title: Guided Imagery for Adolescent Post-spinal Fusion Pain Management: A Pilot Study.
abstract: Orthopedic surgery for adolescent idiopathic scoliosis entails anxiety and severe postoperative pain. The aim of this pilot study was to investigate an intervention for adolescent post-spinal fusion pain management in patients from a tertiary care hospital in Montreal, Canada. Participants were adolescents and young adults ages 11 to 20 years undergoing spinal fusion. Participants were randomized to standard care or standard care with adjunct intervention. The intervention consisted of a DVD with information and guided imagery/relaxation exercises to practice at least three times a week at home. A nurse screened the DVD with the patient preoperatively and at discharge (T1) and telephoned 2 weeks post-discharge (T2) to reinforce the technique. Both groups completed questionnaires at T1, T2, and T3 (1-month postoperative follow-up). Outcome measures included pain intensity, anxiety, coping mechanisms, and daily activities. From March 2010 to June 2011, we enrolled 40 of 45 eligible participants (n = 20 per group), average age 15 ± 2.1 years, 7 participants were male. Compared with the control group, the experimental group experienced significantly less overall pain at all time points, with moderate to large effect sizes at T2, T3 (p ≤ .007). Worst pain in 24 hours was moderately decreased at T2 (p = .01). State-trait anxiety remained high. On a 10-point scale, a median 2.5-point benefit was seen in eating and sleeping (Mann-Whitney test, p = .002), and 2 points in walking (Mann-Whitney test, p = .003). Coping strategies showed no significant differences. Addition of a guided imagery and relaxation exercise DVD for home use was more effective than standard care alone for postoperative pain. Our nonpharmacologic adjunct looks promising. Larger sample size and longer (6-9 months) follow-up will permit refinement.
authors.affiliation: Pain Clinic, CHU Sainte-Justine, Montreal, Quebec, Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Charette
authors.affiliation: Research Centre, CHU Sainte-Justine, Montreal, Canada; Faculty of Nursing, University of Montreal, Montreal, Canada.
authors.forename: Jacinthe Lachance
authors.initials: JL
authors.lastname: Fiola
authors.affiliation: Pain Clinic, CHU Sainte-Justine, Montreal, Quebec, Canada.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Charest
authors.affiliation: Pain Clinic, CHU Sainte-Justine, Montreal, Quebec, Canada; Research Centre, CHU Sainte-Justine, Montreal, Canada.
authors.forename: Edith
authors.initials: E
authors.lastname: Villeneuve
authors.affiliation: Research Centre, CHU Sainte-Justine, Montreal, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Théroux
authors.affiliation: Research Centre, CHU Sainte-Justine, Montreal, Canada; Orthopedic Clinic, CHU Sainte-Justine, Montreal, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Joncas
authors.affiliation: Research Centre, CHU Sainte-Justine, Montreal, Canada; Orthopedic Clinic, CHU Sainte-Justine, Montreal, Canada; Faculty of Medicine, Department of Surgery, University of Montreal, Montreal, Canada.
authors.forename: Stefan
authors.initials: S
authors.lastname: Parent
authors.affiliation: Research Centre, CHU Sainte-Justine, Montreal, Canada; Faculty of Nursing, University of Montreal, Montreal, Canada. Electronic address: sylvie.lemay@umontreal.ca.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Le May
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy; D008297:Male; D059408:Pain Management / Q000451:nursing; D010149:Postoperative Pain / Q000451:nursing / Q000517:prevention & control*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011792:Quebec; D012064:Relaxation Therapy / Q000379:methods / Q000451:nursing; D012600:Scoliosis / Q000451:nursing / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects* / Q000451:nursing; D011795:Surveys and Questionnaires; D016896:Treatment Outcome