Clinical Briefs

Distraction Therapy and Procedural Pain

With Comments from Russell H. Greenfield, MD

Source: Diette GB, et al. Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy. Chest 2003; 123:941-948.

Goal: To determine whether the use of nature sights and sounds during flexible bronchoscopy (FB) would lessen patient anxiety and pain.

Design: Prospective, randomized, controlled trial.

Subjects: Eighty consecutive patients out of 104 eligible subjects, including both in- and out-patients (n = 41 intervention, n = 39 control group).

Methods: Subjects were randomized using a pre-set allocation schedule focusing on day of presentation—all subjects scheduled for FB on a given day were offered the same treatment, either the study intervention or control status. The intervention consisted of placing a large mural photograph of a mountain stream by the bedside and supplying a continuous tape of associated nature sounds to the patients through headphones. Subjects in the control group received neither form of distraction therapy. Medications were administered per usual practice. Subjects completed surveys before and after the procedure, including a shortened state anxiety measure (S-STAI).

Results: Older patients, and those in better health, reported significantly less pain with distraction therapy, but no patient benefit was noted with respect to level of anxiety.

Conclusion: Distraction therapy using nature sights and sounds can reduce pain in subjects undergoing FB.

Study strengths: A variety of bronchoscopists were employed; approach can be generalized to most endoscopy suites.

Study weaknesses: Patients were free to turn the tape recording on, off, or to adjust the volume (inconsistent dosing); no individual choice was afforded participants regarding what constitutes a relaxing nature scene; 20 of 104 eligible subjects were not enrolled because the nursing staff were too busy; no determination of the intervention’s effects on staff performing the procedure.

Of note: Mean doses of medication employed in each group to control pain and anxiety were essentially the same; patients in the intervention group more commonly underwent highly invasive procedures than those in the control group, yet required no additional medication; no benefit was noted with respect to a subject’s level of anxiety; one patient urinated while on the table, blaming the incident on the sounds of the running stream.

I knew that: An oft-quoted study published in Science that assessed people recovering from cholecystectomy found less pain medication was required, and hospital discharge was earlier, if the windows of patients’ hospital rooms provided a view of trees as compared to views of a brick wall.

Clinical import: The anxiety experienced prior to an invasive procedure generally receives insufficient medical attention, but this is changing. Similarly, there is a renewed emphasis on exploring additional means of providing adequate pain control for our patients. It is logical to assume that relaxation therapy might positively impact anxiety level and even degree of comfort during a potentially painful intervention. In this study, select patients did experience additional pain relief with distraction therapy. Significant methodologic flaws, however, severely limit acceptance of the authors’ conclusions, logical though they might be.

What to do with this article: Remember that you read the abstract.

Dr. Greenfield, Medical Director, Carolinas Integrative Health, Carolinas HealthCare System, Charlotte, NC, is Executive Editor of Alternative Medicine Alert.