Abstract
Despite decades of research, postoperative pain is still not being relieved. To date there has been no clinical trial that integrates testing of both pharmacological and non-pharmacological methods of pain relief. Patients remain unaware of a variety of methods that can be used to relieve their own pain and care-providers do not effectively impart this information to patients. In her previous NINR-funded study, Dr. Good found that the combination of non-pharmacological (non-pharm) interventions relieved postoperative abdominal pain significantly more than patient-controlled analgesia (PCA) opioids alone. The effect of these non-pharm adjuvants for pain was also clinically significant; patients reported up to 31% less pain than when PCA opioids alone were used. However, patients continued to have moderate pain. More relief was needed to reduce the effect of pain on stress and immune function, thereby placing patients in a better position to resist infection and surgical complications. Teaching patients about appropriate use of both pharmacological and non-pharmacological methods of analgesia merited testing. Patient teaching about pain management (PM) is expected to increase patient knowledge of pharmacological methods they can use for relief, and to decrease apprehension and opioid fears; while the other interventions relax and distract patients from pain.
The purpose of the current study, entitled “Nursing Care After Surgical Experiences” (NCase), is to test and compare the efficacy of non-pharm methods, patient teaching about pain management, and the combination of both. Male and female abdominal surgical patients will be randomly assigned to one of the three treatment groups and one control group. The interventions for pain will be tested in 452 abdominal surgical patients before and after 20-minute periods of rest, once on the day of surgery, and twice on postoperative day 1 and day 2. Outcome measures include postoperative pain, stress, side effects of opioids, and immunity. Pain sensation and distress and saliva for salivary cortisol and IgA will be assessed at the pre and posttests. Knowledge of the effects of patient teaching and non-invasive methods to reduce postoperative pain, stress, and increase immune function may facilitate postoperative recovery with lower health care cost. This study is supported by the National Institute of Nursing Research at NIH (RO1 NR03933 1994-2005 to Dr. Good) and by the General Clinical Research Center at Case Western Reserve University .
Dr. Good has also added a genetics component to the NCase study, which looks at whether certain genetic markers are related to patient-reported pain. She is also conducting a study of the effect of non-pharm interventions on postoperative pain in Korea, which will lead to intercultural comparisons of pain.
These pilot studies are supported by Research Initiation Grants from Case Western Reserve University. Dr. Good's research methods are currently used by international researchers conducting pain studies in the U.S., South Korea, Taiwan, Thailand, and Egypt.
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