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									                                                       The effect of pain on postoperative adjustment in patients
                                                                         undergoing colposcopy
                                                                                                    Susanna Kola & Jane C. Walsh                                                                            DISCUSSION
              INTRODUCTION                                                        1School   of Psychology, National University of Ireland, Galway
                                                                                                                                                                                      These findings show that patients undergoing
Invasive medical procedures are considered very
stressful and anxiety evoking by patients. Anxiety
                                                                                                                                                                                      colposcopy,       a    stressful       invasive    cancer
                                                     Procedure                                                          A one-way ANOVA showed a significant effect of level of       screening procedure, benefited from sensory
in turn affects acute pain, such that heightened
                                                     State anxiety, positive and negative affect were assessed          pain experienced on observations of distress during the
anxiety reduces pain threshold, which may limit a                                                                                                                                     focus and relaxation during the procedure,
                                                     before and after the procedure. During colposcopy, patients        procedure, F(2, 159) = 4.41, p=0.14.
physician’s ability to complete a procedure.                                                                                                                                          whereas     distraction       led   to    higher    post-
                                                     were assigned to one of four conditions: audiovisual
   Anxiety and pain experienced by patients prior                                                                                                                                     colposcopy state anxiety levels. In other words,
                                                     relaxation (watching relaxing DVD using head-mounted
to and during medical procedures also impact                                                                                                                                          those women who focused on the objective
                                                     display), distraction (playing computer game), sensory focus
negatively on postoperative outcomes, e.g., post-                                                                                                                                     sensory aspects of the experience while viewing
                                                     (focus on sensations experienced and view procedure) , or
operative pain, poorer recovery, increased
                                                     control (standard care). Observational measures of anxiety                                                                       the colposcopy screen and those that relaxed by
analgesic use, increased physical complaints,
                                                     were assessed during the procedure. Following colposcopy,                                                                        watching a nature DVD through audio-visual
and reduced immune function (e.g., Kain et al.,
                                                     patients were again assessed on anxiety, mood, and                                                                               glasses     had       lower    state     anxiety    post-
2000; Kielcolt-Glaser et al., 1998; Osborn &
                                                     experienced pain and discomfort. Additionally, pulse and
Sandler, 2004).                                                                                                                                                                       colposcopy, compared with patients who were
                                                     blood pressure readings were taken before, during and after
                                                                                                                                                                                      actively distracted by a computer game during
                                                     the procedure.
PURPOSE                                                                                                                                                                               the procedure.
                                                                                                                        A one-way ANOVA revealed a significant effect of pain
The results reported are from a distraction                                                                                                                                            In addition, high levels of pain experienced
                                                                                                                        experienced on post-colposcopy positive affect, F(2, 157) =
intervention study designed to reduce anxiety,                                RESULTS                                                                                                 during the procedure were associated with
                                                                                                                        12.24, p=0.00.
pain and discomfort in a clinical setting with       Preliminary results are reported. Three pain intensity groups                                                                    poorer adjustment both during and following
patients undergoing invasive cancer screening.       were created based on patients reports of experienced pain
                                                                                                                                                                                      colposcopy. Patients in the high pain group were
                                                     during the procedure: high, medium and low pain.
                                                                                                                                                                                      observed to engage in more distress-related
                                                                                                                                                                                      behaviours, such as moaning and groaning and
Participants and design                              A two-way factorial analysis of variance (ANOVA) revealed a
164 first-time colposcopy patients, aged between     significant main effect for condition on post-colposcopy state                                                                   body      movements       during        the   procedure,
18-58 years (mean age 30.28, SD = 8.66)              anxiety levels, F(3, 150) = 2.79, p<0.05. Pairwise                                                                               compared with patients who experienced low or
participated in a randomised controlled trial.       comparisons showed that state anxiety levels were                                                                                moderate pain. Finally, those patients who
                                                     significantly lower for the sensory focus condition than for the                                                                 reported high levels of pain experienced higher
Materials                                            distraction condition, and for the relaxation condition than for                                                                 state anxiety levels, lower positive affect, and
• Anxiety prior to the procedure was measured        the distraction group.                                             A one-way ANOVA showed a significant effect of pain           greater negative affect following the procedure,
by STAI (Spielberger et al., 1983)
                                                                                                                        experienced on post-colposcopy negative affect , F(2, 157)    compared with those that reported low or
•Experienced pain and discomfort intensity was       There was also a significant main effect for pain intensity        = 7.78, p=0.01.                                               moderate pain.
measured by two 100 mm visual analogue scales        experienced on post-colposcopy state anxiety, F(2, 150) =
• Sensory, affective and evaluative pain                                                                                                                                                These results, while preliminary, suggests
                                                     19.20, p<0.05. Pairwise comparisons revealed that state
measured by McGill Pain Questionnaire                anxiety was significantly lower for those patients who                                                                           relaxation and sensory focus are beneficial
(Melzack, 1975)                                      experienced low pain compared with the other two groups,                                                                         interventions, and that pain during colposcopy is
•Positive and negative affect measured by            which were also significantly different from one another.                                                                        associated with poor adjustment at the time of
PANAS (Watson et al., 1988)                                                                                                                                                           colposcopy and following it.
                                                     There was no significant interaction effect.

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