The effect of relaxation and preparatory information on postoperative pain in sensitizers and avoiders

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Virginia Polytechnic Institute and State University


The effectiveness of preoperative relaxation training and preparatory information, separately and in combination, on postoperative pain was examined with respect to surgical patients' coping style (avoidance-sensitization). Subjects were 64 patients undergoing elective cholecystectomy or hysterectomy (abdominal or vaginal) in a large private hospital. Experimenters were advanced clinical psychology graduate students and trained undergraduate research assistants.

On the afternoon prior to surgery, patients were contacted, completed an interview that was used to assess their coping style in the surgical situation (Cohen & Lazarus, 1973), and completed the state anxiety portion of the State-Trait Anxiety Inventory. Patients also completed the Pain Rating Index and the Present Pain Index of the McGill Pain Questionnaire. At this point in the preoperative session, patients were presented with materials and/or information corresponding to the group to which they were assigned. Treatments consisted of training in the Benson relaxation technique, receiving information about procedures and specific sensations they would experience, or a combination of relaxation training and information-imparting. Controls talked briefly with the experimenter of feelings about surgery and experiences in the hospital. Patients in all groups were revisited on the second (counting the day after surgery as the first postoperative day) and fourth postoperative days, and again completed the pain measures and the state anxiety measure. Patients were also encouraged to practice the relaxation technique, instructed concerning procedures and sensations they had yet to experience, both, or neither, depending on the group to which they were assigned. After each patient was discharged, his/her medical records were examined and the number and type of analgesics administered during the postoperative period, from the day of surgery until discharge, was tabulated.

Preoperative interviews were rated according to coping style and patients were divided into two groups, sensitizers and avoiders. Data were analyzed in a 2 x 4 analysis of covariance. Results indicated that there were no main effects for treatment. It is possible that the treatments provided in this study were too brief to provide an adequate test of their effectiveness for patients in general. There were no significant main effects for coping style, although sensitizers generally reported more pain and received more analgesics than avoiders. An avoidant method of coping appeared to be an adequate method of adjustment to elective surgery and did not result in poorer recovery, as previous authors have suggested.

Significant effects on postoperative pain were primarily a function of the interaction between treatment and coping style. Sensitizers reported less pain with relaxation training alone than sensitizers in any of the other groups. This effect was apparently owing to the anxiety-reducing nature of the technique and the fact that it encourages redirection of attention, away from discomforts. Avoiders reported low levels of pain and anxiety with no treatment. However, of the treatments provided, relaxation plus information did reduce some indices of pain below that of avoider controls.

Finally, information-imparting did not appear to be beneficial for either sensitizers or avoiders. It was suggested that specific information may contribute to further sensitization to discomforts for sensitizers and conflict with avoidant processes of coping in avoiders. It was also suggested that more extensive preoperative preparation of sensitizers may be necessary to promote habituation to the discomforts of surgery.