(799) What children and parents report at home after ambu-latory surgery

M. Huth, D. Van Kuiken, L. Lin; Case Western Reserve University, Cleveland, OHThis un-blinded RCT investigated the effectiveness of imagery, in addi-tion to routine analgesics, in reducing pain and other outcomes afterdischarge from an ambulatory surgery setting (AS) for a tonsillectomyand/or adenoidectomy. Seventy-three children, ages 7-12, were re-cruited from five AS settings. Thirty-six children randomly assigned tothe treatment group listened to a 30-minute audio tape of imagery bothbefore surgery (M � 3.78 times) and after surgery at home (M � 1.58times). The 37 children in the attention-control group received standardcare. Measures of sensory pain were the Oucher and amount of analge-sics used. Affective pain was measured with the Facial Affective Scale(FAS). All children, with help from parents, were asked to keep a homediary of fluid intake, pain measures report, and analgesics given in thefirst day after surgery. Analysis was performed using parametric tests orcorresponding non-parametric tests when necessary. There were no sig-nificant differences between the groups on length of AS stay, number ofemesis, total amount of fluid intake, and analgesics administered whileat home (p � .05). However, the amount of fluid intake at home wassignificantly lower than the minimum recommended by the AmericanAcademy of Otolaryngology (p � .02). Pain scores at home indicate thatchildren experienced moderate pain in the first 24 hours. Oucher scoresaveraged 37.25 (SD � 24.76) and FAS scores averaged 0.56 (SD � 0.21).Children prescribed hydrocodone and acetaminophen as analgesic (n �33), received significantly less than the recommended mg/kg/dose (p �.0001), with 97% of these children receiving less than suggested dosing.All children over 50 kg (n � 13) received less than recommended doses ofeither hydrocodone or codeine. Teaching parents about adequate homeadministration of analgesics and fluids are essential for postoperativerecovery at home.

(800) Effectiveness of virtual reality for pediatric pain distrac-tion during IV placement

S. Kim, J. Gold, A. Rizzo, A. Kant, M. Joseph; Children’s Hospital Los Angeles,Los Angeles, CAIntravenous (IV) placement is an essential procedure for imaging studiesin pediatric patients, particularly for sedation and contrast injection.However, venipuncture is often a painful and frequently feared medicalprocedure among pediatric patients. Attention plays an important rolein the perception of painful stimuli and several studies have identifiedthe efficacy of distraction for reducing pain among children undergoingvenipuncture. Virtual reality (VR) has been identified as a potentiallyeffective tool for pain distraction due to its immersing nature, whichdemands substantial attentional resources. The present study is recruit-ing 60 children (ages 7-12) and their caregivers who arrive at the radi-ology department of Childrens Hospital of Los Angeles requiring IVplacement for MRI or CT Scan. Children and their parents are randomlyassigned, stratified for age and gender, to one of two treatment condi-tions. One group of participants undergoes IV placement following theexisting hospital protocol, while the second group adds distraction by avirtual environment (VE) presented in a head-mounted display (HMD).The VE is Street Luge (5DT), which features a fast-moving reality-basedworld in which the player races downhill lying on top of a big skate-board. The child navigates through the VE with a rumble pad that pro-vides tactile feedback. Visual occlusion prevents all participants fromviewing the placement of the IV needle. Pre-post measures include vi-sual analogue scales for anticipatory anxiety and pain intensity, theWong-Baker FACES, and the State Scale of the State-Trait Anxiety Inven-tory for Children. Additionally, the child’s involvement with VE will beassessed with subjective child and parent self-report measures. Parentsand nurses will be asked to report their level of satisfaction with VRdistraction. We expect that children in the VR distraction group willreport significantly less pain, while parents and nurses will report highlevels of satisfaction with VR distraction.

F04 - Other Psychological Approaches(801) Pain as an assault on the selfM. Osborn, J. Smith; Pain Management Unit, University of Bath, Bath, UKThis paper presents an in-depth, idiographic study illustrating howchronic benign low back pain may have serious debilitating impact onpatients’ sense of self. Semi-structured interviews were conducted withpatients and the resultant transcripts subjected to interpretative phe-nomenological analysis. Three super-ordinate themes emerged and arepresented in detail: living with an unwelcome self, the social threat tothe self, a self that cannot be understood or controlled. The results arethen considered in relation to relevant constructs in the extant litera-ture, including work on illness, identity and shame. They highlight themany ways in which chronic pain is ’unpleasant’ and the potential path-way between its social and sensory domains. The everyday experience ofchronic pain is shown to go beyond loss and uncertainty to involve anactive and ongoing sense of threat which could play a significant role inthe attentional processes which maintain and entrench chronic pain inthe consciousness.

F05 - Pain and Depression(802) Interpersonal factors and depression in outpatient

chronic painD. Tripp, A. Kelly, D. Cane, Y. Borshch, D. Santor; Queen’s University, Kingston,ONChronic pain sufferers report ranges of physical, interpersonal, and emo-tional impairments (Turk & Okifuji, 2002). Of all chronic medical popu-lations, chronic pain patients have the highest incidence of depression(30-54%; Banks & Kerns, 1996). Second to demographics, pain is thestrongest predictor of depression. The relationship between chronicpain and depression is robust, but directionality and mechanismsthrough which other factors influence pain and depression remain lessclear. A variety of interpersonal factors are related to the chronic painexperience and this study examined the contributions of demographics,concurrent pain, catastrophizing, negative responses from a significantother, perceived social support, and interpersonal sensitivity in 89 out-patient pain clinic patients. Zero order correlations show no relationsbetween education (Meduc�12yrs;SD�2.35), age (Mage�49;SD�11.30), gender (54 Female), years in pain (Myrs�8.2;SD�8.9), ormarital status (69% with partner) and depression and thus were notused as regression covariates. Hierarchical regression modeling of de-pression shows that concurrent pain is a significant predictor of depres-sion (a�.41; Fchange (df�1,87) � 17.89; �.001). While controlling forconcurrent pain (a�.33; �.001), interpersonal sensitivity (a�.22; �.01)and negative responses from a significant other (a�.31; �.002) weresignificant predictors of depression (catastrophizing, a�.15; perceivedsocial support a��.13). These data support related findings that per-ceived interpersonal stress is associated with depression in painful med-ical conditions such as osteoarthritis and rheumatoid arthritis. Collec-tively, these data suggest that quality of social interactions plays animportant role in the depression of people suffering from chronic pain.Theoretical and clinical implications are discussed.

S58 Abstracts