Pain is the most common and feared symptom associated with a cancer diagnosis. Although much work has been done to improve pain relief through the appropriate use of analgesic medications, adequate pain control remains a significant problem for many persons with cancer. Guided imagery, a cognitive strategy, has been suggested as an adjuvant intervention to enhance pain relief. Melzak and Wall's Gate Control Theory proposes that sufficient sensory input at the level of the central nervous system can cause impulses from the brainstem to inhibit transmission of pain from peripheral nerves to ascending spinal tracts. This theory acknowledges the possibility of individual differences in the ability to imagine which may make certain persons more receptive and persons who are not receptive to this cognitive intervention based on imaging ability (IA). I propose that imaging ability moderates the impact of guided imagery on outcomes such as relief of pain and anxiety. The proposed research program will develop an instrument which nurses can use to predict whether individual patients can use guided imagery successfully to relieve cancer pain. A series of three studies will be conducted. Study 1 will examine various existing measures of image generation, hypnotic suggestibility, and absorption for correlations with ability to use guided imagery successfully. """"""""Success"""""""" in using guided imagery will be defined as achieving a clinically meaningful decrease in anxiety score. A sample of undergraduate students will complete the series of questionnaires. Their scores on individual items and subscales for image generation, hypnotic suggestibility, and absorption will be tested for correlations with success in using guided imagery. Study 2 will involve development of a single instrument to identify ability to use guided imagery. This study will seek to establish internal consistency and stability of the items identified in study 1. Study 3 will use scores on this new instrument to predict success with guided imagery in a population of cancer patients with pain. This prediction will be tested by blocking subjects by imaging ability (good vs. poor) and then randomly assigning patients to a guided imagery intervention, an attention control intervention, or a treatment as usual condition, Results of these studies will contribute to the scientific knowledge base regarding the use of guided imagery to relieve cancer pain as well as provide practicing nurses with an effective method to determine where they may best apply a specific nursing intervention. Future research will seek to identify what types of pain are most likely relieved with guided imagery and to explore the role of individual variables in ability to use other cognitive pain relief strategies.
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