Coping with pain

Coping with pain

96 Abstracts (950) The impact of SARS visitation restrictions on patients’ perception of nursing support (952) Selective attention to signals of im...

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96

Abstracts

(950) The impact of SARS visitation restrictions on patients’ perception of nursing support

(952) Selective attention to signals of impending pain: an experimental approach

M. Rubenstein, D. Tripp, M. Harrison, D. Goldstein, L. Gagliese; Queen‘s University, Kingston, ON Severe Acute Respiratory Syndrome (SARS) had a great impact on the medical community. The effect on medical staff has been reported widely. The impact on patient care, however, has yet to be systematically examined. The goal of this study is to examine any effect that SARS visitation restrictions had on mood, pain ratings, pain catastrophizing, perceived social support from nurses, and satisfaction with care from nurses during acute postoperative hospitalization following total knee replacement surgery for knee joint osteoarthritis. 15 consecutive patients who underwent surgery when SARS visitation restrictions were imposed and 14 consecutive patients who underwent surgery following the lifting of SARS visitation restrictions were assessed on the first three says after surgery. Participants completed the Shortened Version of Profile of Mood States (SPOMS; Shacham, 1983), the Modified Short Version – McGill Pain Questionnaire (MSF-MPQ, Melzack, 1987), the Pain Catastrophizing Scale (PCS; Sullivan, Bishop, & Pivik, 1995), the Medical Outcomes Study SS Scale (MOS SSS; Sherbourne & Stewart, 1991), and the Nursing Satisfaction Questionnaire. Results: Patients reported perceiving more social support from nurses after the SARS visitation restrictions were lifted (t(80) ⫽ -3.352, p ⬍ .001). No significant differences were found on mood, pain ratings, pain catastrophizing, and satisfaction with care from nurses. It is clear that SARS visitation restrictions had a significant impact on the degree of support that patients perceived to be available from nursing staff.

S. VanDamme, G. Crombez, C. Eccleston; Ghent University, Ghent, Belgium Two experiments are reported that investigated different components of selective attention (shift, engagement, disengagement) towards signals of pain using an exogenous cueing paradigm. Healthy undergraduate students were instructed to detect the location of targets, preceded by exogenous cues. In the first experiment (27 undergraduates), cues became signals of impending pain (electrocutanous stimulus at tolerance level) using differential classical conditioning: the conditioned stimulus (CS⫹) was sometimes followed by an aversive electrocutaneous stimulus (UCS), whereas no UCS followed the other stimulus (CS-). Results of the first experiment showed that the CS⫹ cue facilitated engagement and impaired disengagement, in comparison with the CScue, t(26)⫽3.97, p⬍.001. In the second experiment (34 undergraduates), targets instead of cues were aversively conditioned to physical threat signals. The results suggested that the CS⫹ target facilitated attentional shifting, as compared to the CS- t(33)⫽3.91, p⬍.001. The findings are discussed in terms of the decomposition of attention to threat and the evolutionary importance of attentional bias to signals of impending threat.

F03 - Hypnosis/Distraction

(953) Distraction from chronic pain during a pain-inducing activity is associated with greater post-activity pain

(951) Relations between children‘s coping styles and the efficacy of distraction for procedural pain J. MacLaren, L. Cohen; West Virginia University, Morgantown, WV Approach-avoidance is considered to be one of the core components of health-related coping. However, few studies have examined this dichotomy in children and how it relates to treatment efficacy. The current study examines the relative efficacy of a distraction intervention during painful medical procedures for children identified as “avoiders” and those identified as “approachers.” Fifty-nine, 1- to 7-year-old children receiving venipuncture were assigned, on an alternating basis, to receive standard care or movie distraction. Children‘s approach-avoidant coping styles was assed by self-report and procedural distress was assessed via parent-report and self-report. Observational coding was used to assess children‘s engagement in distraction. Analyses revealed that “approachers” and “avoiders” did not differ significantly in terms of their engagement in distraction. In terms of parent-report of child distress, a significant interaction between children‘s self-reported coping style (approach versus avoidance) and treatment condition (control versus distraction) was evidenced. Specifically, “approachers” were significantly less distressed than “avoiders” in the control condition; however, both “approachers” and “avoiders” demonstrated low distress in the distraction condition. This interaction was not significant for child selfreport of distress – however, significant main effects for treatment condition and coping style were evidenced. “Approachers” were less distressed than “avoiders,” and children in the distraction condition were significantly less distressed than children in the control condition. In general, children who are categorized as “approachers” were less distressed during a painful procedure than children who were categorized as “avoiders.” In terms of treatment effects, according to parent-report of distress, relative to control, distraction was more effective for “avoiders” than “approachers.” According to child self-report of distress however, it appears that distraction was effective for children, regardless of coping style. Although further research is necessary, these results highlight the importance of comprehensively assessing children‘s coping style when selecting pain management interventions.

L. Goubert, G. Crombez, C. Eccleston; Ghent University, Ghent, Belgium Distraction is a common and intuitive way of attempting to control pain. It is a common part of packages of cognitive behavioural therapy. Despite its intuitive appeal, there is equivocation as to the merits of distraction. In particular, the results from clinical and experimental research about its effectiveness are inconclusive. The aim of the present study was to investigate the effects of distraction from pain during and after a pain-inducing lifting task in a sample of chronic low back pain patients. Fifty-two chronic low back pain patients performed a paininducing lifting task twice, once alone and once with a simultaneous cognitive distraction task. The results revealed (1) that distraction only had an effect upon self-reported pain immediately after the lifting task, but not upon experienced pain during the lifting task, (2) that both pain-related fear and pain catastrophizing did not moderate the effects of distraction on pain, and (3) that patients who catastrophized during the lifting task were more vigilant to pain during the lifting task, and were less engaged in the distracting task, compared with patients who did not catastrophize. Further investigation of the catastrophizing data showed that the effect of catastrophizing during the lifting task on the cognitive distraction task was mediated by the amount of attention paid to pain. Distraction was not effective in reducing pain. There was a paradoxal increase of pain after immediately after the distraction. The implications for the clinical application of distraction are discussed.