Effectiveness of Guided Imagery Therapy in Reducing Pain Among Adult Post-Appendectomy Patients: A Quasi-Experimental Study
DOI:
https://doi.org/10.55018/janh.v8i2.650Keywords:
Guided Imagery, Pain Management, Appendectomy Patients, Postoperative Pain, Complementary TherapiesAbstract
Background: Pain is a common complaint among postoperative patients, including those undergoing appendectomy. Guided imagery therapy is a non-pharmacological intervention that can help reduce pain by diverting patients’ attention from discomfort with minimal side effects. However, evidence regarding its effectiveness in adult post-appendectomy patients remains limited. This study aimed to determine the effect of guided imagery therapy on reducing pain intensity in adult post-appendectomy patients.
Methods: This study used a quasi-experimental design with a pretest-posttest control group, conducted in accordance with the TREND reporting guidelines. This study received ethical approval from the Research Ethics Committee of the Karsa Husada Garut College of Health Sciences. The sample consisted of 50 patients, equally divided into intervention and control groups (25 per group), recruited according to the inclusion and exclusion criteria. The independent variable was guided imagery therapy administered twice a day for 15–20 minutes over three consecutive days by the researcher, while the dependent variable was pain intensity measured using the Numeric Rating Scale (NRS). The control group received routine care. Data were analyzed using the Mann-Whitney test for differences between groups, with a significance level of 0.05. All statistical analyses were performed using IBM SPSS Statistics version 29.
Results: The intervention group showed a significant reduction in pain intensity (p<0.05). The intervention group demonstrated a marked reduction in mean pain scores from 4.88 at pretest to 1.68 at posttest, representing a very large within-group effect. In contrast, the control group showed only a minimal change from 4.84 to 4.44. Between-group comparison indicated a significantly greater reduction in pain in the intervention group than in the control group. All main statistical results are presented with 95% confidence intervals to provide an estimate of precision and uncertainty around the observed effects.
Conclusion: Guided imagery therapy has been shown to significantly reduce pain intensity in adult patients after appendectomy compared to the control group. It is recommended that nurses teach and provide guided imagery therapy regularly to reduce pain intensity in adult post-appendectomy patients
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References
Acar, K., & Aygin, D. (2019). Efficacy of Guided Imagery for Postoperative Symptoms, Sleep Quality, Anxiety, and Satisfaction Regarding Nursing Care: A Randomized Controlled Study. Journal of Perianesthesia Nursing, 34(6), 1241–1249. https://doi.org/10.1016/j.jopan.2019.05.006
Aghakhani, N., Faraji, N., Alinejad, V., Goli, R., & Kazemzadeh, J. (2022). The effect of guided imagery on the quality and severity of pain and pain-related anxiety associated with dressing changes in burn patients: A randomized controlled trial. Burns, 48(6), 1331–1339. https://doi.org/10.1016/j.burns.2021.11.020
Alsharari, A. F., Alshammari, F. F., Salihu, D., & Alruwaili, M. M. (2023). Postoperative Pain Management in Children Undergoing Laparoscopic Appendectomy: A Scoping Review. In Healthcare, 11(6), 1–17. https://doi.org/10.3390/healthcare11060870
Anamagh, M. A., Kouhpayeh, M. S., Khezri, S., Goli, R., Faraji, N., Anzali, B. C., Maroofi, H., Eskandari, N., & Ghahremanzad, F. (2024). The effect of Guided imagery on perioperative anxiety in hospitalized adult patients: A systematic review of randomized controlled trials. Surgery in Practice and Science, 18, 1–8. https://doi.org/10.1016/j.sipas.2024.100255
Baldor, D., Lewis, P. R., & Tadlock, M. D. (2022). Routine in-person postoperative follow-up for uncomplicated laparoscopic appendectomy does not change management. Surgical Endoscopy, 36(6), 3775–3780. https://doi.org/10.1007/s00464-021-08693-7
Bella, A., Diego, A. M., Finn, D. P., & Roche, M. (2022). Stress-induced changes in nociceptive responding post-surgery in preclinical rodent models. Frontiers in Pain Research, 3, 1–10. https://doi.org/10.3389/fpain.2022.1106143
Biput, S. J., Slouha, E., Gregory, J. A., Krumbach, B., Clunes, L. A., & Kollias, T. F. (2024). Pain Management During Adult Laparoscopic Appendectomy: A Systematic Review. Cureus, 16(1), 1–10. https://doi.org/10.7759/cureus.52037
Burhenn, P., Olausson, J., Villegas, G., & Kravits, K. (2014). Guided imagery for pain control. Clinical Journal of Oncology Nursing, 18(5), 501–503. https://doi.org/10.1188/14.CJON.501-503
Choi, S., Yoon, S. H., & Lee, H. J. (2024). Beyond measurement: a deep dive into the commonly used pain scales for postoperative pain assessment. Korean Journal of Pain, 37(3), 188–200. https://doi.org/10.3344/kjp.24069
Dillah, A., Warsoedoedi, D., Larasati, P., Wahidin DTI, Fitrie, A., Loebis, I., & Luthfi, M. (2025). Karakteristik dan Gambaran Histopatologi Pada Pasien Apendisitis di RSU 45 Kabupaten Kuningan Tahun 2022. Tunas Medika Jurnal Kedokteran & Kesehatan, 11(2). https://sinta.kemdiktisaintek.go.id/authors/profile/6802124/?view=garuda#!
Dixon, F., & Singh, A. (2023). Acute appendicitis. Surgery (Oxford), 38(6). 310–317. https://doi.org/10.1016/j.mpsur.2020.03.015
Emerson, R. (2023). Mann-Whitney U test and t-test. Journal of Visual Impairment and Blindness, 117(1), 99–100. https://doi.org/10.1177/0145482X221150592
Felix, M. M. dos S., Ferreira, M. B. G., da Cruz, L. F., & Barbosa, M. H. (2019). Relaxation Therapy with Guided Imagery for Postoperative Pain Management: An Integrative Review. Pain Management Nursing, 20(1), 1–10. https://doi.org/10.1016/j.pmn.2017.10.014
Ferreira-Valente, M. A., Pais-Ribeiro, J. L., & Jensen, M. P. (2011). Validity of Four Pain Intensity Rating Scales. Pain, 152(10), 2399–2404. https://doi.org/10.1016/j.pain.2011.07.005
Fillingim, R. B., King, C. D., Ribeiro-Dasilva, M. C., Rahim-Williams, B., & Riley, J. L. (2009). Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings. Journal of Pain, 10(5), 447–485. https://doi.org/10.1016/j.jpain.2008.12.001
Gagliese, L. (2009). Pain and Aging: The Emergence of a New Subfield of Pain Research. Journal of Pain, 10(4), 343–353. https://doi.org/10.1016/j.jpain.2008.10.013
Green, G. (2022). Seniors’ eHealth literacy, health and education status and personal health knowledge. Digital Health, 8, 1–9. https://doi.org/10.1177/20552076221089803
Han, H., Letourneau, I. D., Abate, Y. H., Abdelmasseh, M., Abu-Gharbieh, E., Adane, T. D., Ahinkorah, B. O., Ahmad, A., Ahmadi, A., Ahmed, A., Alhalaiqa, F. N., Al-Sabah, S. K., Al-Worafi, Y. M., Amu, H., Andrei, C. L., Anoushiravani, A., Arabloo, J., Aravkin, A. Y., Ashraf, T., … Dirac, M. A. (2024). Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021. The Lancet Gastroenterology and Hepatology, 9(9), 825–858. https://doi.org/10.1016/S2468-1253(24)00157-2
Kubulus, C., Komann, M., Paxian, M., Schubert, A., Schwarzkopf, D., Rose, N., Meissner, W., Marschall, U., Dreiling, J., Fleischmann-Struzek, C., & Volk, T. (2025). Does the quality of pain relief after major surgery influence the risk of postoperative complications? A prospective observational study. PLOS ONE, 20(9), 1–15. https://doi.org/10.1371/journal.pone.0332866
Liu, K., Su, P., Wang, H., & Tao, D. (2022). Contextualizing Visualizations of Digital Health Information among Young and Older Adults Based on Eye-Tracking. Sustainability, 14(24), 1. https://doi.org/10.3390/su142416506
Lu, Y.-J., Lee, M.-C., Chen, C.-Y., Liang, S.-Y., Li, Y.-P., & Chen, H.-M. (2022). Effect of Guided Imagery Meditation During Laparoscopic Cholecystectomy on Reducing Anxiety: A Randomized Controlled Trial. Pain Management Nursing, 23(6), 885–892. https://doi.org/10.1016/j.pmn.2022.07.003
Moayedi, M., & Davis, K. D. (2013). Theories of pain: from specificity to gate control. J Neurophysiol, 109(1), 5–12. https://doi.org/10.1152/jn.00457.2012.-Several
Mogil, J. S. (2020). Qualitative sex differences in pain processing: emerging evidence of a biased literature. Nature Reviews Neuroscience, 21(7), 353–365. https://doi.org/10.1038/s41583-020-0310-6
Mullins, S., Hosseini, F., Gibson, W., & Thake, M. (2022). Physiological changes from ageing regarding pain perception and its impact on pain management for older adults. Clinical Medicine, Journal of the Royal College of Physicians of London, 22(4), 307–310. https://doi.org/10.7861/clinmed.22.4.phys
Niang, I., Dieng, C. K., Diouf, P. M. D., Diop, C. T., Welle, I. B., Ndong, A., Dia, S. A. M., Sarr, P. B., Ndiaye, O., Sinake, R. B., & Ba, A. L. (2022). “Worm within worm”: acute appendicitis containing an adult Ascaris lumbricoïdes. BJR|case Reports, 8(3), 1–3. https://doi.org/10.1259/bjrcr.20210035
Pappas, J., Sutton, L. A., & Wilson, D. R. (2024). Guided Imagery and Other Complementary Pain Control Approaches for Critical Care Patients. Critical Care Nursing Clinics of North America, 36(4), 539–551. https://doi.org/10.1016/j.cnc.2024.01.008
Posadzki, P., Lewandowski, W., Terry, R., Ernst, E., & Stearns, A. (2012). Guided imagery for non-musculoskeletal pain: A systematic review of randomized clinical trials. Journal of Pain and Symptom Management, 44(1), 95–104. https://doi.org/10.1016/j.jpainsymman.2011.07.014
Qian, J., Lin, X., & Zhou, Z. (2022). Skin/muscle incision and retraction regulates the persistent postoperative pain in rats by the Epac1/PKC-βII pathway. BMC Anesthesiology, 22(1), 1–9. https://doi.org/10.1186/s12871-022-01771-w
Santana, E. de O., Silva, L. D. S., da Silva, L. A. A., Lemos, J. L. de A., Marcondes, L., Guimarães, P. R. B., & Kalinke, L. P. (2023). Effect of guided imagery relaxation on anxiety in cervical cancer: randomized clinical trial. Revista Brasileira de Enfermagem, 76(5), 1–7. https://doi.org/10.1590/0034-7167-2021-0874
Sgourdou, P. (2022). The Consciousness of Pain: A Thalamocortical Perspective. NeuroSci, 3(2), 311–320. https://doi.org/10.3390/neurosci3020022
Singh, H., Kolschen, J., Samkange-Zeeb, F., Brand, T., Zeeb, H., & Schüz, B. (2022). Modifiable predictors of health literacy in working-age adults - a rapid review and meta-analysis. BMC Public Health, 22(1), 1–13. https://doi.org/10.1186/s12889-022-13851-0
World Medical Association. (2013). World Medical Association declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053
Zhang, Y., Liu, D., Wang, D., Chen, Y., Li, L., Fu, J., Liu, W., & Zhang, J. (2026). Postlaparoscopic appendectomy acute pain: identifying risk factors and building a clinical prediction model. Frontiers in Surgery, 13, 1–10. https://doi.org/10.3389/fsurg.2026.1793752
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