@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2015;21(2):75-80

Background
… [1-8] Methods of pain relief are achieved in two ways: Drug treatment and non-drug treatments. Non-drug treatments such as relaxation reduce the pain [9]. … [10, 11] One of the relaxation techniques, that is easy to learn, is Benson muscle relaxation. Benson claimed that the results of the relaxation are due to reduced activity of the autonomic nervous system [12]. … [13]
Previous Studies
Relaxation is a non-pharmacological intervention for pain medicine in different situations, and studies usually have used a combination of relaxation, massage or visualization [10].
Aim(s)
This study aimed to determine the effects of muscle relaxation techniques on hemodialysis patients’ pain.
Research type
This is a randomized controlled clinical trial.
Research society, place and time
All hemodialysis patients in hemodialysis centers of Khatmalanbya and Zahedan Emam Ali (Iran) were studied in 2013-2014.
Sampling method and number
The sample size was calculated by the use of formula for determining mean after pilot study and 42 patients were selected for each group. 45 patients in each group and a total of 90 patients were enrolled by means of purposive sampling method. Inclusion criteria included: minimum 18 years and maximum 65 years, having at least 2 months of hemodialysis and hemodialysis for 2 to 3 times a week, having full consciousness, having acceptable hearing and speech ability for learning, being relaxed, absence of known mental illness such as anxiety and depression, having no history of known muscle diseases and having open file in the mentioned centers. Exclusion criteria, also, included each condition which occurs for the patients during the intervention that makes the continuation of intervention impossible. The subjects were randomly divided into two groups of control and experimental by block permutation of 4.
Used devices&materials
The instrument used in this study included a demographic questionnaire on demographic information (gender, age, marital status, level of education) and information about the disease and treatment (history of hypertension and diabetes, renal failure and dialysis duration risk ), McGill pain registration and registration form for relaxation. The validity and reliability of McGill Pain Questionnaire has been reported as high [14]. … [15] Initially, patients were asked to complete a demographic questionnaire, and pain severity was, also, determined. Then, muscle relaxation techniques were instructed to the subjects in the experimental group individually in three sessions. After that, patients exercised the techniques for 30 days, 2 times a day at home. The performance method included the followings: 1. the patients should be placed in a comfortable position; 2. they should close the eyes slowly; 3. they should relax all the muscles gradually from the feet to the face, staying calm; 4. they should have nasal breathing and be aware of their breath; they should breathe out slowly through the mouth and mutter number 1when breath out; they should breath naturally and easily; 5. they ought to do this for 15 to 20 minutes and they try to be flabby. Then they should slowly open their eyes and they do not get up for several minutes; and 6. They should not be concerned about whether they have reached a deep level of relaxation; they should let relaxation happen with their own rhythm. When distracting thoughts occur they should try to ignore it and be indifferent to it [16]. In order to analyze data, collected data entered into the SPSS 21 software and Mann-Whitney test was used to compare the pain intensity before and after the intervention. Independent T test was used to compare the average age of the subjects and to compare the difference between the mean pain intensity before and after intervention in the two groups. The chi-square test was used to compare qualitative variables in two groups.
Findings by Text
The mean age of the subjects was 43.0± 15.0 years. In terms of age, no significant difference was observed between control group (46.11 ± 14.75) and experimental group (40.41 ± 15.22). The majority of the subjects in both groups were male, married, illiterate and unemployed. Two groups of control and experimental were not significantly different and were homogenous in terms of demographic variables, gender, marital status, education and occupation. The majority of subjects had a history of high blood pressure but had no history of diabetes. The duration of hemodialysis in subjects was between one and 10 years. There were no significant differences in the variables between the two groups and the groups were similar (Table 1). Before the intervention, the mean of pain score in experimental group was more than the mean of the pain in control group, but there was no significant difference between the two groups. The average pain score in the control group after intervention was higher in the experimental group, but no significant differences were observed between the groups. The mean of pain intensity was reduced in experimental group, but it increased in control group and this indicated that this technique has significantly reduced the intensity of pain (Table 2).
Main comparison to the similar studies
Benson muscle relaxation technique reduced pain in the hemodialysis patients. After two months of intervention, the effects of relaxation technique have been observed [15]. The positive effects of muscle relaxation have been reported after 20 weeks in chronic musculoskeletal pain [17], but in the current study, with a month intervention, significant results were reported. Reductions in anxiety and prevention of the transmission of pain to the spinal cord and muscle relaxation have been reported [18, 19]. Jacobson relaxation technique has reduced the chronic pain in MS patients [20]. A study on 22 patients and 10-week performance of the technique by patients have shown that relaxation techniques by relieving chronic pain leads to more energy and less patient motion limitation [21]. It has been reported that using Jaw relaxation techniques for 20 minutes and with the duration of a session intervention in experimental group has reduced pain after the intervention [22]. The results are consistent with the findings of the present study. 12 weeks of progressive muscle relaxation reduces pain in patients with osteoarthritis [23]. Progressive muscle relaxation after two-month utilization of audio tapes and practical training reduces pains such as osteoarthritis, chronic headache pain and cancer [24]. Progressive muscle relaxation after 4 sessions of training and two months of conducting relaxation by patients has been significantly effective on reducing nerve pain [25]. The results of all these studies are consistent with the results of the present study. In the present study, despite a shorter treatment time (two or three months), statistically significant results were obtained. At a session of relaxation and systematic intervention, the effect of relaxation on the severity of postoperative patients was statistically significant [26]. … [27-29]The relationship of some factors such as occupation, education, gender, marital status, age, and the records of diabetes with pain were not significant. The result is consistent with the results of another study [30].
Suggestions
Other non-pharmacological methods should be compared with the performed method.
Limitations
Completion of a self-report questionnaire for nausea by patients and lack of direct access to the patients and continuous monitoring were the limitations of this study.
Conclusions
Benson muscle relaxation with simple exercises at no cost, easily and without adverse effects can reduce pain intensity in the hemodialysis patients.
Acknowledgments
Council of Graduate Studies and Research Council of Gonabad University of Medical Sciences and the cooperation of patients are appreciated.
Conflict of interest
Non-declared
Ethical Permissions
The ethical code of the research is recGMU/1392/43 and code of clinical trial registry is IRCT2014051117656N1.
Funding Sources
This article is an MA thesis in Critical Care Nursing.

TABLES and CHARTS

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