nonpharmacologic analgesia for invasive procedures

Conditions: Pain; Anxiety

Summary: analgesics and sedatives administered to control distress from minimally invasive surgical procedures have limited effectiveness and serious side effects. unabated distress not only interferes with smooth progression of the ongoing procedure, but can elicit adverse responses when patients need additional intervention. the long-term objective of this research is to provide a safe and practical behavioral method for reducing cognitive and physiologic distress associated with invasive procedures. currently, this method should benefit at least 8 million patients annually in the us. extrapolating the risk of intravenous conscious sedation to the number of invasive procedures performed annually, we predict that 47,000 patients will suffer serious cardiorespiratory complications and 2,600 will die. these numbers do not include effects of the psychological damage inflicted by poorly managed procedure-related stress on patients' subsequent health behavior. this application sets out to pursue three aims: 1) prospectively determine the impact of self-hypnotic relaxation on cognitive and physiologic distress during tumor embolizations; 2) prospectively determine the impact of self-hypnotic relaxation on distress in the postoperative period; 3) determine the impact of intraprocedural self-hypnotic relaxation on distress during subsequent tumor embolization. we hypothesize that: 1) self-hypnotic relaxation decreases cognitive and physiologic distress during tumor embolizations. 2) self-hypnotic relaxation decreases cognitive and physiologic distress after tumor embolization when post-embolization ischemia is expected to induce painful stimuli and systemic distress. 3) the beneficial effect of self-hypnotic coping skills acquired during an invasive procedure carries over to the next invasive procedure. upon completion, the efficacy and durability of procedural administration of nonpharmacologic analgesia will be known by a rigorous and practical assessment. the relative performance of self-hypnotic relaxation will be quantified compared to standard care and empathic controls in a well-characterized population of patients within the controlled and monitored environment of a busy interventional radiology practice. results from this competing renewal will provide the next level of data needed for future study design to determine broad clinical utility in a multicenter randomized controlled trial.


Eligibility criteria:
inclusion criteria: * patients referred for transcatheter embolization for benign uterine fibroid tumors or malignant hepatic tumors. * patients referred for radiofrequency ablation of malignant hepatic or renal tumors exclusion criteria: * unable to give informed consent * impaired mental function, psychosis, severe chronic obstructive pulmonary disease, intolerance towards midazolam or fentanyl * weigh \< 55 kg * pregnant * unable to hear or understand english

Keywords: hypnosis relaxation invasive medical procedures interventional radiology conscious sedation anesthesia complications cost analysis interventional procedures, complications angiography nephrostomy hepatic chemoembolization fibroid embolization