The Impact of Relaxation Technique and Pre-Operative Psychological Counselling on Pain, Analgesic Consumption and Psychological Symptoms on Patients Scheduled for Breast Cancer Surgery - a Randomized Clinical Study

By Zgâia, Armeana; Pop, Florina et al. | Journal of Evidence-Based Psychotherapies, September 2016 | Go to article overview

The Impact of Relaxation Technique and Pre-Operative Psychological Counselling on Pain, Analgesic Consumption and Psychological Symptoms on Patients Scheduled for Breast Cancer Surgery - a Randomized Clinical Study


Zgâia, Armeana, Pop, Florina, -Cadariu, Patriciu Achima, Vlad, Catalin, Rogobete, Alexandru, Lisencu, Cosmin, Ignat, Florin, Lazar, Gabriel, An, Mihai Mure, Mure An, Mihai Tefan, Ciorogar, George, Irimie, Alexandru, Journal of Evidence-Based Psychotherapies


Breast cancer is the most common cancer among female patients with an estimated 1.67 million new cancer cases diagnosed in 2012 worldwide (25% of all cancers) (Iarc, 2012). In Romania, breast cancer is by far the most common cancer among women, with an incidence of 66.2% of all types of cancers (Steliarova-Foucher et al., 2014). The crude rate of breast cancer incidence per 100,000 inhabitants, by primary site and gender, in the North-Western region of Romania in 2011 was almost 60 (Coza et al., 2014). About 22-47% of breast cancer patients will develop emotional and psychological distress from the moment of the diagnosis and during each stage of the disease, despite the progress in the treatment and a relatively good prognosis (survival 80% at 5 years) (DeSantis et al., 2016; Holland & Alici, 2010; Kornblith & Ligibel, 2003; Tatrow & Montgomery, 2006). 90% of female patients with breast cancer undergo surgery as part of their treatment, surgery improving localized tumour control and the survival rate (Osteen & Karnell, 1994). Research has consistently found an elevated level of distress in these patients (Montgomery, Schnur, Erblich, Diefenbach, & Bovbjerg, 2010). Response expectancy is one of the psychological factors having an important role in the patient experience of side effects following breast surgery (Hart, 1997). In cancer surgery settings, expectancies have been shown to predict that cancer patient experiences pain, nausea and fatigue (Katz et al., 2005; Montgomery & Bovbjerg, 2004; Montgomery et al., 2003). In this context, pre-surgery psychological counseling/support can be proven very helpful for patients scheduled for breast cancer surgery (Johnston & Vogele, 1993). For example, Montgomery et al. (2007) have demonstrated the effectiveness of brief hypnosis intervention to control side effects in breast surgery patients. This intervention was associated with a reduced intra-operative analgesic and sedative, patient-reported post-surgical pain intensity, nausea, fatigue, discomfort and emotional upset (Montgomery et al., 2007; Montgomery, Hallquist, et al., 2010). On the contrary, Burton et al. (1995) could not identify any changes in temperature, pulse, blood pressure, or pain after mastectomy in patients receiving a psychotherapeutic intervention provided by a clinical psychologist or a trained surgeon.

Post-operative pain is the most common symptom after surgery (Katz et al., 2005). Research shows 30-80% of moderate or severe post-surgery pain for patients having breast cancer surgery (Burton et al., 1995; Polomano, Dunwoody, Krenzischek, & Rathmell, 2008). Despite the proper administration of post-operative regimen of analgesics, studies concluded that only 1 out of 4 patients is effectively treated regarding acute post-operative pain in all types of surgery (Cleeland, 1984). However, analgesics are effective for the physical component of pain.

Cicely Saunders (2006) pointed that the pain is not purely a physical experience, actually including physical, psychological/emotional, social and spiritual components. The contribution of each component of this "total pain" will be specific to each individual in his or her case (Montgomery et al., 2003; Syrjala & Chapko, 1995). By accepting this point of view, in order to have an adequate pain management, it is necessary to address to all these four components of the pain experience, not only the physical pain.

Based on these concepts, the present study was designed to investigate the effectiveness of the RT and PC intervention in reducing post-operative acute pain, analgesic consumption and psychological symptoms for the patients scheduled for breast cancer surgery. In a previous meta-analysis study, it was shown that, by informing patients of the procedures that will follow, the distress associated with these surgical procedures will be significantly reduced and the physical and affective recovery will be improved (Johnston & Vogele, 1993). …

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