INTRODUCTIONEveryone experiences painful noxious stimulation sometime during his or her lifetime. Eighty percent of medical patients consult physicians because of pain related problems. Millions of Americans suffer from chronic pain, and more than $900 million are spent annually by Americans on medications to relieve pain (Kiel, 1997). Unfortunately, a behavioral technology for coping with pain has not been developed. Although a variety of cognitive strategies for pain control are being examined. Recent research is examining whether non-chemical methods are effective in coping with and reducing pain. Many cognitive studies have been shown to reduce painful experiences and shown a higher level of pain tolerance. These techniques include social encouragement and Lamaze training (Worthington, Martin, Shumate & Carpenter, 1983), focusing on sensory aspects of stimuli (Gilligan, Ascher, Wolpar & Bochachevsky, 1984). The role of relaxation has been experimentally demonstrated (Westcott & Horan, 1977). The Lamaze method of childbirth involves educating women in pain control techniques and training the partner to "coach" the women through labor by giving encouragement and distraction to endure pain. Distraction is broadly defined as the direction of attention away from sensory or emotional reactions produced by an adverse stimulus. Some studies ( Rosenbaum, 1980; Fernandez, 1986) have shown results that are not supported in the use of distraction in regards to chronic pain. While others ( Johnson, Breakwell, Douglas, Humphries, 1998; McCaul, Haugtvedt, 1982) endorse its usefulness for chronic pain, leading to inconsistent results. Although there is evidence for the effectiveness of distraction and imagery overall in reducing pain, the plethora of distraction and imagery tasks used, the different measures of pain and distress, and the variety of types of painful stimulation used, have produced a confusing picture within which it is difficult to compare procedures in order to identify the most effective distraction and imagery procedures. Furthermore, literature on cognitive strategies is also ridden with inconsistencies of terminology that present major difficulties in the conceptualization and evaluation of different strategies. This experiment was designed to examine the individual differences, if any, in pain tolerance associated with the use of distraction and imagery cognitive strategies. In some subjects studies have shown that the use of these strategies is associated with dramatic elevations in pain threshold. For many others however, the pain reductions are minimal or non-existent.
43 undergraduate college students attending Missouri Western State College, in St. Joseph, Missouri were used. The campus is located in Northwest Missouri, it is a medium sized, 4 year, open admission college. This campus is surrounded by a rural environment. The students volunteered and were not paid, although some volunteers did receive extra credit points for their participation.
I conducted the cold pressor test by using metal 10 to 15 quart stockpots filled with water, ice cubes, and a small amount of salt. All of the stockpots will have approximately the same amount of water, ice and salt. For accurate time measuring, stopwatches of the same brand name and model number were used. For two of the different levels of the independent variable, I used a three-minute brief Lamaze video clip and a three-minute relaxation music tape.
Each subject was assigned to one of three groups to determine the effect, if any, on the dependent variable, Pain tolerance. Subjects in the no-treatment control condition, were simply instructed to place their hand in the ice water for as long as they were able until the discomfort level rose to the time at which they would like to remove it. This condition was designed to closely approximate a real life situation in which no coping mechanism is provided. The second condition listened to a three minute relaxation tape (Solitudes, 1999) an auditory distraction. They were then asked to place their hand in the ice water and to keep it in the ice water as long as they were able, until the discomfort level rose to the time at which they would like to remove it. The music continued to play as long as the subjects` hand remained in the ice water. The third condition will watch a brief, 3 minute Lamaze training video clip (MCA Home Video, 1986). The subjects were then asked to place their hand in the ice water as long as they are able, until the discomfort level rose to the time at which they would like to remove it. The time will be recorded from the second the subject places their hand into the ice water until the subject removes their hand from the water. A Sportline xt stopwatch was used. When more then one stopwatch was used, the same brand and model was utilized.
RESULTSFor my statistical analysis, a 3x2 between subjects factorial ANOVA was calculated comparing the scores of the subjects in a cold pressor test using the three conditions and also to determine if the gender of the subject had an effect. A significant main effect for gender was found (F(1,37)=5.524, p= .024.) Males did leave their hand in the ice water longer then women (Female mean =105.0, Male mean =173.33.) The main effect for the conditions was not significant (F(2,37) = 2.101, p= .137.) Students who were exposed to the conditions did not leave their hands in the ice water longer than those who received no treatment. The interaction was also not significant (F(2,37)= .735, p= .486.) Thus, it appears that the time that subjects kept their hands in the water was not significantly influenced by the conditions or the gender of the subjects. (See figure 1 for the mean times of all conditions and genders.)
DISCUSSION The purpose of this study is to examine whether the distraction techniques of relaxation music or brief Lamaze training has an effect on pain tolerance in a cold pressor test. I was disappointed to find that there was not a significant effect found for either condition. It must be pointed out that there was a large difference between the times of the control condition (M= 98.66), and the time with the condition of music (M= 149.06).This was a large difference that showed quite an effect but was not significant. This may have to do with the amount of individual difference in pain tolerance acceptability, which would mask any significant findings. This effect could be controlled for in further studies by using a very large sample size, by matching subjects or with a repeated measures design. Further studies need to be conducted to determine whether with modification these treatments would be effective, such as a different type of music, the level of the volume of the music, a different video perhaps. Many factors miniscule and large can effect the results making the experiments results significant, insignificant or inconclusive. Can this study in essence be generalized? Is the pain of a cold pressor test really similar to the pain felt in child birth? In my experience, the answer is no. This experiment lends support to the studies conducted by Rosenbaum (1980) and Fernandez (1986). This study did not support the findings of Johnson, Breakwell, Douglas and Humpheries (1989), McCall and Haugtvedt (1982). This leads me to believe that the issue is still very unclear whether distraction is indeed a valid method of controlling with and dealing with pain. The inconsistencies in cognitive strategies leads to inconsistent results. To further improve this study in future research, it would be suggested that the subjects be measured individually and not in a group setting to control for the effect of error or the distraction element of competition. It would also be advisable to have all participants place their hand in a container of lukewarm water to stabilize and have the hands at a consistent temperature before starting the experiment.
REFERENCESFernandez, E. (1986). A classification system of cognitive coping strategies for pain. Pain, 26, 141-151Gilligan, R. M., Ascher, L. M., Wolper, J., & Bochachevsky, C. (1984). Comparison of three cognitive strategies in altering pain behaviors on a cold pressor task. Perception and Motor Skills, 59, 235-240.Johnson, M. H., Breakwell, G., Douglas, W., & Humphries, S., (1998). The effects of imagery and sensory detection distracters on different measures of pain: How does distraction work? British Journal of Clinical Psychology, 37, 141-154Kiel, K. J., (1997). Effects of self-efficacy sources on pain tolerance in a cold pressor test. Journal of Psychological Inquiry, 2, 13-17. MCA Home Video, (1986). The joy of natural childbirth. United States.McCaul, K. D., & Haugtvedt, C. (1982). Attention, distraction, and cold pressor pain. Journal of Personality and Social Psychology, 43, 154-162.Rosenbaum, M. (1980). Individual differences in self control behaviors and tolerance of painful stimulation. Journal of Abnormal Psychology, 89, 581-590Solitudes, Ltd., (1999). Natural Concentration, Toronto, Canada.Westcott, T. B., Horan, J. J. (1977). The effects of anger and relaxation forms of in vivo emotive imagery on pain tolerance. Canadian Journal of Behavior Science, 9, 216-232. Worthington, E. L., Martin, G. E., Shumate, M., & Carpenter, J. (1983). The effect of brief Lamaze training and social encouragement on pain endurance in a cold pressor test. Journal of Applied Social Psychology, 13, 3, 223-233.