect the psychological status of the individuals with the conditions as well as their families.
The aim of this study was to identify characteristics that predispose older residents of Adelaide to falling. Information collected in the baseline phase of the Australian Longitudinal Study of Ageing was used to draw cross–sectional comparisons between participants who reported having fallen on at least one occasion in the previous 12 months and those participants who reported not having fallen. The baseline cohort consisted of 1947 participants aged 70 years or more, of whom 550 (28 per cent) reported having fallen at least once in the previous year. Independent risk factors for falling were: age; having left school at an early age; a worsening of vision in recent years; and histories of Parkinson's disease, fractured hip, glaucoma, stroke (including transient ischaemic attack), corns or bunions, or arthritis. The findings regarding medical histories suggest some possible opportunities for reducing the risk of falls in the elderly by managing the symptoms and risk factors of underlying conditions such as stroke and loss of vision. (Aust N Z J Public Health 1997; 21: 462–8)
PURPOSE: Guided imagery uses the power of thought to influence psychologic and physiologic states. Some studies have shown that guided imagery can decrease anxiety, analgesic requirements, and length of stay for surgical patients. This study was designed to determine whether guided imagery in the perioperative period could improve the outcome of colorectal surgery patients. METHODS: We conducted a prospective, randomized trial of patients undergoing their first elective colorectal surgery at a tertiary care center. Patients were randomly assigned into one of two groups. Group 1 received standard perioperative care, and Group 2 listened to a guided imagery tape three days preoperatively; a music-only tape during induction, during surgery, and postoperatively in the recovery room; a guided imagery tape during each of the first six postoperative days. Both groups had postoperative patient-controlled analgesia. All patients rated their levels of pain and anxiety daily, on a linear analog scale of 0 to 100. Total narcotic consumption, time to first bowel movement, length of stay, and number of patients with complications were also recorded. RESULTS: Groups were similar in age and gender distribution, diagnoses, and surgery performed. Median baseline anxiety score was 75 in both groups. Before surgery, anxiety increased in the control group but decreased in the guided imagery group (median change, 30;
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Within the context of a double blind randomized controlled parallel trial of 2 nonsteroidal antiinflammatory drugs, we validated WOMAC, a new multidimensional, self-administered health status instrument for patients with osteoarthritis of the hip or knee. The pain, stiffness and physical function subscales fulfil conventional criteria for face, content and construct validity, reliability, responsiveness and relative efficiency. WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials.
In the Western world today, there is a growing interest in nonpharmacological, self induced, altered states of consciousness because of their alleged benefits of better mental and physical health and improved ability to deal with tension and stress. During the experience of one of these states, individuals claim to have feelings of increased creativity, of infinity, and of immortality; they have an evangelistic sense of mission, and report that mental and physical suffering vanish. Subjective and objective data exist which support the hypothesis that an integrated central nervous system reaction, the 'relaxation response', underlies this altered state of consciousness. Physicians should be knowledgeable about the physiologic changes and possible health benefits of the relaxation response.
To provide an indication of the economic, social, and psychological impact of musculoskeletal conditions in the United States.
Review of the literature combined with estimates of data concerning health care utilization and acute and chronic disability due to musculoskeletal conditions, from the 1990-1992 National Health Interview Survey.
The cost of musculoskeletal conditions was $149.4 billion in 1992, of which 48% was due to direct medical care costs and the remainder was due to indirect costs resulting from wage losses. This amount translates to approximately 2.5% of the Gross National Product, a sharp rise since the prior studies, even if part of the increase is an artifact of improved accounting methods. Each year, persons with musculoskeletal conditions make 315 million physician visits, have more than 8 million hospital admissions, and experience approximately 1.5 billion days of restricted activity. Approximately 42% of persons with musculoskeletal conditions--more than 17 million in all--are limited in their activities.
The economic and social costs of musculoskeletal conditions are substantial. These conditions are responsible for a sizable amount of health care use and disability, and they significantly affect the psychological status of the individuals with the conditions as well as their families.
Guided imagery uses the power of thought to influence psychologic and physiologic states. Some studies have shown that guided imagery can decrease anxiety, analgesic requirements, and length of stay for surgical patients. This study was designed to determine whether guided imagery in the perioperative period could improve the outcome of colorectal surgery patients.
We conducted a prospective, randomized trial of patients undergoing their first elective colorectal surgery at a tertiary care center. Patients were randomly assigned into one of two groups. Group 1 received standard perioperative care, and Group 2 listened to a guided imagery tape three days preoperatively; a music-only tape during induction, during surgery, and postoperatively in the recovery room; a guided imagery tape during each of the first six postoperative days. Both groups had postoperative patient-controlled analgesia. All patients rated their levels of pain and anxiety daily, on a linear analog scale of 0 to 100. Total narcotic consumption, time to first bowel movement, length of stay, and number of patients with complications were also recorded.
Groups were similar in age and gender distribution, diagnoses, and surgery performed. Median baseline anxiety score was 75 in both groups. Before surgery, anxiety increased in the control group but decreased in the guided imagery group (median change, 30; P < 0.001). Postoperatively, median increase in the worst pain score was 72.5 for the control group and 42.5 for the imagery group (P < 0.001). Least pain was also significantly different (P < 0.001), with a median increase of 30 for controls and 12.5 for the imagery group. Total opioid requirements were significantly lower in the imagery group, with a median of 185 mg vs. 326 mg in the control group (P < 0.001). Time to first bowel movement was significantly less in the imagery group (median, 58 hours) than in the control group (median, 92 hours; P < 0.001). The number of patients experiencing postoperative complications (nausea, vomiting, pruritus, or ileus) did not differ in the two groups.
Guided imagery significantly reduces postoperative anxiety, pain, and narcotic requirements of colorectal surgery and increases patient satisfaction. Guided imagery is a simple and low-cost adjunct in the care of patients undergoing elective colorectal surgery.
To develop a short form of the Arthritis Impact Measurement Scales 2 (AIMS2) questionnaire, preserving content validity as the priority criterion.
A 2-step reduction procedure was used: 1) Delphi technique, with 1 panel of patients and 1 panel of experts each selecting 1 set of items independently; and 2) nominal group technique, where members of both panels reached consensus on the final selection of items, using information derived from item analysis. Psychometric properties of the AIMS2-Short Form (AIMS2-SF) and AIMS2 were compared using data from a cohort of 127 rheumatoid arthritis patients who completed the AIMS2 twice prior to the initiation of methotrexate (MTX) treatment and 3 months post-initiation of MTX treatment.
The 2 panels reached consensus on a 26-item AIMS2-SF (54.4% reduction from the AIMS2). Factor analysis showed preservation of the 5-component structure. Convergent validity (Physical and Symptom components with clinical variables: r = 0.24-0.59), test-retest reproducibility (intraclass correlation coefficient >0.7), and sensitivity to change at 3 months (standardized response mean 0.36-0.8, except Social Interaction component [0.08]) were very close to the values for the original AIMS2.
The AIMS2-SF is a shorter version of the AIMS2 (i.e., available in 2-page format) and has psychometric properties similar to those of the AIMS2.
This article reviews the efficacy of the psychological and behavioral pain management interventions that have been evaluated among adult patients with rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia (FM). Using published criteria for empirically validated interventions, it is concluded that cognitive-behavioral therapies and the Arthritis Self-Management Program represent well-established treatments for pain among patients with RA and OA. These interventions involve education, training in relaxation and other coping skills, and rehearsal of these skills in patients' home and work environments. There currently are no psychological or behavioral interventions for pain among FM patients that can be considered as well-established treatments. Future intervention research should use clinically meaningful change measures in addition to conventional tests of statistical significance, attend to the pain management needs of children, and assess whether outcomes produced in university-based treatment centers generalize to those in local treatment settings.
The gate control theory's most important contribution to understanding pain was its emphasis on central neural mechanisms. The theory forced the medical and biological sciences to accept the brain as an active system that filters, selects and modulates inputs. The dorsal horns, too, were not merely passive transmission stations but sites at which dynamic activities (inhibition, excitation and modulation) occurred. The great challenge ahead of us is to understand brain function. I have therefore proposed that the brain possesses a neural network--the body-self neuromatrix--which integrates multiple inputs to produce the output pattern that evokes pain. The body-self neuromatrix comprises a widely distributed neural network that includes parallel somatosensory, limbic and thalamocortical components that subserve the sensory-discriminative. affective-motivational and evaluative-cognitive dimensions of pain experience. The synaptic architecture of the neuromatrix is determined by genetic and sensory influences. The 'neurosignature' output of the neuromatrix--patterns of nerve impulses of varying temporal and spatial dimensions--is produced by neural programs genetically build into the neuromatrix and determines the particular qualities and other properties of the pain experience and behavior. Multiple inputs that act on the neuromatrix programs and contribute to the output neurosignature include. (1) sensory inputs (cutaneous, visceral and other somatic receptors); (2) visual and other sensory inputs that influence the cognitive interpretation of the situation; (3) phasic and tonic cognitive and emotional inputs from other areas of the brain; (4) intrinsic neural inhibitory modulation inherent in all brain function; (5) the activity of the body's stress-regulation systems, including cytokines as well as the endocrine, autonomic, immune and opioid systems. We have traveled a long way from the psychophysical concept that seeks a simple one-to-one relationship between injury and pain. We now have a theoretical framework in which a genetically determined template for the body-self is modulated by the powerful stress system and the cognitive functions of the brain, in addition to the traditional sensory inputs.
To validate the WOMAC Osteoarthritis Index for use in Sweden.
Test-retest reliability, internal consistency, validity, and responsiveness was determined in 52 patients (mean age 48 (20-69)) with arthroscopically assessed cartilage damage of the tibio-femoral knee joint.
All WOMAC scales were internally consistent with Cronbach's alpha coefficients of 0.83, 0.87, and 0.96 pre-operatively. Test-retest reliability was satisfactory with intraclass correlation coefficients of 0.74, 0.58, and 0.92. As hypothesized worse post-operative but not pre-operative outcomes were associated with radiographic OA. In comparison with the SF-36 the expected correlations were found when comparing items measuring similar and dissimilar constructs, supporting the concepts of convergent and divergent construct validity. Three months after arthroscopy significant mean improvement was seen in all WOMAC scales (p<0.0004).
The Swedish version of WOMAC is a reliable, valid, and responsive instrument with metric properties in agreement with the original widely used version.
To validate a short-form Arthritis Impact Measurement Scales 2 (AIMS2-SF) among 147 patients with osteoarthritis (OA).
We used factor analysis to identify domains of functional health associated with OA. Multitrait scaling analysis was used to evaluate the reliability and validity of the AIMS2-SF.
The results suggested that upper body limitations should be distinguished from lower body limitations in the physical function scale. The AIMS2-SF was psychometrically sound, with all 5 scales having high item-discriminant validity and Cronbach's alpha reliability above the 0.70 criterion (except 0.67 for the social function scale).
The AIMS2-SF is a reliable and valid instrument among patients with OA. Because of its simplicity and ease of application, it may be useful in routine evaluation of health status, in clinical research, and in predicting use of medical services among OA patients.
Pain is a universal experience that lends itself to nursing interventions based on a holistic approach. Pain is a dynamic process, and relaxation techniques are based on the recognition of the interaction between the physiological and psychological components of the human body. Although acute episodes of pain are found in all areas of nursing practice, limited research using relaxation techniques as supplements to pharmacologic intervention has been reported. This article reviews six research studies that have implications for holistic interventions in nursing practice. Theoretical bases, findings, and discussion of relevance for holistic nursing practice are presented as well as recommendations for future research in the area of relaxation technique use during episodes of acute pain.
The McGill Pain Questionnaire (MPQ) is widely used in assessing a variety of pain problems. MPQ has been found to be sensitive enough to detect differences in pain relief and differences between acute and chronic pain. It requires, however, 5 to 10 minutes to administer. Because of this time factor, the Short-Form McGill Pain Questionnaire (SF-MPQ) was developed. A visual analogue scale (VAS) was not included in the original MPQ but is part of the SF-MPQ. Studies addressing the best way to present a VAS suggest that a vertical line is easier for patients to see; however, the VAS on the SF-MPQ is a horizontal line. This study examined the relationship between SF-MPQ scores with both the horizontal and vertical VAS.
Osteoarthritis (OA) is the most common rheumatologic health problem of older adults. Developing a greater understanding of what it is like to live with this chronic, progressive, and frequently unsuccessfully treated condition is necessary to improve evidence-based nursing care to support independent living. Eighteen women aged 65 to 92 years participated in narrative descriptive research based on naturalistic-framework and qualitative-analysis methods. Data were the transcribed narratives of the participants, field notes of observations and impressions, theoretical memos, coded units of the narratives, and categories noted. Deconstructions and reconstructions of the narratives led to the meaning of "Being With OA," with intermediate categories, "Living With Hurting" and "Living With Difficulty Doing." Recommendations included nursing interventions based on individual problems and strengths and further studies of older adults with chronic health problems.
The prevention of disability in activities of daily living (ADL) may prolong older persons' autonomy (older persons are defined in this study as those aged > or =60 years). However, proved preventive strategies for ADL disability are lacking. A sedentary lifestyle is an important cause of disability. This study examines whether an exercise program can prevent ADL disability.
A 2-center, randomized, single-blind, controlled trial was conducted in which participants were assigned to an aerobic exercise program, a resistance exercise program, or an attention control group. Of the 439 community-dwelling persons aged 60 years or older with knee osteoarthritis originally recruited, the 250 participants initially free of ADL disability were used for this study. Incident ADL disability, defined as developing difficulty in transferring from a bed to a chair, eating, dressing, using the toilet, or bathing, was assessed quarterly during 18 months of follow-up.
The cumulative incidence of ADL disability was lower in the exercise groups (37.1%) than in the attention control group (52.5%) (P =.02). After adjustment for demographics and baseline physical function, the relative risk of incident ADL disability for assignment to exercise was 0.57 (95% confidence interval, 0.38-0.85; P =.006). Both exercise programs prevented ADL disability; the relative risks were 0.60 (95% confidence interval, 0.38-0.97; P =.04) for resistance exercise and 0.53 (95% confidence interval, 0.33-0.85; P =.009) for aerobic exercise. The lowest ADL disability risks were found for participants with the highest compliance to exercise.
Aerobic and resistance exercise may reduce the incidence of ADL disability in older persons with knee osteoarthritis. Exercise may be an effective strategy for preventing ADL disability and, consequently, may prolong older persons' autonomy.
The neuromatrix theory of pain proposes that pain is a multidimensional experience produced by characteristic "neurosignature" patterns of nerve impulses generated by a widely distributed neural network-the "body-self neuromatrix"-in the brain. These neurosignature patterns may be triggered by sensory inputs, but they may also be generated independently of them. Acute pains evoked by brief noxious inputs have been meticulously investigated by neuroscientists, and their sensory transmission mechanisms are generally well understood. In contrast, chronic pain syndromes, which are often characterized by severe pain associated with little or no discernible injury or pathology, remain a mystery. Furthermore, chronic psychological or physical stress is often associated with chronic pain, but the relationship is poorly understood. The neuromatrix theory of pain provides a new conceptual framework to examine these problems. It proposes that the output patterns of the body-self neuromatrix activate perceptual, homeostatic, and behavioral programs after injury, pathology, or chronic stress. Pain, then, is produced by the output of a widely distributed neural network in the brain rather than directly by sensory input evoked by injury, inflammation, or other pathology. The neuromatrix, which is genetically determined and modified by sensory experience, is the primary mechanism that generates the neural pattern that produces pain. Its output pattern is determined by multiple influences, of which the somatic sensory input is only a part, that converge on the neuromatrix.
The effectiveness of an attention distracting and an attention focusing guided imagery as well as the effect of amitriptyline on fibromyalgic pain was studied prospectively.
Fifty-five women with previously diagnosed fibromyalgia were monitored for daily pain (VAS) in a randomized, controlled clinical trial. One group received relaxation training and guided instruction in "pleasant imagery" (PI) in order to distract from the pain experience (n=17). Another group received relaxation training and attention imagery upon the "active workings of the internal pain control systems", "attention imagery" (AI) (n=21). The control group (CG) received treatment as usual (n=17). Patients were also randomly assigned to 50-mg amitriptyline/day or placebo. Some psychological and socio-demographic variables were also measured initially. The slopes of diary pain ratings over a 4-week period were used as the outcome measures.
We found significant differences of the pain-slopes between the three psychological conditions (P=0.0001). The pleasant imagery (P<0.005), but not the attention imagery group's slope, declined significantly when compared with the control group (P>0.05). There was neither a difference between the amitriptyline and placebo slopes (main effects, P=0.98) nor a significant amitriptyline x psychological interaction (P=0.76).
Pleasant imagery (PI) was an effective intervention in reducing fibromyalgic pain during the 28-day study period. Amitriptyline had no significant advantage over placebo during the study period.
Osteoarthritis is the most common form of arthritis, its prevalence increasing with age: as much as 80% of the population over 75 years show radiologic signs of the condition. Symptoms include pain, stiffness, and functional impairment; however, not all patients are symptomatic. Management starts with nonpharmacologic interventions, followed by pharmacologic means, and ultimately by surgical intervention. The management is multidisciplinary and is tailored to the needs of the individual patient. It is, therefore, a good model of collaborative care: multidisciplinary management of a chronic condition for which the patients themselves coordinate the use of the management options, with information and guidance from health care professionals and written materials, as needed. Guidelines for the management of osteoarthritis have been developed and are applied in different continents. These guidelines are based on searches of the literature and evidence-based interpretation, in combination with expert opinion. Pharmacologic management guidelines state that based on its overall efficacy, toxicity profile, and cost, paracetamol-acetaminophen should be tried first and, if successful, should be used as the preferred long-term analgesic. In patients who do not experience adequate symptomatic relief with paracetamol-acetaminophen, alternative or additional pharmacologic agents should be considered, especially nonsteroidal anti-inflammatory drugs (NSAIDs). When the combination of paracetamol-acetaminophen with NSAIDs fails, tramadol may be given. Most patients with osteoarthritis are able, after discussion with their physician, to manage their symptoms themselves. They make use of educational occupational, and physical advisers, and they use their medication on demand. The basis of this self-administered pharmacologic management is paracetamol-acetaminophen, sometimes in combination with NSAIDs. A promising option for the future is the development of symptomatic slow-acting drugs for osteoarthritis that possess structure-modifying properties.
To characterize the public health burden and impact of arthritis among women, document the growing interest in addressing arthritis as a public health problem, and review new national (Centers for Disease Control and Prevention [CDC]) and state arthritis programs.
Arthritis and other rheumatic diseases are a major public health problem, affecting nearly 27 million women in 1997 and accounting for 23.9 million ambulatory medical care visits and 451,000 hospitalizations among women in that year. Arthritis is also the leading cause of disability and is associated with considerable functional limitations. The 1999 National Arthritis Action Plan: A Public Health Strategy prompted first-time congressional funding to the CDC to monitor the burden of arthritis and to establish state arthritis prevention programs through cooperative agreements. The CDC's Arthritis Program also used this funding to build the public health science base, develop national health communications campaigns, foster partnerships, and initiate health systems change.
Arthritis in general and selected types, such as rheumatoid arthritis, systemic lupus erythmatosus (SLE), and fibromyalgia, disproportionately affect women. The CDC, state health departments, and their partners are working toward improving the quality of life for women affected by arthritis. Effective, evidence-based interventions, such as self-management education and physical activity programs, are currently available and can reduce pain, improve function, and delay disability, but they remain underused. Future research should focus on improving earlier diagnosis and increasing access to effective interventions.
To describe the usefulness of daily pain management diaries to outpatients with cancer who participated in a randomized clinical trial of the PRO-SELF Pain Control Program.
Randomized clinical trial in which a daily pain management diary was used for data collection in the control group and for data collection and nurse coaching regarding the pain management program in the intervention group.
Seven outpatient oncology settings.
155 patients with pain from bone metastases and 90 family caregivers.
Content and statistical analysis of audiotaped answers to a semistructured questionnaire.
Patients' and family caregivers' perceptions of the usefulness of a daily pain management diary; specific ways in which the diary was used.
Patients in both the intervention (75%) and control groups (73%) found the diary useful. The diary was used to heighten awareness of pain, guide pain management behavior, enhance a sense of control, and facilitate communication. Family caregivers in both groups also reported that the diary was useful.
The completion of a daily pain management diary is useful to patients and family caregivers and may function as an intervention for self-care.
Research-based evidence supports the importance of using a daily pain management diary in clinical practice.
To determine the direct and indirect cost of osteoarthritis (OA) according to disease severity, and to estimate the total cost of the disease in Hong Kong.
This study is a retrospective, cross-sectional, nonrandom, cohort design, with subjects stratified according to disease severity based on functional limitation and the presence or absence of joint prosthesis. Subjects were recruited from primary care, geriatric medicine, rheumatology, and orthopedic clinics. There were 219 patients in the mild disease category, 290 patients in the severe category, and 65 patients with joint replacement. A questionnaire gathered information on demographic and socioeconomic characteristics, function limitation, use of health and social services, and effect on occupation and living arrangements over the previous 12 months. Costs were calculated as direct and indirect.
Low education and socioeconomic class were associated with more severe disease. OA affected family or close relationships in 44%. The average cost incurred as a result of side effects of medication is similar to the average cost of medication itself. Excluding joint replacement, the direct costs ranged from Hong Kong (HK) dollar $11,690 to $40,180 per person per year and indirect costs, HK $3,300-$6,640. The direct costs are comparable to those reported in Western countries; however, the ratio of direct to indirect costs is much higher than 1, in contrast to the greater indirect versus direct costs reported in whites. The total cost expressed as a percentage of gross national product is also much lower in Hong Kong.
The socioeconomic impact of OA in the Hong Kong population is comparable to Western countries, but the economic burden is largely placed on the government, with patients having relatively low out-of-pocket expenditures.
This paper reviews the evidence for mind-body therapies (eg, relaxation, meditation, imagery, cognitive-behavioral therapy) in the treatment of pain-related medical conditions and suggests directions for future research in these areas. Based on evidence from randomized controlled trials and in many cases, systematic reviews of the literature, the following recommendations can be made: 1) multi-component mind-body approaches that include some combination of stress management, coping skills training, cognitive restructuring and relaxation therapy may be an appropriate adjunctive treatment for chronic low back pain; 2) multimodal mind-body approaches such as cognitive-behavioral therapy, particularly when combined with an educational/informational component, can be an effective adjunct in the management of rheumatoid and osteoarthritis; 3) relaxation and thermal biofeedback may be considered as a treatment for recurrent migraine while relaxation and muscle biofeedback can be an effective adjunct or stand alone therapy for recurrent tension headache; 4) an array of mind-body therapies (eg, imagery, hypnosis, relaxation) when employed pre-surgically, can improve recovery time and reduce pain following surgical procedures; 5) mind-body approaches may be considered as adjunctive therapies to help ameliorate pain during invasive medical procedures.
To determine: (1) the psychometric properties and utility of 5 types of commonly used pain rating scales when used with younger and older adults, (2) factors related to failure to successfully use a pain rating scale, (3) pain rating scale preference, and (4) factors impacting scale preference.
A quasi-experimental design was used to gather data from a sample of 86 younger (age 25-55) and 89 older (age 65-94) adult volunteer subjects. Responses of subjects to experimentally induced thermal stimuli were measured with the following pain intensity rating scales: vertical visual analog scale (VAS), 21-point Numeric Rating Scale (NRS), Verbal Descriptor Scale (VDS), 11-point Verbal Numeric Rating Scale (VNS), and Faces Pain Scale (FPS).
All 5 pain scales were effective in discriminating different levels of pain sensation; however the VDS was most sensitive and reliable. Failure rates for pain scale completion were minimal, except for the VAS. Although age did not impact failure to properly use this pain intensity rating scale, but rather those conditions more commonly associated with advanced age, including cognitive and psychomotor impairment did. The scale most preferred to represent pain intensity in both cohorts of subjects was the NRS, followed by the VDS. Scale preference was not related to cognitive status, educational level, age, race, or sex.
Although all 5 of the pain intensity rating scales were psychometrically sound when used with either age group, failures, internal consistency reliability, construct validity, scale sensitivity, and preference suggest that the VDS is the scale of choice for assessing pain intensity among older adults, including those with mild to moderate cognitive impairment.
Osteoarthritis (OA) is a common, chronic condition that affects most older adults. Adults with OA must deal with pain that leads to limited mobility and may lead to disability and difficulty maintaining independence. A longitudinal, randomized clinical trial pilot study was conducted to determine whether Guided Imagery (GI) with Progressive Muscle Relaxation (PMR) would reduce pain and mobility difficulties of women with OA. Twenty-eight older women with OA were randomly assigned to either the treatment or the control group. The treatment consisted of listening twice a day to a 10-to-15-minute audiotaped script that guided the women in GI with PMR. Repeated-measures ANOVA revealed a significant difference between the two groups in the amount of change in pain and mobility difficulties they experienced over 12 weeks. The treatment group reported a significant reduction in pain and mobility difficulties at week 12 compared to the control group. Members of the control group reported no differences in pain and non-significant increases in mobility difficulties. The results of this pilot study justify further investigation of the effectiveness of GI with PMR as a self-management intervention to reduce pain and mobility difficulties associated with OA.
We examined the direct medical costs for patients with osteoarthritis (OA) and chronic back pain (CBP) in comparison to similar patients not treated for these conditions.
All persons age 18 years and over enrolled in the Lovelace Health Plan (LHP) who had at least 2 outpatient or one inpatient visits during the study period (June 30, 2000 to July 1, 2001) for OA or CBP were identified using discharge billing records. Each patient with OA or CBP was matched to 3 persons of the same age group, sex, and ethnicity, and then utilization and pharmacy records for each study subject were abstracted for comparison.
The prevalence of OA and CBP increased with age (11.0% and 7.2% of persons in the 75-79 age group, respectively), although more than two-thirds of OA and CBP patients in the LHP were below age 65. Patients with OA or CBP were more than 3 times more likely than controls to be admitted to hospital, and their average length of stay, costs per hospital day, and readmission rate were all significantly higher (p < 0.01). However, only 58.8% of the excess admissions in the OA group and 48.8% of the excess admissions in the CBP group were attributed to musculoskeletal disease. Outpatient costs were more than doubled among both OA and CBP cases (mean annual outpatient costs of US dollars 4684 and US dollars 4350, respectively), with increased costs seen in all service areas. Prescription drug costs for OA patients (mean average wholesale price, AWP, US dollars 1184) were increased by 102%, with the greatest increases seen in the use of nonsteroidal antiinflammatory drugs (NSAID), gastric acid secretion reducers, and antidepressants. Prescription drug costs for CBP patients were increased by 107% (mean AWP US dollars 1331), with the greatest increases seen in the use of antidepressants, NSAID, narcotics, and gastric acid secretion reducers.
Health services and prescription medication costs for patients with OA and CBP were more than double those of matched controls. Much of the increased utilization occurred in areas not commonly associated with musculoskeletal conditions.
The purpose of this study was to compare pain and anxiety in orthopaedic patients scheduled for elective total hip or knee arthroplasty who have received a kit of nonpharmacologic strategies for pain and anxiety in addition to their regularly prescribed analgesics to those who receive the usual pharmacologic management alone.
Descriptive comparative and correlational design using surveys and chart audits.
Sixty-five patients randomized to receive usual care or usual care plus a kit of nonpharmacologic strategies.
Patients who received the kit used nonpharmacologic measures for pain and anxiety more often than patients who did not receive the kit. The kit group tended to use less opioid and have less anxiety on postoperative day 1 (not statistically significant) and use significantly less opioid on postoperative day 2 than the patients who did not receive the kit. There were no between-group differences in pain intensity. There were significant correlations among postoperative pain intensity, opioid use, and anxiety. The coping method of diverting attention was related to lower present (now) pain scores, and ignoring the pain was associated with higher worst pain.
Providing a kit of nonpharmacologic strategies can increase the use of these methods for postoperative pain and anxiety and decrease the amount of opioid taken. The influence of coping strategies in acute postoperative pain needs to be examined further.
To investigate hip or knee symptoms in older persons from a longitudinal, population perspective, and to determine the impact of persistent hip or knee pain on general health status over time.
A postal questionnaire was sent to a random sample of 5,500 individuals ages > or = 65 years containing the Short Form 36 (SF-36) general health survey, Lequesne hip and knee indices, and a hip/knee pain severity item. Respondents reporting hip or knee symptoms at baseline received an identical questionnaire 1