Effect of Guided Imagery in reducing the pain of Children: A Systemic Review

 

Mr. Rinu J George1, Mr. Jophin Joseph2, Mrs. Shiny. T. Sam3, Mrs. Jyothy George4

1Department of Nursing and Midwifery, College of Public Health and Medical Science, Jimma University

  Jimma , Ethiopia

2Department of Nursing and Midwifery, College of Public Health and Medical Science, Jimma University

  Jimma, Ethiopia

3Lecturer,  MGM Muthoot College of Nursing, Pathanamthitta, Kerala, India

4Department of Pediatrics, Narayana Hrudayalaya, Bommasandra Industrial Area, Bangaluru, India

*Corresponding Author’s Email: rinugeorge57@yahoo.com

 

ABSTRACT:

Background and objectives :No perfect modality for pain reduction was used in children ,all the methods to relieve added at least some more pain  .this systematic review give an assessment of evidence of guided imagery in reducing pain in children, which stood non-invasive and inexpensive.

Methods: The databases of Medline/PubMed and Google scholar were searched for relevant articles about the effect of guided imagery in reducing pain among children. The articles were searched according to the inclusion criteria specified for this review. An extraction data sheet was designed. Study design, sampling, intervention, and outcome of the study were extracted.

Results: From the 39 titles identified, 20 were irrelevant and 19 were evaluated for more details. Only five articles met the inclusive criteria. The evidence from the selected studies was convincing enough to recommend guided imagery as an effective technique in reduction of pain in children. No side effects of this method were reported.

Interpretation and conclusions: Current evidence suggests that guided imagery is an effective and safe method to reduce pain in children. However, further studies with larger sample size and longer duration are required.

 

KEYWORDS: guided imagery, children, abdominal pain, effectiveness, review.

 

 

INTRODUCTION:

According to the International Association for Pain, pain is defined as "an unpleasant sensory and emotional experience". Children should learn a specific strategy before pain occurs or before it becomes severe. Relief of pain is a basic need and right of all children. Perhaps one of the most difficult challenges professionally and emotionally is learning to handle pain in pediatric patients. It is sometimes a necessary part of our work to inflict pain during procedures, immunizations and other treatments. In the past, there was a relative lack of accountability for providing pain relief. The major focus now is on how to properly assess pain. Culture has changed as evidenced by the new Joint Commission on Accreditation of Healthcare Organizations (JCAHO) regulations. Pain is considered “the fifth vital sign” requiring caregivers to regularly assess and address pain [1]. However, pain remains one of the most misunderstood, under diagnosed, and undertreated /untreated medical problems. Researches has shown that pediatric pain is not treated as comprehensively and attentively in children as it is in adults, in part because of the slow translation of empirical knowledge into routine clinical practice (Howard, 2003; Schechter, 1989). Despite the fact that non-pharmacological pain treatment procedures have been cited as promising in the effort to reduce pediatric pain (Lassetter, 2006).

 

Guided imagery (GI) is a widely used complementary therapy, and its use for pain management has increased over the past two decades. However, definitions of GI used in various health science disciplines are inconsistent. In this review, we define GI as follows: GI involves the generation or recall of different mental images, such as perception of objects or events, and can engage mechanisms used in cognition, memory, and emotional and motor control [2].  The images are typically visualized within a state of relaxation, possibly with a specific outcome in mind (e.g., pain relief) [3] Weydert et al [4] suggested that during GI, all the senses should be used because the more detail with which the image is sensed, the more potential for pain relief it has. A recent systematic review concluded that the evidence of the effectiveness of GI in alleviating musculoskeletal pain is encouraging but inconclusive [5]. The therapeutic value of GI in the treatment of pain other than musculoskeletal and cancer pain, however, remains unclear. The rationale for this research was to continue investigations into the possible analgesic effects of GI. Therefore, the aim of this systematic review was to critically evaluate the evidence for the effectiveness of GI as a treatment for pain in children.

 

MATERIALS AND METHODS:

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol was used to perform this systematic review [6].

 

Search strategy:

Systematic literature searches were conducted to retrieve all studies related to effectiveness of guided imagery in reducing the pain of children irrespective of their design. The databases of MEDLINE, Google Scholar and The Cochrane Library were searched up to 2014. The terms for conducting the search were “guided imagery in children”, “effect of guided imagery+ children”, and “guided imagery+ child pain”. Potentially relevant titles were selected and articles retrieved. A preliminary selection based on the titles was conducted. The references of the articles were also searched to find possible relevant articles. No language limitation was imposed.

 

Study inclusion criteria:

·         Studies conducted on children between 5-18 years

·         Children experiencing pain due to various diseases or procedures.

·         Studies which measure only guided imagery effectiveness.

·         Original research studies published between 2004 -2014.

 

Data extraction:

An extraction data sheet was designed. Study design, sampling, intervention, and outcome of the study were extracted.

 

RESULT:

Total number articles retrieved were 39 out of these ‘18’ where found irrelevant .These studies only detailed about  the nurses and health professionals  knowledge, attitude and practices of different non pharmacological methods in which guided imagery was also included but no effect of guided imagery was tested specifically[21]-[40]. The other reasons for exclusion were as follows: 2 studies mentioned the effect of only hypnosis on pain reduction[7],[9] , 2 studies tested effect of  distraction instead of guided imagery[8],[19],  1 study the term guided imagery was switched by mental imagery[10], 2 only the pattern of  use was assessed [11],[20], 1 study assessed age appropriate guided imagery techniques, failed to test effect [13], 1 was a systematic review[14], 2 were  articles[15],[18], 1 study has heterogeneity in sampling[16], 1 study was done among children with Cerebral Palsy[17] ,1 resulted that no effect for guided imagery in pain reduction[12].

 

Only five studies meet the inclusion criteria, in one randomized clinical trial the effect of guided imagery in pain reduction was specifically tested and significant positive result was obtained. This study was regarding most reported abdominal pain [42], another retrospective study also added with the above study in which guided imagery was found very effective in reduction of pain in functional gastrointestinal diseases, guided imagery improved the quality of life [41].In a development and evaluative study a new guided imagery and relaxation audio reported beneficial effects for children with cancer pain [44]. Furthermore A quasi design in which training module of guided imagery was effective against pain due to sickle cell disease [45]. Finally a pilot study concludes that Guided imagery treatment plus medical care was superior in treating the pain of children [43].

 

DISCUSSION:

In this systematic review, five published studies on the effect of guided imagery were reviewed. The best evidence from these studies shows Guided imagery is an effective technique for managing and limiting pain in a pediatric population, especially in 5-18 years of children. When considering the other type of non-pharmacological methods this review suggests that Guided imagery techniques are superior especially in children, further more Audio recorded Guided imagery techniques were more feasible, enjoyable and beneficial in children for limiting their pain.

 

While the heterogeneous modalities and methodologies of the included studies prohibited in conducting uniform systemic review on guided imagery since then it collectively provide encouraging evidence for the effectiveness of guided imaginary to managing pain in children with various diseases. This systemic review showed convincing evidence of effectiveness when guided imagery combined with other modalities like muscle relaxation and medical care.

 

Regarding the sample size uniquely smaller sample size used by the five selected studies which range from 18 to 34, this is considered one of the significant limitations of this study in addition to that  Only published journal article (research) were included, no dissertations or conference abstracts were considered . All these studies included children and adolescents. Therefore, it is not clear whether these results can be generalized to adult individuals with pain.

 

Based on this review, further research is needed in guided imagery. Larger sample sizes, perhaps through multisite studies are needed in order to recommend the modalities reviewed in this study and the many other possibilities such as meditation, aroma therapy, yoga, acupuncture, Reiki, and other integrative therapies that may have benefit for this population. The clinical implications of the use of guided imagery for children undergoing various diseases treatment include empowering children and their families to gain control over their pain, anxiety, and to increase well-being. Many of these modalities are within the scope of practice for nursing. While some nurses may view this as another task, many nurses will welcome adding a simple tool to their toolbox that enables them to help children in their care.

 

In conclusion, the current evidences support the efficacy and feasibility of guided imagery for treating pain in children and adolescents.

 

ACKNOWLEDGEMENT:

We acknowledge and thank the valuable suggestions given by Mr Manoj Kumar L (Lecturer, Department of Mental Health Nursing, Sree Gokulam Nursing College, Venjaramoodu, Trivandrum.)

 

 

Data extraction

Table 1: extraction data sheet was designed.  Study title, author and year, Study design, sampling, intervention, outcome and main result of the study were extracted. (Table 1)

Sl

 no

Study title

Authors and year of publication

design

Sample size

intervention

Main outcome measure

Main result

1

Treatment of Functional Abdominal Pain in Childhood With

Cognitive Behavioral Strategies

Nader N. Youssef, Joel R. Rosh, Mary Loughran, Stephanie G. Schuckalo, Ann N. Cotter,Barbara G. Verga, and Richard L. Mones (2004)

A retrospective chart review of children

between 2001 and 2002

 

 

18 patients

with chronic abdominal pain caused by FGIDs

guided imagery and progressive

relaxation techniques

change in abdominal pain

And quality of life, evaluated by the Pediatric Quality of Life Scale (PedsQL®).

Guided imagery and progressive relaxation can

safely and effectively reduce chronic abdominal pain in children

With FGIDs. This treatment also improved social functioning

And school attendance.

2

Evaluation of guided imagery as treatment for recurrent abdominal

pain in children: a randomized controlled trial

Joy A Weydert, Daniel E Shapiro, Sari A Acra, Cynthia J Monheim,

Andrea S Chambers and Thomas M Ball (2006)

Randomized clinical trial with breathing exercises alone or guided imagery

with progressive muscle relaxation

22 Children reported the abdominal

Pain.

 

 

 

 

 

 

breathing exercises VS guided imagery

 

Children reported the numbers of days with pain, the pain intensity, and missed activities due to abdominal pain using a daily pain diary. rate the intensity

Children used the FACES scale. Documented any days the child missed a normal activity because of abdominal pain. Monthly phone calls to the children

Guided imagery techniques along with progressive muscle

relaxation is more effective than breathing and relaxation

techniques for reducing pain episodes and missed activities

in children with Recurrent abdominal pain..

3

Audio-Recorded Guided Imagery Treatment Reduces

Functional Abdominal Pain in Children: A Pilot Study

Miranda A. L. van Tilburg, Denesh K.

Chitkara,  Olafur S. Palsson,  Marsha Turner, Nanette Blois-Martin,  Martin Ulshen, and

William E. Whitehead (2009)

A Pilot Study

34 children with physician diagnosis of functional abdominal

Pain.

standard medical care with or without homebased,

Guided imagery treatment.

(1)Questionnaires

(2) 25-minute, instructional

DVD,

(3) 3biweekly sessions, including 1 booster

session

 (4) a calendar; and

(5) a portable CD player, to enable the children to listen to the CDs in a comfortable place at home.

Guided imagery treatment plus medical care was superior

to standard medical care only for the treatment of abdominal pain,

and treatment effects were sustained over a long period.

 

4

 Guided Imagery and Relaxation Audio for Children with Cancer: Development and Evaluation

 Azizah Othman1, Muhammad Junaidi Buang, Mai Nurul Ashikin Taib, Norsarwany Mohamad, Ariffin Nasir (2013)

 

 

Development and Evaluation studies.

18 children are treated for any kind of cancer.

Guided Imagery Relaxation in Children.

 a Guided Imagery and Relaxation (GIR) audio

This is the first known study developing GIR audio in Bahasa Malaysia which is feasible, enjoyable and beneficial for children that warrants efficacy study.

 

5

Original research: using guided imagery to manage pain in young children with sickle cell disease.

 

Dobson CE, Byrne MW. (2014)

A quasi-experimental interrupted time-series design.

20 children with sickle cell disease.

effects of guided imagery training

-- Pain Assessment Tool (PAT), for visual imaging ability using the Kids Imaging Ability Questionnaire (KIAQ), for sickle cell disease– specific self-efficacy using the Sickle Cell Self-Efficacy Scale (SCSES).

-- Children completed pain diaries daily for two months, and investigators measured baseline and end-of-treatment imaging ability and self-efficacy.

Guided imagery is an effective technique for managing and limiting sickle cell disease-related pain in a pediatric population.

 

 

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Received on 22.12.2015          Modified on 16.01.2016

Accepted on 23.02.2016          © A&V Publication all right reserved

Int. J. Adv. Nur. Management. 2016; 4(2): 173-177.

DOI: 10.5958/2454-2652.2016.00040.8