Murray, James Lewis; (1999) Psychological factors in the management of post-operative acute pain: The role of self-efficacy beliefs in the use of patient controlled analgesia. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Patient controlled analgesia (PCA) was first discussed in the literature during the early 1970s, but it was not until the late 1980s and early 1990s that a number of reliable PCA systems became available. PCA has since been deployed throughout most of the developed world for the treatment of post-operative acute pain. As an alternative to traditional intramuscular injections and oral treatments, PCA has achieved rapid acceptance in medical centres as a tool for administering analgesic medication to postoperative patients. However, PCA equipment is expensive and this ultimately places constraints on its availability. Published research in the area has suggested that an understanding of the psychological factors that make PCA beneficial to patients is important for their post-operative recovery, and to allocate the system effectively. Close examination of the published literature in the area generated the following review questions: Is PCA effective?; Is patient satisfaction with PCA important?; Can anxiety affect pain management with PCA? and; Does control influence pain with PCA? Due to controversy and inconsistency in the literature, the purpose of the study contained in this academic thesis was to partially replicate previous findings, as well as assess the role of self-efficacy beliefs in post-operative pain management with PCA. Forty five women undergoing elective, non-malignant total abdominal hysterectomy (TAH) operations at a central London teaching hospital volunteered to participate. PCA with morphine sulphate as the analgesic drug was used as standard procedure for treating the post-operative pain of TAH patients. A longitudinal design was employed with each participant assessed on two occasions. Self-report questionnaires with known psychometric properties were used to assess generalised self-efficacy beliefs, state anxiety, emotional distress and pain expectations prior to surgery. The post-operative assessment conducted 24-36 hours after surgery included self-report questionnaires of pain, pain coping strategies, and PCA satisfaction. The total volume of morphine consumed by participants while using PCA was also recorded. Firstly, the results indicated that participants who experienced post-operative analgesic side effects reported significantly lower PCA satisfaction and used more maladaptive pain coping strategies than those without side effects. Secondly, after controlling for dimensions of pain, maladaptive pain coping strategies helped predict pain intensity scores. Thirdly, after controlling for pain, state anxiety helped predict the total volume of morphine consumed during PCA use. Finally, none of the pre and post-operative variables helped to predict PCA satisfaction scores as measured in this study. Although this study partially replicated the previous finding that state anxiety helped predict morphine consumption, there was no empirical support to suggest that self-efficacy beliefs helped to understand acute post-operative pain management with PCA. The results were discussed in terms of the review questions presented above. The discussion focused upon the clinical implications of patient education to reduce anxiety and maladaptive pain coping strategies, as well as encourage the autonomy and control that PCA allows. The limitations of this study and directions for future consideration were also discussed.

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