): Analgesics administered to control pain during minimally invasive surgical procedures have limited effectiveness, serious side effects, and high cost. The long-term objective of this research is to provide a cost-effective and safe behavioral method for reducing pain and intravenous drug use during invasive procedures. Analgesia for these procedures, in general, relies on intravenous conscious sedation with narcotics and sedatives. Extrapolating the risk of intravenous conscious sedation to the number of procedures, we predict annually 47,000 patients to suffer serious cardiorespiratory complication and 2,600 deaths. We propose nonpharmacologic analgesia for safe management of acute procedural pain. Nonpharmacologic analgesia includes relaxation training, self-hypnosis, and guided imagery applied by a member of the operating team.
The specific aims are: (1) prospectively determine the effect of nonpharmacologic analgesia on pain and drug use during minimally invasive procedures, (2) assess the effect of nonpharmacologic analgesia on the safety of minimally invasive procedures, and (3) determine the effect of nonpharmacologic analgesia on resource utilization. We hypothesize that nonpharmacologic analgesia reduces pain and need for intravenous drugs during minimally invasive procedures, improves procedure safety, and reduces resource requirements compared with conventional intravenous analgesia. On completion, the periprocedural administration of nonpharmacologic analgesia will be validated by a rigorous and practical assessment in 320 patients. The relative performance of nonpharmacologic analgesia will be compared to a standard of care and empathic attention control in a well characterized population under the controlled monitored environment of a busy interventional radiology practice. Integration of nonpharmacologic analgesia into mainstream management of acute pain will be done to provide the basis for design of a larger study to determine clinical utility in a multicenter randomized trial.
| Benotsch, E G; Lutgendorf, S K; Watson, D et al. (2000) Rapid anxiety assessment in medical patients: evidence for the validity of verbal anxiety ratings. Ann Behav Med 22:199-203 |
| Lang, E V; Benotsch, E G; Fick, L J et al. (2000) Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet 355:1486-90 |
| Fick, L J; Lang, E V; Logan, H L et al. (1999) Imagery content during nonpharmacologic analgesia in the procedure suite: where your patients would rather be. Acad Radiol 6:457-63 |
