Self -selected distraction for acute procedural pain in adolescents: An intervention feasibility study
Purpose. This feasibility study evaluated all phases of the planned main study. The study tested the effect of self-selected distraction on acute pain perception in adolescents undergoing allergy skin testing. Distraction is a cognitive-behavioral nonpharmacologic nursing intervention used to divert attention from painful stimuli, which is supported by the gate control theory and distraction framework. A developmental model of adolescence provided a framework for testing self-selected distraction with adolescents for whom choice and control are important developmental concerns.
Specific aims. What is the effect of distraction on acute procedural pain perception in adolescents? Specifically, what is the effect of self-selected distraction, rather than nurse-selected distraction, on acute procedural pain perception? What is the relationship between level of engagement with the distraction and perception of pain? How does anxiety interact with the effect of distraction on pain perception?
Method. The study utilized a post-test, experimental design with random assignment to three groups: self-selected distraction, nurse-selected distraction, and usual care. Adolescents in the self-selected group chose a videotape, music CD, or book-on-cassette from a researcher-developed media library. The sample included 32 adolescents ages 11 to 17 years. Pain perception was measured by the Adolescent Pediatric Pain Tool and the FACES pain scale. Investigator-developed pre- and post-allergy testing questionnaires measured demographic data, “needle” anxiety, engagement in the distraction, and perceived effectiveness of distraction. Pre-testing anxiety was measured by the Spielberger State Anxiety Inventory.
Results. The feasibility study piloted the analysis planned for the main study. No statistically significant differences were found among the three groups on pain perception. An unanticipated finding resulted in a trend toward the highest pain ratings for the self-selected distraction group during the more painful allergy testing phase. Greater level of engagement in the distraction was related to lower pain ratings. Higher levels of anxiety were correlated with higher pain ratings.
Implications. The planned main study was not conducted based on the results of the feasibility study. The small effect size increased the proposed sample size. Matching coping style with choice of nonpharmacologic interventions is recommended for future research.
0573: Public health