Effect of Relaxation Exercises on Controlling Postoperative Pain

Sacide Yildizeli Topcu, RN, MSc; Ummu Yildiz Findik, RN, MSc, PhD

Disclosures

Pain Manag Nurs. 2012;13(1):11-17. 

In This Article

Review of the Literature

Pain, which is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage" by the International Association for the Study of Pain (IASP), is the primary area of complaint and fear in postoperative patients (Aslan, 2002,International Association for the Study of Pain (IASP) (2010)). Yates, Dewar, Edwards, Fentiman, Najman, and Nash, (1998) reported that 78.6% of patients undergoing treatment in hospitals suffer from pain.

Postoperative pain is an acute pain beginning with surgical trauma, tapering off gradually and ending with tissue recovery (Arslan & Çelebioğlu, 2004,Green and Trait, 2002,Meeker, 1998). Carr and Thomas (1997) observed that all patients expect postoperative pain. It is reported that 46 million people undergo surgery each year in the USA, of whom 77% experience postoperative pain (Centers for Disease Control and Prevention (CDC) (2010), Warfield and Kahn, 1995). Kuhn et al. (1990), in their study of 101 patients, found that 40 of them suffered from severe pain and 47 experienced moderate pain. Seventy-five percent of patients undergoing surgery report that they endure moderate to severe pain which on movement causes very severe pain, reaching 85%-100% (Apfelbaum et al., 2003, Good, 1996,McDonald et al., 2000,Sloman et al., 2005, Warfield and Kahn, 1995). In Turkey, 93.7% of the patients undergoing surgery report that they suffer from severe pain (Aslan, 2005).

The place and duration of the surgery, the preoperative physical and psychologic preparedness of the patient, the presence of complications, types of anesthetics and analgesics used, and the quality of postoperative care influence the severity of the pain patients experience (Good et al., 2005,Ignatavicius et al., 1995). Abdominal surgeries are one of the most painful surgical procedures, due to the proximity to the diaphragm and the nerve supply to the area, and 37% of the patients undergoing elective abdominal surgery report that they experience severe pain (Kuhn, Cooke, Collins, Jones, and Mucklow, 1990). Similarly, Good et al. (2001b) observed that postoperative pain during ambulation after abdominal surgery increases by 31%.

Postoperative pain exerts several adverse psychologic and physical effects, such as increasing coagulation and fluid retention by raising the stress response, prolonging the recovery process by adversely affecting appetite and sleep, and causing complications in the cardiovascular, gastrointestinal, and urinary systems. In addition, postoperative pain can cause stress and anxiety. Particularly, severe pain after upper abdominal surgeries can multiply the complications by adversely affecting the respiratory functions and mobilization of the patient owing to the proximity of the incision site to the diaphragm (Good, 1996,Richards and Hubbert, 2007,Agency for Health Care Policy and Research, 1992).

Postoperative pain management strives to prevent the side effects of pain, facilitate recovery, and reduce treatment costs by minimizing or eliminating the patient's distress (Arslan & Çelebioğlu, 2004). Despite significant technologic developments and existing research in pain control, postoperative pain cannot be eliminated in most patients (Apfelbaum et al., 2003, Yates et al., 1998). Thus, although various pharmacologic pain control methods have been developed, such as patient-controlled analgesia, continuous intravenous infusion, and intraspinal application of opioids and/or local anesthetics, analgesic applications cannot sufficiently relieve postoperative pain and may instead precipitate adverse side effects (Carr and Thomas, 1997,Good et al., 1999,Warfield and Kahn, 1995). In their study, Apfelbaum et al. (2003) demonstrated that 23% of patients using postoperative analgesics experienced adverse effects.

In postoperative pain control, nonpharmacologic pain control methods can be used to increase the effect of analgesics, in case of insufficient effect of analgesics, or when analgesics cannot be used. Among nonpharmacologic pain control methods, transcutaneous nerve stimulation, application of hot and/or cold compresses, exercises, positioning, and massage are physical techniques commonly used in postoperative pain control, and relaxation, distraction, and hypnosis are cognitive/behavioral techniques (Arslan & Çelebioğlu, 2004). In their study on pain prevalence and perception among inpatient individuals, Yates et al. (1998) reported that patients preferred relaxation and distration more than other nonpharmacologic pain control methods. Relaxation is defined as an absence of physical, mental, and emotional tension (Friesner, Curry, & Moddeman, 2006). The resolving of muscle tension caused by anxiety is the mainstay of relaxation exercises. Because skeletal muscles close to the incision site significantly influence postoperative pain, relaxation exercises resolve the tension in the skeletal muscles and thus reduce postoperative pain (Wilkie, 2000,Willens, 2006). The literature demonstrates that relaxation causes a drop in blood pressure, heart rate, and breathing rate, as well as in pain responses and anxiety (Kesler, Patterson, & Dane, 2003). Relaxation exercises first became the subject of nursing research in 1971, when Aiken and Henrichs used systematic relaxation training as a nursing approach for patients scheduled to undergo open-heart surgery. From then on, nurse researchers have used relaxation exercises to reduce anxiety, muscle tension, and pain in preoperative and postoperative patients (Demiralp and Oflaz, 2007,Friesner et al., 2006). In their study using relaxation techniques in acute pain control, Seers and Carroll (1998) demonstrated that postoperative pain was reduced by relaxation exercises. Aslan (1998) observed that postoperative pain scores were lower in patients trained in relaxation exercises during the preoperative period. Good et al. (2001a) and Friesner, Curry, and Moddeman (2006) demonstrated that the pain levels in patients using both analgesics and relaxation exercises were lower than in those who used analgesics alone. Relaxation exercises reduce analgesic usage by increasing the comfort of the patient, although it is recommended that they be used along with analgesics for effective pain control (Cheung et al., 2001,Good et al., 2005). The present research aimed to study the effect of relaxation exercises on controlling postoperative pain in patients undergoing upper abdominal surgery.

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