Stress balls, DVDs and conversation ease pain and anxiety during surgery

The study, published today in the European Journal of Pain, analysed 398 patients, splitting them into four groups.

The first group was played music during their surgery, while the second was offered a choice of DVD to watch from a wall-mounted monitor. In the third group, a dedicated nurse was positioned next to the patient's head to interact with them throughout the procedure. The nurse was instructed not to touch the patient's hand during surgery, but to try and engage them in conversation.  In the fourth group, two palm-sized stress balls were given to participants once they were comfortably in place on the operating table. They were instructed to squeeze these whenever they were feeling anxious or if they anticipated or experienced any uncomfortable sensations.

Anxiety and pain levels were measured through a short questionnaire filled in immediately after the operation.

The results showed that:

• The group that watched a DVD showed 25% less anxiety than those who received treatment as usual (but no differences for pain). 
• The group that interacted with a nurse showed 30% less anxiety and 16% less pain than those who received treatment as usual.
• The group that used stress balls showed 18% less anxiety and 22% less pain than those who received treatment as usual.
• Music did not have any effect on anxiety or pain.

This is the first study to examine the effect of simple distraction techniques on patients undergoing varicose vein surgery. The team of researchers focused on this type of surgery as it is usually done with the patient awake, using a local anesthetic. In addition, during this surgery, patients have previously experienced a burning sensation and have reported unfamiliar smells, sounds and feelings. As they are awake throughout, they have also reported overhearing conversations between the surgeon and nurse, containing upsetting details about the surgery. Although the procedure is highly effective and safe, patients often experience anxiety, as they are fully aware of everything that is happening.

"Undergoing conscious surgery can be a stressful experience for patients,” said study author Professor Jane Ogden from the University of Surrey.

“Finding ways of making them feel more comfortable is really important. The use of simple distraction techniques can significantly improve patient experience.

"Our research has found a simple and inexpensive way to improve patients' experiences of this common and unpleasant procedure, and could be used for a wide range of other operations carried out without a general anesthetic. This could also include the great number of exploratory procedures, such as colonoscopies and hysteroscopies, which are all done while patients are conscious."

Consultant vascular surgeon and study author, Professor Mark Whiteley, said: “Since performing the first keyhole varicose vein operation in the UK in March 1999, The Whiteley Clinic has been at the forefront of research into getting the very best results for our patients. For the first decade, this focused on making the treatments better and better, including inventing the TRLOP operation and discovering that pelvic varicose veins are a major cause of leg varicose veins in many women – a fact that is still missed by most vein surgeons.

"Over the last five years our technical results have become so good and our patients satisfaction so high, that we have added the reduction of patient perception of anxiety and pain to our research aims. This study is the result of the work into this area, which has shown us how to reduce patient pain and anxiety whilst giving them the technical excellence for which we are famous.”

Editors' notes

The 398 patients were recruited from The Whiteley Clinic in Guildford, which is a private medical facility specialising in the treatment of varicose veins and other venous conditions.