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Guided Imagery Helps Children Facing Surgery

The technique eases anxiety and lessens pain, study says

WEDNESDAY, March 29, 2006 (HealthDay News) -- Anyone who's ever "met" a child's imaginary friend knows that children are innately more creative and open to the world of make believe than adults.

That's one reason why Ohio researchers thought that children undergoing routine surgeries might be less anxious about the procedure and feel less pain afterward if they were taught to use "guided imagery."

"Guided imagery really works. It should be used in conjunction with pain medications, but it really works, and it's something that can be used at home," said the study's lead author, Myra Huth, assistant vice president of the Center for Professional Excellence Research at Cincinnati Children's Hospital Medical Center.

Guided-imagery exercises attempt to distract a person who's feeling anxious or in pain by taking them to another time or place -- at least in their imagination. These exercises are designed to get the individual to feel with all of their senses that they are in a different place.

In the guided-imagery tapes used in the new study, the researchers wanted the children, scheduled to have their tonsils and adenoids removed, to think about a park. So, the exercises tried to get the child to think about what they might see at the park, such as the green grass or children swinging on the swings. They also tried to get the children to imagine the sounds of the park, the smells, the way the playground equipment or grass might feel on the skin, and even tastes from the park, such as ice cream.

"A good imagery tape should evoke all of the senses it can and really engage the child," Huth explained.

For the first part of the study, Huth and her colleagues randomly assigned a group of 75 children into two groups. The first group was taught to use guided imagery before the surgical procedure and encouraged to use it after the procedure. The other group did not get such training and served as a control group.

In a 2004 issue of the journal Pain, the researchers reported that children using guided imagery reported significantly less pain and anxiety after the procedure than the control children did. On a pain scale of zero to 100, the average score of the control group after surgery was 42, while the group using guided imagery had an average score of 30.

For the new study, which appears in the April issue of the Journal of Pediatric Nursing, Huth and her team tried to tease out exactly how the children used guided imagery. Did they follow the tapes exactly? Or, did they come up with their own scenarios? When did the youngsters turn to the tapes, and why?

Huth said she told the children the tapes were just to get them started, that they could "go" wherever they wanted to.

But, the researchers found, many of the children did, in fact, use the tapes to "go" to a park. Not all, however, went to a traditional community park suggested in the tape. Some children let their imagination take them to an amusement park, a swimming pool, or a lake near family vacation cottages, Huth said.

Most children "traveled" to different places at different times, depending on what they were using the tape for, she said. The researchers also discovered that before the surgery, the children turned to the tapes for relaxation and to ease their anxiety. In addition to guided-imagery exercises, the tapes also began with relaxation exercises.

After surgery, the children used the tapes most when they were feeling pain. However, they still turned to the tapes for relaxation and to help them fall asleep after surgery.

"Pain is not only a physiologic phenomenon, but also an emotional one," Huth said, adding that if you can pull someone "away" from their pain, that distraction may help them feel a bit less uncomfortable.

While not a substitute for pain medications, guided imagery can significantly reduce pain and anxiety in the hospital after surgery, Huth said. She said one parent asked her, "Why aren't all hospitals doing this?"

Not everyone is sold on the benefits of guided imagery, however. Linda Downs, the tracheostomy resource nurse at Children's Memorial Hospital in Chicago, expressed doubts about using guided imagery to help control pain.

"Pain is not in your mind. Post-operative pain is for real. Listening to a tape and being able to calm a child to forget about pain? I just don't see it. It may work for anxiety, but I can't see it for pain," she said.

Downs said she was also concerned about the time needed to teach children such exercises. She said that in a small hospital it might be feasible, but in a large hospital with a busy surgical department, nurses just don't have the time.

She also noted that post-operative pain can be affected by many factors, including how much a patient had to drink and whether their doctor prescribed acetaminophen or acetaminophen with codeine.

Huth said she felt that adding guided imagery to treatment would only take a few extra minutes, and was likely something most nurses could fit in to the patient's treatment plan.

More information

To learn more about preparing your child for surgery, visit KidsHealth.org.

SOURCES: Myra Huth, Ph.D., R.N., assistant vice president, Center for Professional Excellence Research, Cincinnati Children's Hospital Medical Center, Ohio; Linda Downs, R.N., Tracheostomy Resource Nurse, Children's Memorial Hospital, Chicago; April 2006, Journal of Pediatric Nursing
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