Skin-to-skin contact diminishes pain from hepatitis B vaccine injection in healthy full-term neonates.

PURPOSE: This study was conducted to test the hypothesis that skin-to-skin contact (SSC) would reduce hepatitis B vaccine injection pain in full-term neonates. DESIGN: Randomized controlled trial (RCT). SAMPLE: Thirty-six mother-;neonate dyads were randomly assigned to SSC or control groups. MAIN OUTCOMES: Cry time (CT ), behavioral state (BSt), and heart rate (HR ) were measured throughout the 16-minute protocol. HR and BSt were measured every 30 seconds; CT was recorded continuously. RESULTS: SSC neonates cried less compared with controls (23 vs 32 seconds during injection; 16 vs 72 seconds during recovery), reached calmer BSts sooner (M = 2.8 vs M = 6.5 time points), and trended toward more rapid HR decrease. SSC as described was safe and effective and merits further testing.

Effects on postoperative salivary cortisol of relaxation/music and patient teaching about pain management.

The physiological and psychological stress of surgery and postoperative pain can leave patients more susceptible to infection and complications. The present study was designed to determine whether two interventions, patient teaching (PT) for pain management and relaxation/music (RM), reduced cortisol levels, an indicator of stress, following abdominal surgery. Patients (18-75 years) were randomly assigned to receive PT, RM, a combination of the two, or usual care; the 205 patients with both pre- and posttest cortisol values were analyzed. A 2 × 2 factorial design was used to compare groups for PT effects and RM effects. Stress was measured by salivary cortisol before and after 20-min tests of the interventions in the morning and afternoon of postoperative Day 2. Saliva was stimulated with lemon juice and analyzed with high-sensitivity salivary cortisol enzyme immunoassay. Comparisons using analysis of covariance (ANCOVA), controlling for baseline levels, showed no PT effect or RM effect on cortisol in the morning or afternoon. Post hoc ANCOVA showed no significant effects when intervention groups were compared to the control group. Although in previous studies, RM reduced pain and music reduced cortisol on Day 1, in the present study the cortisol response to surgery was not attenuated by PT or RM on Day 2. The RM intervention can be used for pain but needs to be further tested for effects on plasma cortisol in abdominal surgery patients on their first postoperative day.

Supplementing relaxation and music for pain after surgery.

BACKGROUND: Most postoperative patients have unrelieved pain despite the use of patient-controlled analgesia. Nurses need additional effective modalities. Relaxation and music (RM), in addition to analgesics, have been shown to reduce pain more than do analgesics alone. OBJECTIVES: The objectives of the study were to test an intervention of patient teaching for pain management (PT) and compare it with RM for immediate and general effects on postoperative pain. METHODS: Patients having abdominal surgery and receiving patient-controlled analgesia aged 18-75 years (n = 517) were randomized to four groups: PT, RM, a combination (PTRM), and a control. A 2 x 2 factorial design was used to assess PT-Effects and RM-Effects. Immediate effects on pain were measured on visual analogue sensation and distress scales before and after five 20-min tests in the first 2 days. Because participants also listened independently, general nonimmediate effects were examined at eight other times. RESULTS: Using multivariate analysis of covariance with contrasts and pretest control, immediate RM-Effects on pain were found at Day 1 a.m. (p < .001), Day 1 p.m. (p = .04), and Day 2 a.m. (p = .04). No PT-Effects or nonimmediate RM-Effects were found. DISCUSSION: Patient teaching did not result in less pain and did not support the theoretical proposition that PT reduces pain. However, the immediate RM-Effects supported the proposition that nonpharmacological adjuvants to analgesics can ease pain without adding side effects.

The effectiveness of music in relieving pain in cancer patients: a randomized controlled trial.

OBJECTIVES: To examine effects of sedative music on cancer pain. DESIGN: A randomized controlled trial. SETTINGS: Two large medical centers in Kaoshiung City, in southern Taiwan. PARTICIPANTS: 126 hospitalized persons with cancer pain. METHODS: Participants were randomly assigned to an experimental (n=62) or a control group (n=64), with computerized minimization, stratifying on gender, pain, and hospital unit. Music choices included folk songs, Buddhist hymns (Taiwanese music), plus harp, and piano (American). The experimental group listened to music for 30 min; the control group rested in bed. Sensation and distress of pain were rated on 100mm VAS before and after the 30-min test. RESULTS: Using MANCOVA, there was significantly less posttest pain in the music versus the control group, p<.001. Effect sizes were large, Cohen's d=.64, sensation, d=.70, distress, indicating that music was very helpful for pain. Thirty minutes of music provided 50% relief in 42% of the music group compared to 8% of the controls. The number needed to treat (NNT) to find one with 50% sensation relief was three patients. More patients chose Taiwanese music (71%) than American music (29%), but both were liked and effective. CONCLUSIONS: Offering a choice of familiar, culturally appropriate music was a key element of the intervention. Findings extend the Good and Moore theory (1996) to cancer pain. Soft music was safe, effective, and liked by participants. It provided greater relief of cancer pain than analgesics alone. Thus nurses should offer calming, familiar music to supplement analgesic medication for persons with cancer pain.

Korean and American music reduces pain in Korean women after gynecologic surgery.

American music has been found to relieve pain in adults in several countries but has not been tested in Korea. Korean women have reported that they would like American music as well as Korean folk songs and religious music sung in Korean. The study purpose was to pilot-test the effects of music on pain after gynecologic surgery in Korean women and to compare pain relief between those who chose American or Korean music. Using a quasiexperimental pretest-posttest design, 73 South Korean women on a preoperative unit were assigned by day of the week to receive music (n = 34; 47%) or no music (n = 39; 53%). The music group chose among Korean (ballads and religious and popular songs) and American (soft slow piano and orchestra) music and heard it for 15 minutes at four time points (postoperatively), whereas the controls rested in bed. They marked VAS Sensation and Distress of Pain scales before and after each test. The two groups were similar on pretest pain. When controlling for pretest pain, MANCOVA indicated that there was significantly less posttest pain in those with music plus analgesics than those with analgesics alone at three of the four tests: p = .04 to .001. Two-thirds in the music group (n = 21; 62%) chose Korean music and one-third (n = 13; 38%) chose American, with no difference in pain: both were effective. In addition to analgesics, music can be used to reduce postoperative pain in Korean women. Patients selected music that was appealing to them. Nurses in many countries can consider music of the country and seek individual preferences to use in addition to analgesics for postoperative pain.

Effect of music on power, pain, depression and disability.

AIM: This paper reports a study testing the effect of music on power, pain, depression and disability, and comparing the effects of researcher-provided music (standard music) with subject-preferred music (patterning music). BACKGROUND: Chronic non-malignant pain is characterized by pain that persists in spite of traditional interventions. Previous studies have found music to be effective in decreasing pain and anxiety related to postoperative, procedural and cancer pain. However, the effect of music on power, pain, depression, and disability in working age adults with chronic non-malignant pain has not been investigated. METHOD: A randomized controlled clinical trial was carried out with a convenience sample of 60 African American and Caucasian people aged 21-65 years with chronic non-malignant pain. They were randomly assigned to a standard music group (n = 22), patterning music group (n = 18) or control group (n = 20). Pain was measured with the McGill Pain Questionnaire short form; depression was measured with the Center for Epidemiology Studies Depression scale; disability was measured with the Pain Disability Index; and power was measured with the Power as Knowing Participation in Change Tool (version II). RESULTS: The music groups had more power and less pain, depression and disability than the control group, but there were no statistically significant differences between the two music interventions. The model predicting both a direct and indirect effect for music was supported. CONCLUSION: Nurses can teach patients how to use music to enhance the effects of analgesics, decrease pain, depression and disability, and promote feelings of power.

Changes in the meaning of pain with the use of guided imagery.

The purpose of this study is to determine how verbal descriptions of pain change with the use of a guided imagery technique. A mixed method, concurrent nested design was used. Participants in the treatment group used the guided imagery technique over a consecutive 4-day period, and those in the control group were monitored. Verbal descriptions of pain were obtained before randomization and at four daily intervals. A total of 210 pain descriptions were obtained across the five time points. Data were analyzed using content analysis. Six categories emerged from the data: pain is never-ending, pain is relative, pain is explainable, pain is torment, pain is restrictive, and pain is changeable. For participants in the treatment group, pain became changeable. The meaning of pain as never-ending was a prominent theme for participants before randomization to treatment and control groups. It remained a strong theme for participants in the control group throughout the 4-day study period; however, pain as never-ending did not resurface for participants in the treatment group.

Relaxation and music reduce pain following intestinal surgery.

Three nonpharmacological nursing interventions, relaxation, chosen music, and their combination, were tested for pain relief following intestinal (INT) surgery in a randomized clinical trial. The 167 patients were randomly assigned to one of three intervention groups or control and were tested during ambulation and rest on postoperative days 1 and 2. Pain sensation and distress were measured with visual analog scales (VAS). Multivariate analysis of covariance showed significantly less post-test pain in the intervention groups than in the control group on both days after rest and at three of six ambulation post-tests (p = .024-.001), resulting in 16-40% less pain. Mixed effects after ambulation were due to the large variation in pain and difficulty relaxing while returning to bed; but post hoc explorations showed effects for those with high and low pain. These interventions are recommended along with analgesics for greater postoperative relief without additional side effects.

Music improves sleep quality in older adults.

AIM: The aim of this paper is to report an investigation of the effects of soft music on sleep quality in older community-dwelling men and women in Taiwan. BACKGROUND: Sleep is a complex rhythmic state that may be affected by the ageing process. Few studies have focused on the effects of music, a non-pharmacological method of improving the quality of sleep in older adults. METHOD: A randomized controlled trial was used with a two-group repeated measures design. Sixty people aged 60-83 years with difficulty in sleeping were recruited through community leaders and screened using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale. Those reporting depression, cognitive impairment, medical or environmental problems that might interfere with sleep; and those who used sleeping medications, meditation, or caffeine at bedtime were excluded. Participants listened to their choice among six 45-minute sedative music tapes at bedtime for 3 weeks. There were five types of Western and one of Chinese music. Sleep quality was measured with the PSQI before the study and at three weekly post-tests. Groups were comparable on demographic variables, anxiety, depressive symptoms, physical activity, bedtime routine, herbal tea use, napping, pain, and pretest overall sleep quality. RESULTS: Music resulted in significantly better sleep quality in the experimental group, as well as significantly better components of sleep quality: better perceived sleep quality, longer sleep duration, greater sleep efficiency, shorter sleep latency, less sleep disturbance and less daytime dysfunction (P = 0.04-0.001). Sleep improved weekly, indicating a cumulative dose effect. CONCLUSION: The findings provide evidence for the use of soothing music as an empirically-based intervention for sleep in older people.

Sedative music reduces anxiety and pain during chair rest after open-heart surgery.

Open-heart surgery patients report anxiety and pain with chair rest despite opioid analgesic use. The effectiveness of non-pharmacological complementary methods (sedative music and scheduled rest) in reducing anxiety and pain during chair rest was tested using a three-group pretest-posttest experimental design with 61 adult postoperative open-heart surgery patients. Patients were randomly assigned to receive 30 min of sedative music (N=19), scheduled rest (N=21), or treatment as usual (N=21) during chair rest. Anxiety, pain sensation, and pain distress were measured with visual analogue scales at chair rest initiation and 30 min later. Repeated measures MANOVA indicated significant group differences in anxiety, pain sensation, and pain distress from pretest to posttest, P<0.001. Univariate repeated measures ANOVA (P< or =0.001) and post hoc dependent t-tests indicated that in the sedative music and scheduled rest groups, anxiety, pain sensation, and pain distress all decreased significantly, P<0.001-0.015; while in the treatment as usual group, no significant differences occurred. Further, independent t-tests indicated significantly less posttest anxiety, pain sensation, and pain distress in the sedative music group than in the scheduled rest or treatment as usual groups (P<0.001-0.006). Thus, in this randomized control trial, sedative music was more effective than scheduled rest and treatment as usual in decreasing anxiety and pain in open-heart surgery patients during first time chair rest. Patients should be encouraged to use sedative music as an adjuvant to medication during chair rest.

Systematic relaxation to relieve postoperative pain.

BACKGROUND: Unrelieved pain after surgery can lead to complications, prolonged hospital stay, and delayed recovery. Because of side effects from opioids and differences in response, it is important to use non-pharmacological methods in addition to analgesics to decrease patient discomfort and anxiety. AIMS: We examined the effects of a systematic method of relaxing the body on the sensory and affective components of postoperative pain, anxiety, and opioid intake after initial ambulation. DESIGN: A randomized controlled trial with relaxation and control groups was used. METHOD: The convenience sample of 102 adults underwent abdominal surgery at a large hospital in Thailand. Systematic relaxation was used for 15 minutes during recovery from the first ambulation after surgery. Pain was measured with 100 mm Visual Analogue Sensation and Distress of Pain Scales before and after the intervention. State anxiety was measured before surgery and after the intervention; opioid intake was recorded 6 hours later. RESULTS: The relaxation group had less post-test sensation and distress of pain (26 and 25 mm less, respectively) than the control group (P = 0.001). Relaxation did not result in significantly less anxiety or 6-hour opioid intake. However, group differences in state anxiety were in the expected direction and fewer participants in the relaxation group requested opioids. Nearly all reported that systematic relaxation reduced their pain and increased their sense of control. CONCLUSION: Substantial reductions in the sensation and distress of pain were found when postoperative patients used systematic relaxation. Although tested in Thailand, we recommend that nurses in other countries try systematic relaxation with postoperative patients, in addition to analgesic medication, measuring pain scores and asking about cultural acceptance.

Obtaining parotid saliva specimens after major surgery.

The purpose of this study was to develop and test a standard method of collecting saliva from postoperative patients. Saliva was collected from patients following major abdominal surgery from both parotid glands in intraoral cups and measured in milliliters. Trained research nurses stimulated saliva production with lemon juice and collected saliva at 4 time points on postoperative day 2. Collection time was measured with a stopwatch, and flow rate was calculated by dividing the amount in milliliters by collection time in minutes. Attrition was 9% due to ineligibility after enrollment and 1 withdrawal. In participating patients (n = 68), there were 272 tests planned and 28% were missing. The reasons were postoperative health problems, hospital discharge, and not wanting to be bothered. When saliva collection attempts were made, three-fourths were successful, but the remainder resulted in "dry mouth." Milliliters, minutes, and flow rate were calculated with and without those with dry mouth. Mean flow rates were 0.23 to 0.33 ml/min excluding those with dry mouth and 0.17 to 0.24 ml/min including those with dry mouth. Saliva variables were correlated with antihypertension medications, opioids, opioid side effects, and length of surgery, but statistically significant correlations were not found consistently at all 4 time points. The findings suggest that nurse-researchers studying biological markers can successfully collect saliva from postoperative patients if they recognize the difficulties and make efforts to minimize and control for them.

Imagery reduces children's post-operative pain.

This un-blinded experimental study investigated the effectiveness of imagery, in addition to routine analgesics, in reducing tonsillectomy and/or adenoidectomy pain and anxiety after ambulatory surgery (AS) and at home. Seventy-three children, aged 7-12, were recruited from five AS settings. Thirty-six children randomly assigned to the treatment group watched a professionally developed videotape on the use of imagery and then listened to a 30-min audio tape of imagery approximately 1 week prior to surgery (T1). They listened to only the audio tape 1-4 h after surgery (T2), and 22-27 h after discharge from AS (T3). The 37 children in the attention-control group received standard care. Pain and anxiety were measured at each time-point in both groups. Measures of sensory pain were the Oucher and amount of analgesics used in AS and home; affective pain was measured with the Facial Affective Scale (FAS). Anxiety was measured using the State Trait Anxiety Inventory for Children (STAIC). When controlling for trait anxiety and opioid and non-opioid intake 1-4 h before the pain measures, MANCOVA showed significantly lower pain and anxiety in the treatment group at T2, but not at T3. When controlling for trait anxiety, a two-way RM MANCOVA indicated no significant group differences in combined opioid and non-opioid use between the groups, or between times. Appropriately trained health care providers should use imagery to reduce post-operative pain following tonsillectomy and/or adenoidectomy in AS. Teaching parents about adequate home administration of analgesics may increase the effectiveness of imagery at home.

Music reduces sensation and distress of labor pain.

Labor pain is often severe, and analgesic medication may not be indicated. In this randomized controlled trial we examined the effects of music on sensation and distress of pain in Thai primiparous women during the active phase of labor. The gate control theory of pain was the theoretical framework for this study. Randomization with a computerized minimization program was used to assign women to a music group (n = 55) or a control group (n = 55). Women in the intervention group listened to soft music without lyrics for 3 hours starting early in the active phase of labor. Dual visual analog scales were used to measure sensation and distress of pain before starting the study and at three hourly posttests. While controlling for pretest scores, one-way repeated measures analysis of covariance indicated that those in the music group had significantly less sensation and distress of pain than did the control group (F (1, 107) = 18.69, p <.001, effect size =.15, and F (1, 107) = 14.87, p <.001, effect size =.12), respectively. Sensation and distress significantly increased across the 3 hours in both groups (p <.001), except for distress in the music group during the first hour. Distress was significantly lower than sensation in both groups (p <.05). In this controlled study, music--a mild to moderate strength intervention--consistently provided significant relief of severe pain across 3 hours of labor and delayed the increase of affective pain for 1 hour. Nurses can provide soft music to laboring women for greater pain relief during the active phase when contractions are strong and women suffer.

A randomized controlled trial of early kangaroo care for preterm infants: effects on temperature, weight, behavior, and acuity.

Kangaroo care (KC) has been the intervention for preterm infants in numerous published studies. However, most well designed studies to date have used a one-group repeated measure design. This methodology is not as definitive as an experimental design. Because of the absence of a comparable control group, change between pretest and posttest may be due to any other environmental variables or normal variation of subjects (Kirk, 1995). This randomized controlled trial (RCT) was done to test the hypotheses that KC infants would have higher mean tympanic temperatures, less weight loss, more optimal behavioral states, and lower acuity (length of stay). Thirty-four eligible mother-infant dyads were randomly assigned to the KC or the control group by computerized minimization on the day following birth. Stratification variables included infant gender, birth weight, delivery method, and parity. KC infants compared to control infants had higher mean tympanic temperature (37.3 degrees C vs. 37.0 degrees C), more quiet sleep (62% vs. 22%), and less crying (2% vs. 6%) all at p=.000. No significant difference was found for weight loss and acuity (length of stay). These findings can be used for evidence-based nursing practice in Taiwan. With the knowledge attained from this RCT, nurses can educate and motivate mothers to keep their stable preterm infants warm by skin-to- skin contact inside their clothing, thereby encouraging self-regulatory feeding.

Relaxation and music reduce pain after gynecologic surgery.

The purpose of this randomized controlled trial was to investigate the effect of three nonpharmacologic nursing interventions: relaxation, music, and the combination of relaxation and music on pain following gynecologic (GYN) surgery. A total of 311 patients, ages 18 to 70, from five Midwestern hospitals, were randomly assigned using minimization to either three intervention groups or a control group and were tested during ambulation and rest on postoperative days 1 and 2. Pain sensation and distress were measured using visual analogue scales. Multivariate analysis of covariance of posttest sensation and distress was used with pretest control and a priori contrasts. The intervention groups had significantly less posttest pain than the control group (p =.022-.001) on both days. The three interventions were similar in their effect on pain. Patients who received the interventions plus patient-controlled analgesia (PCA) had 9% to 29% less pain than controls who used PCA alone. Reduced pain was related to amount of activity (ambulation or rest), mastery of the use of the intervention, and decreased pulse and respiration. Those who slept well had less pain the following day. Nurses who care for GYN surgical patients can provide soft music and relaxation tapes and instruct patients to use them during postoperative ambulation and also at rest on days 1 and 2.