Attention focus, trait anxiety and pain perception in patients undergoing colposcopy

Abstract

Few studies have compared the relative efficacy of attention-focus strategies in reducing clinical pain. Colposcopy, a medical diagnostic examination performed to identify premalignant cervical cell changes, elicits both anxiety and pain in patients, while allowing little or no behavioural control over the event. Employing a multi-group experimental design, the present study sought to investigate how different types of attention-focus strategies impacted upon pain perception, state anxiety, and affect, in a sample of 123 colposcopy patients. Patients were randomly assigned to one of three groups: sensory focusing, active distraction, and undirected control. Psychometric measures of pre-colposcopy pain expectancy and dispositional trait anxiety were also taken, in order to assess whether these factors further contributed to outcomes. Overall, when controlling for pain expectancy and trait anxiety, self-reported pain intensity, sensory pain, and affective pain did not differ across groups. Further, there were no significant between-groups differences in colposcopy-related state anxiety or affect. However, pre-colposcopy psychometric measures were found to be predictive of a range of outcomes. Pre-colposcopy pain expectancy, but not trait anxiety, was found to be positively related to colposcopy-related pain. It was further demonstrated that heightened state anxiety following colposcopy was due to experienced pain and pain unpleasantness, rather than to aspects of the pre-colposcopy prediction of pain. The results have implications for management of acute clinical pain.

Correlates of psychological distress immediately following colposcopy

“…In these analyses, active coping style did not influence post-colposcopy distress, and we also had little success in our intra-procedural interventions aimed at reducing pain and anxiety during colposcopy [22,23]. Mixed results have been reported from other studies assessing interventions during colposcopy, with some finding support for the use of music [34], while others have not [35], or viewing the colposcopy monitor [36], although contrary findings have been reported [37].…”

“…Women followed different management pathways depending on colposcopic impression, and within the sample 80 women (51.2%) underwent punch biopsy during colposcopy and 35 women (21.3%) underwent LLETZ treatment. There were no significant differences in self-reported pain between women who underwent punch biopsy (M = 25.49, 22, p = .83). There were also no significant differences in self-reported pain between women who received LLETZ treatment (M = 28.89, SD = 18.95) and those who did not (M = 24.11, SD = 21.11; t(162) = 1.21, p = .23).…”

Patients’ perceptions of colposcopy pain

“…Procedures have been described elsewhere (Kola & Walsh ; Kola et al . , ). Between October 2006 and June 2007 on arrival at the colposcopy clinic, following an initial interview by a nurse, women were invited to take part in the study by the researcher and presented with study information and written consent was obtained.…”

“…Providing women with details of the likely sensations during colposcopy may ensure expectations are appropriate and may also reduce the pain experienced during colposcopy (Kola et al . ). Colposcopy‐related pain is associated with increased post‐colposcopy distress (Sharp et al .…”

“…These data were collected as part of a larger study assessing the efficacy of distraction interventions to reduce pain and anxiety in women undergoing colposcopy, and the results have been published elsewhere (Kola et al . , ). The focus of these analyses was on the different pain descriptors used by women undergoing diagnostic colposcopy, punch biopsy or large loop excision of the transformation zone (LLETZ) treatment.…”