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8. NON-PHARMACOLOGICAL TECHNIQUES
8.1 PSYCHOLOGICAL INTERVENTIONS
The role of psychological interventions in the management of acute pain is generally seen as
adjunctive to somatic modalities, but evidence for the value of their contribution is
strengthening.
Psychological interventions can be grouped under a number of headings, but, by their very
nature, they share some common features. Some of these features may also apply to effective
pharmacological and physical interventions. Typically, the treatment provider is encouraged to
firstly establish a degree of rapport or acceptance with the patient as well as give some
information about the purpose and nature of the intervention and reasonable expectations
the patient should hold for their outcome. These aspects may be seen as necessary to gain
both the informed consent of the patient for treatment, as well as their active cooperation.
Interestingly, one of the conclusions that can be drawn from the available studies is that good
psychological preparation for surgical interventions can enhance the outcome of such
procedures, including length of hospital stay. Thus, skilled combination of psychological and
medical/surgical modalities may lead to better outcomes than either alone.
Psychological interventions may be divided into four broad categories: information
provision (procedural or sensory); stress/tension reduction (relaxation and hypnotic
strategies); attentional strategies; and cognitive‐behavioural interventions. It should be
emphasised that these are rarely ‘stand‐alone’ interventions and elements of each may form
a single intervention.
8.1.1 Provision of information
Procedural information is information given to a patient before any treatment that
summarises what will happen during that treatment. Preparatory information has been
found to be effective in improving postoperative recovery and reducing pain reports, pain
medication use, and length of hospital stay (Johnston & Vogele, 1993) (see also Section 3.1.1). CHAPTER 8
Sensory information is information that describes the sensory experiences the patient may
expect during treatment. Sensory information given alone has some positive, albeit
inconsistent, effects compared with no instruction (Suls & Wan, 1989 Level I). This review also
found that sensory information reduced self‐rated pain more than procedural information;
however, the effect sizes were variable. Sensory information had no significant effect on
postoperative pain perception in patients who underwent two types of elective surgery
(Campbell et al, 1999 Level II).
Combined sensory‐procedural preparatory information yielded the strongest and most
consistent benefits in reducing negative affect, pain reports and other related distress (Suls &
Wan, 1989 Level I). This finding was replicated in a controlled study of ear‐piercing in children.
In this case, those children whose parents were provided with accurate information about the
procedure and sensory (pain) expectations reported significantly less pain and more accurate
expectations than controls (Spafford et al, 2002 Level II).
However, a recent meta‐analysis of 28 trials of different psychological interventions for
procedure‐related pain in children concluded the evidence for the efficacy of information/
preparation is only tentatively supportive; the evidence is not sufficient to make firm
recommendations (Uman et al, 2006 Level I).
Acute pain management: scientific evidence 221
