Antalgic Positions in Alleviating Postthoracotomy Pain: Their Introduction in a Pain Relief Program

Abstract

To the Editor: During close observation of 126 patients who underwent thoracic surgery and who had been instructed to actively deal with their pain,1Bachiocco V Morselli Labate AM Rusticali AG Bragaglia R Mastrorilli M Carli G Intensity, latency and duration of postthoracotomy pain: relationship to personality traits.Funct Neurol. 1990; 4: 321-322Google Scholar we noticed that 59 deliberately assumed certain body positions to alleviate discomfort (Table 1).Table 1Antalgic Positions and Number of PatientsPositionsNo. of PatientsSemisitting position (120 degrees)35Sitting position (90 degrees)27Reclined on the side of pain1Reclined on the opposite side5 Open table in a new tab Of these patients, 51 maintained the same position while 8 assumed multiple positions. An association between “main site of pain” and “position assumed” was observed. Subjects complaining of axillary pain preferred to stay reclined on the opposite side (p<0.05 Fisher test) while patients reporting pain in the anterior hemithorax usually recurred to a semisitting position (p<0.0001; x2Wallenstein SL The VAS relief scale and other analgesics measures: carryover effect in parallel and crossover studies.in: Max BM Portenoy RK Laska EM The design of analgesic clinical trials: advances in pain research and therapy. Raven Press, New York1991: 97-103Google Scholar test). Every patient subjectively admitted a considerable sense of well-being, but only 30 showed a real decrease in pain at the Visual Analogue Scale (VAS) (VAS 0-10; 2.03 ±1.5 Mean±SD).2Wallenstein SL The VAS relief scale and other analgesics measures: carryover effect in parallel and crossover studies.in: Max BM Portenoy RK Laska EM The design of analgesic clinical trials: advances in pain research and therapy. Raven Press, New York1991: 97-103Google Scholar No significant differences in sex, age, or educational level were ever found. Psychologic features with clinically predictive values were detected instead. Subjects who defined themselves at presurgical assessment as “active” with regards to coping with postoperative pain, restored to this strategy in a higher percentage than patients who defined themselves as “passive” (Self-control Expectancy Questionnaire;3Bachiocco V Morselli AM Carli G Self-control expectancy and post-surgical pain: relationships to previous pain, behavior in past pain, familial pain tolerance models and personality.J Pain Symp Manage. 1993; 8: 205-214Abstract Full Text PDF PubMed Scopus (32) Google Scholar 81.4 percent vs 18.6 percent; p<0.05; x2Wallenstein SL The VAS relief scale and other analgesics measures: carryover effect in parallel and crossover studies.in: Max BM Portenoy RK Laska EM The design of analgesic clinical trials: advances in pain research and therapy. Raven Press, New York1991: 97-103Google Scholar test). The State-Trait Anxiety Inventory, Minnesota Multiphasic Personality Inventory, and Eysenck Personality Inventory personality tests showed that patients maintaining the same position were significantly more anxious (Mann-Whitney, p<0.01) depressed (p<0.01) and introverted (p<0.05) than patients adopting multiple ones. Finally, the real decrease in pain was observed in patients with higher scores in anxiety trait (p<0.05), depression (p<0.01), psychopathic deviate (p<0.01), psychasthenia (p<0.01), schizophrenia (p<0.0001), and lower scores in extroversion (p<0.05). On the whole, the population that used this device requested less painkillers than others. We think that this spontaneous way of facing pain is a real coping technique and its introduction in a postthoracothomy pain relief program is advisable. Pain is a multidimensional experience, and it can be managed through a multimodality approach.4Loeser JD Seres JL Newman RI Interdisciplinary, multimodal management of chronic pain.in: Bonica JJ The management of pain. Lea & Fabiger, Philadelphia1990: 2107-2120Google Scholar Furthermore, this coping technique is efficacious, inexpensive, and with no side effects. It is evident that mapping antalgic positions according to each pain is an important requisite for its systematic application.