The theory of a balance between analgesia and side effects proposes that nonpharmacological methods be used with analgesics following surgery. Relaxation/music has been shown to reduce postoperative pain, but it is not known whether blacks and whites respond differently. This secondary analysis was conducted to determine whether there was an interaction between race and treatment group in a sample of blacks and whites in the Midwest and to describe their music preferences. The primary RCT found that two-day postoperative use of relaxation/music (RM) reduced pain. The 388 participants (19-75 yrs) who were randomly assigned to receive RM included 116 (30%) blacks and 272 (70%) whites. Participants were offered their choice among six types of sedative taped music. Effects were measured with pain sensation and distress VAS scales before and after five 20-minutes tests of the interventions. Pretest-posttest difference scores were averaged and analyzed with ANOVA. Results showed that the relaxation/music group (n = 256), had significantly more pain relief than the control group, n = 125, p = .034, but there was no interaction with race. Chi-square analysis showed that there were significant differences in the types of music chosen, p < .001; the most frequently chosen type for blacks was jazz music (64%) and for whites it was orchestra music (34%). Nevertheless, the effect on pain did not differ based on race probably because participants chose from types of music thought to appeal to these two cultural groups. Nearly all (94-99%) liked or loved their chosen music. The music types were similar in their sedative qualities, yet cultural influences and patients' personal preferences were important. It is recommended that for pain relief in addition to analgesics, nurses use taped relaxation plus slow calming music that is culturally appropriate and that their patients like. (Funding: National Institute of Nursing Research.) The theory of a balance between analgesia and side effects proposes that nonpharmacological methods be used with analgesics following surgery. Relaxation/music has been shown to reduce postoperative pain, but it is not known whether blacks and whites respond differently. This secondary analysis was conducted to determine whether there was an interaction between race and treatment group in a sample of blacks and whites in the Midwest and to describe their music preferences. The primary RCT found that two-day postoperative use of relaxation/music (RM) reduced pain. The 388 participants (19-75 yrs) who were randomly assigned to receive RM included 116 (30%) blacks and 272 (70%) whites. Participants were offered their choice among six types of sedative taped music. Effects were measured with pain sensation and distress VAS scales before and after five 20-minutes tests of the interventions. Pretest-posttest difference scores were averaged and analyzed with ANOVA. Results showed that the relaxation/music group (n = 256), had significantly more pain relief than the control group, n = 125, p = .034, but there was no interaction with race. Chi-square analysis showed that there were significant differences in the types of music chosen, p < .001; the most frequently chosen type for blacks was jazz music (64%) and for whites it was orchestra music (34%). Nevertheless, the effect on pain did not differ based on race probably because participants chose from types of music thought to appeal to these two cultural groups. Nearly all (94-99%) liked or loved their chosen music. The music types were similar in their sedative qualities, yet cultural influences and patients' personal preferences were important. It is recommended that for pain relief in addition to analgesics, nurses use taped relaxation plus slow calming music that is culturally appropriate and that their patients like. (Funding: National Institute of Nursing Research.)

Postoperative pain is a major physiological and psychological stressor. Studies have shown that stress and pain leave patients more susceptible to infection and complications. The purpose of this study was to determine whether two interventions, relaxation/music (RM) and patient teaching (PT) for pain management, reduce stress in postoperative abdominal patients. Abdominal surgery patients (N=517) (18-75 yrs) were randomly assigned to receive RM, PT, combination of RM and PT, or control. A 2x2 factorial design with pre and posttests was used to study the overall RM-Effect and PT-Effect on salivary cortisol. The interventions were tested at two 20-minute tests on postoperative day 2, morning and afternoon. Parotid saliva was stimulated with diluted lemon juice, collected in intra-oral cups, timed with a stopwatch, and flow rate was calculated as milliliters per minute. Analysis of obtained samples (N= 164) was with High Sensitivity Salivary Cortisol Enzyme Immunoassay (Salimetrics, LLC). Higher cortisol was significantly related to GI/GU surgery (vs GYN) and male gender, r = .24 to .33. Lower cortisol was significantly related to greater postoperative activity, r = -.20 to -.29. Because pretest cortisol was strongly correlated with posttest cortisol in the morning, r = .82, p < .001 and afternoon, r = .86, p < .001, the pretests were used as covariates. Comparisons using ANCOVA showed that there was no RM-Effect or PT-Effect at either test. Post-hoc ANCOVA, controlling for pretests, indicated no significant effects when each intervention group was compared to the control group. There was no RM effect on pain or cortisol in the afternoon. Although the RM-Effect reduced pain in the morning, it did not reduce cortisol. This may have been because pain was mild by day 2. Further analyses will be conducted to identify subgroups that may have benefited by lower cortisol. Funded by the National Institute of Nursing Research to Marion Good, RO1-NR3933 and the General Clinical Research Center, Case Western Reserve University. (Good, J Pain, 2006).

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.

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.

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.

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.

AIMS:We investigated the effects of relaxation, music, and the combination of relaxation and music on postoperative pain, across and between two days and two activities (ambulation and rest) and across ambulation each day. This secondary analysis of a randomized controlled trial was conducted from 1995 to 1997.BACKGROUND:After surgery, patients do not always receive sufficient relief from opioids and may have undesired side-effects. More complete relief (10-30%) was found recently with adjuvant interventions of relaxation, music, and their combination. Comparison of effects between days and treatments have not been examined longitudinally.METHODS:With a repeated measures design, abdominal surgery patients (n = 468) in five US hospitals were assigned randomly to one of four groups; relaxation, music, their combination, and control. With institutional approval and written informed consent, subjects were interviewed and taught interventions preoperatively. Postoperative testing was at ambulation and rest on days 1 and 2 using visual analogue (VAS) sensation and distress of pain scales.RESULTS:Multivariate analysis indicated that although pain decreased by day 2, interventions were not different between days and activities. They were effective for pain across ambulation on each day, across ambulation and across rest over both days (all P < 0.001), and had similar effects by day and by activity.CONCLUSION:Nurses can safely recommend any of these interventions for pain on both postoperative days and at both ambulation and rest.

Psychometric properties of the Sensation and Distress of Pain Visual Analogue Scales (VAS) are compared to dual numerical rating scales (NRS) with data from a randomized controlled trial of postoperative patients. On postoperative days 1 and 2, 15-minute test-retest reliability was .73 to .82 for the VAS and slightly lower for the NRS, r = .72 to .78, while convergent validity of the scales ranged from r = .90 to .92; construct validity of sensation and distress ranged from r = .72 to .85; and discriminant validity was lower, r = .65 to .78. Both instruments were significantly associated with pain reduction following treatment, p < .05 to .01. The VAS scores were significantly lower, p < .01 to .001, and more evenly distributed than NRS scores. It is recommended that the VAS be used in research to produce continuous scores that are more suited to parametric analysis.

Pain sensation and distress in 38 intestinal surgical patients were moderate to severe on postoperative day 1, ranging from 34 to 49 mm and 33 to 45 mm, respectively, on 100-mm scales. During ambulation, both increased from baseline to post-ambulation, P < 0.01. Half of the patients reported severe pain not relieved by analgesics, and although 44% learned a relaxation technique in the past, only 8% used one for pain after this surgery. Pain disturbed the sleep of 34% of the patients, and pain was related to respiratory, intestinal, febrile, and other complications in 18 (47%) subjects. Attentive analgesic use and nonpharmacologic therapies are recommended.

Journal of Nursing ScholarshipVolume 32, Issue 4 p. 377-377 The Effects of Tai Chi on Older Adults with Chronic Arthritis Pain Patricia Adler, Corresponding Author Patricia Adler Patricia Adler, RN, MSN, Alpha Mu, Doctoral Student, Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, OHMs. Adler, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106. E-mail: PAdler1@msn.comSearch for more papers by this authorMarion Good, Marion Good Marion Good, RN, PhD, Alpha Mu, Associate Professor of Nursing, Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, OHSearch for more papers by this authorBeverly Roberts, Beverly Roberts Beverly Roberts, RN, PhD, Xi, Professor and Associate Dean, Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, OHSearch for more papers by this authorScott Snyder, Scott Snyder Scott Snyder, MS, Doctoral Candidate, Department of Statistics at Case Western Reserve University, Cleveland, OHSearch for more papers by this author Patricia Adler, Corresponding Author Patricia Adler Patricia Adler, RN, MSN, Alpha Mu, Doctoral Student, Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, OHMs. Adler, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106. E-mail: PAdler1@msn.comSearch for more papers by this authorMarion Good, Marion Good Marion Good, RN, PhD, Alpha Mu, Associate Professor of Nursing, Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, OHSearch for more papers by this authorBeverly Roberts, Beverly Roberts Beverly Roberts, RN, PhD, Xi, Professor and Associate Dean, Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, OHSearch for more papers by this authorScott Snyder, Scott Snyder Scott Snyder, MS, Doctoral Candidate, Department of Statistics at Case Western Reserve University, Cleveland, OHSearch for more papers by this author First published: 23 April 2004 https://doi.org/10.1111/j.1547-5069.2000.00377.xCitations: 21 The authors acknowledge the contributions of Master Tzeng-Yu Huang, China Treasure House, Cleveland Heights, OH. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume32, Issue4December 2000Pages 377-377 RelatedInformation

The aim of this randomized controlled trial was to determine the effect of jaw relaxation, music and the combination of relaxation and music on postoperative pain after major abdominal surgery during ambulation and rest on postoperative days 1 and 2. Opioid medication provided for pain, following abdominal surgery, does not always give sufficient relief and can cause undesired side effects. Thus, additional interventions such as music and relaxation may provide more complete relief. Previous studies have found mixed results due to small sample sizes and other methodological problems. In a rigorous experimental design, 500 subjects aged 18-70 in five Midwestern hospitals were randomly assigned by minimization to a relaxation, music, relaxation plus music, or control group. Interventions were taught preoperatively and tested postoperatively. The same amount of time was spent with subjects in the control group. Pain was measured with the visual analogue sensation and distress of pain scales. Demographic and surgical variables, and milligrams of parenteral or oral opioids in effect at the time of testing were not significantly different between the groups, nor did they correlate with pain scores. Controlling for pretest sensation and distress, orthogonal a priori contrasts and multivariate analysis of covariance indicated that the three treatment groups had significantly less pain than the controls, (P = 0.028-0.000) which was confirmed by the univariate analysis of covariance (P = 0.018-0.000). Post hoc multivariate analysis revealed that the combination group had significantly less sensation and distress of pain than the control group on all post-tests (P = 0.035-0.000), and the relaxation and music groups had significantly less on all tests (P = 0.022-0.000) except after ambulation. At post ambulation those using relaxation did not have significantly less pain than the controls on both days and those using music did not on day 1, although there were some univariate effects. A corresponding significant decrease in mastery of the interventions from pre to post ambulation suggests the need for reminders to focus on the intervention during this increased activity. Physicians and nurses preparing patients for surgery and caring for them afterward, should encourage patients to use relaxation and music as adjuvants to medication for postoperative pain.

Music is a method nurses can use to help relieve pain, however little is known about its effectiveness across cultures. In this study, Western music was tested for its effectiveness in reducing postoperative pain in 38 Taiwanese patients, and its acceptability was explored. A pretest and post-test experimental design was used with visual analogue scales to measure sensation and distress of pain. Before surgery, subjects were randomly assigned to receive tape recorded music or the usual care. Those who were assigned to the music group chose among 5 types of sedative music. On postoperative Day 1 and Day 2, the effectiveness of the tape-recorded music was investigated during 15 minutes of rest in bed. Patients were interviewed on Day 3 to determine their liking for the music, its calming effects, and the helpfulness of the music. Repeated measures analysis of variance showed a significant interaction between time and group in the distress of pain on Day 1, but not on Day 2, and in pain sensation on Day 2, but not Day 1. Subjects from Taiwan were similar to subjects in a previous study in the United States in their liking for the music, and in reports of the helpfulness of the music for pain sensation and distress, but fewer Taiwanese found the music calming, and they had different choices: more chose harp music and fewer chose jazz than subjects in the U.S. study, and some would prefer Buddhist hymns or popular songs heard in Taiwan. Findings support the use of culturally acceptable music in addition to analgesic medication for the sensation and distress of postoperative pain.

A middle-range theory of acute pain management has been developed from clinical guidelines published by the Agency for Health Care Policy and Research for use in clinical research. From this theory, testable hypotheses regarding pain management can be deduced, and new findings can be used to support and extend the theory.

ZELLER, RICHARD; GOOD, MARION; ANDERSON, GENE CRANSTON; ZELLER, DENA L. Author Information

Threats to subject retention in a controlled clinical trial require strategies that encourage continued participation of subjects, with consideration of the effect of the strategies on the dependent variable. Methods to encourage retention must be based on sensitivity to the patient's changing condition and perspective. Primary considerations in the design and implementation of an intervention study are the acceptability of the intervention to particular patients and the compatibility of the intervention with other care activities. In addition, qualities of the research personnel and changes in patient conditions are important factors in retention of subjects, Vignettes illustrate the threats to retention and solutions used in a clinical trial. Threats to retention include the research nurse's approach and patient factors such as worries, control issues, visitors, symptoms of confusion and pain, and lack of cooperation. Retention strategies include supporting and educating research nurses, providing empathy and respect, including patients in decisions, negotiating with visitors, alleviating symptoms, and supporting a plan of care consistent with both the research protocol and the patient's recovery. While providing a similar approach to all groups, experimental researchers in a variable clinical environment must also provide some individualization and communication to retain valuable subjects who are ill.

Clinical practice guidelines are a useful source of middle-range prescriptive theory because of their empirical support and specific recommendations for practice. A method of developing nursing theory from the acute pain management guidelines is presented and illustrated with a theory of achieving a balance between analgesia and side effects in adults.