Trance cuts pain of heart procedure

Tuesday April 8th, 2014

Guiding patients into a trance helps them to cope with pain and anxiety during the heart procedure, ablation of atrial fibrillation (AF), according to Danish experts.

Delegates at EuroHeartCare, the official annual meeting of the Council on Cardiovascular Nursing and Allied Professions (CCNAP) of the European Society of Cardiology (ESC), in Stavanger, Norway, were told that visualisation techniques helped patients undergoing the procedure.

Marianne Wetendorff Nørgaard, lead author and a clinical nurse specialist at Copenhagen University Hospital, Rigshospitalet, Denmark, said: “We ask patients to describe a comfortable safe place they want to be during the procedure. People have chosen a summer house, the beach, or the woods.

“During the procedure the nurse asks the patient to focus on their safe place and how it looks, smells and sounds.

“When the patient expresses pain, the nurse helps the patient visualise an alternative scenario to the invasive procedure. For example, if the patient says 'my chest is burning', the nurse may say 'imagine that it's a cold day and there is ice on your chest'. Patients tell us that being in this trance like state with safe images makes the procedure a pleasant experience and it feels shorter.”

She said that visualisation had the potential to reduce pain and anxiety in numerous procedures, and could result in fewer patients having general anaesthesia.

In the first clinical study of visualisation during ablation of AF, the researchers compared outcomes between 76 patients who used visualisation and 71 patients who received conventional care.

All patients were awake during the 2-4 hour treatment and received local anaesthesia plus painkillers when they signalled the nurse using a push button. During the procedure, patients scored their pain and anxiety levels every 15 minutes and after specific painful experiences.

Patients who used visualisation during the procedure were in pain less often and asked for fewer painkillers. When the patients perceived pain, there were no differences between groups in the perception of pain intensity and no differences in anxiety levels.

“Patients who used visualisation expressed pain fewer numbers of times and asked for less painkillers,” explained Mrs Nørgaard, whose research is published in Clinical and Pacing Electrophysiology.

“Their perceived pain intensity may have been the same because we interrupted their visualisation at regular intervals to record pain and anxiety levels. If they had been allowed to stay in their trance like state during the entire procedure, their perceived pain intensity may have also reduced.”

They then undertook more detailed analysis of the experiences felt by 14 patients. Qualitative interviews were conducted and subjected to inductive content analysis.

Patients told the research team that visualising their own safe place during the procedure made them feel involved and helped them to cope with pain and anxiety.

“Patients go through painful procedures every day in different departments of the hospital,” said Mrs Nørgaard. “Visualisation has the potential to reduce the amount of pain patients experience during numerous invasive procedures. We offer visualisation to all our AF ablation patients and those who return for another procedure request it. We also use visualisation during other cardiac procedures because it works so well.”

Nørgaard MW, Werner A et al. Visualization and attentive behavior for pain reduction during radiofrequency ablation of atrial fibrillation. Pacing Clin Electrophysiol 2013;36(2):203-213.

Tags: Alternative Therapy | Europe | Heart Health | Nursing & Midwifery | Pain Relief

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