Li-Yuan WANG, Hai-Yun GAI, Yu WEN,Ming-Hui MA

Department of Nursing, Xi’an Traditional Chinese Medicine Hospital, Xi’an, China

ABSTRACT

Objective: To investigate the effect of moxibustion combined with five-element music therapy on the postoperative pain relief of patients undergoing surgical operation for mixed hemorrhoid with damp-heat syndrome.

Methods: Totally, 159 patients meeting the inclusion criteria were assigned to the control group, study group 1, and study group 2, with 53 cases in each group.All patients received routine care after surgical treatment, including acupoint application and Chinese herbal fumigation.In addition, patients in the study group 1 received moxibustion, and those in the study group 2 were given moxibustion combined with five-element music therapy.The degree of postoperative pain was evaluated using visual analog scale (VAS).

Results: There was no significant difference in VAS score on pain during dressing changes among three groups (P ＞ 0.05).After 3, 5, and 7 days of intervention, there was a significant difference in VAS score on pain at rest among three groups (P ＜ 0.001), and VAS score in the study group 2 was lower than that in the study group 1 and the control group after 3 and 5 days of intervention, respectively (P ＜ 0.05).

Conclusion: Moxibustion combined with five-element music therapy is effective to relieve the postoperative pain of patients undergoing a surgical operation for mixed hemorrhoids with damp-heat syndrome.

Keywords: Five-element music therapy, five-tone therapy, mixed hemorrhoid, moxibustion, nursing of integrated traditional Chinese and western medicine, pain

INTRODUCTION

The incidence of hemorrhoids is high, not related to gender, covering all ages.The total domestic morbidity rate of anorectal diseases is about 46%.Among them, hemorrhoids account for 87.25% of the total number of anorectal diseases, and mixed hemorrhoid is the most common one.[1]In traditional Chinese medicine, there are four different syndrome types of mixed hemorrhoids, namely wind evil invading intestinal collateral, damp-heat invading lower energizer, qi stagnation and blood stasis, and qi sinking due to spleen deficiency.Most patients have a type of damp-heat invading lower energizer, accounting for 95.7%.Surgery is currently the most commonly used treatment for hemorrhoids, a safe and effective treatment.[2,3]Although great progress has been made in the surgical technique of hemorrhoids, no matter what kind of surgery, it will lead to postoperative pain, and even some patients choose some treatments that are not conducive to recovery of the disease because of fear of pain.The incidence of postoperative pain in mixed hemorrhoids is higher than other complications and lasts for a long time.It is also an important factor affecting the postoperative rehabilitation of patients and needs to be paid attention by medical staff.Due to the special location and openness of the incision, the dryness and cleanliness of the wound are relatively low, resulting in a strong pain in the wound, which will adversely affect the circulation and immune system of the body, and then cause a series of complications, such as urinary retention, constipation, and elevated blood pressure.Traditional Chinese medicine has accumulated rich experience in the prevention and treatment of postoperative complications of mixed hemorrhoids.[4-8]This study used moxibustion combined with five-element music therapy to relieve postoperative pain in patients with damp-heat-type mixed hemorrhoids.

MATERIALS AND METHODS

This study was approved by the Ethics Committee of Xi’an Traditional Chinese Medicine Hospital.

Inclusion criteria

Patients met the diagnostic criteria of Chinese and western medicine on mixed hemorrhoids, damp-heat invading lower energizer, were performed with external stripping and internal ligation, aged ＞18 years, and volunteered to participate in the study.

Exclusion criteria

Patients with/complicated with the following conditions were excluded: severe heart, cerebrovascular disease, severe liver and kidney dysfunction, mental illness, pregnancy, peripheral vascular disease or gout, postoperative application of controlled analgesia, local skin damage, blisters, or inflammatory cough not be tolerated after inhaling smoke.

Grouping

Inpatients admitted to the Anorectal Department of Xi’an Traditional Chinese Medicine Hospital from May 2018 to October 2018 were selected.Using purposive sampling, according to practical clinical work, a total of 159 cases with mixed hemorrhoids from those patients conforming to the inclusion criteria were enrolled as study objects.The patients were divided into control group, study group 1, and study group 2, 53 cases for each group.The general data of the three groups are summarized in Table 1.

Methods

All patients underwent surgery.

Patients in the control group received routine nursing postoperatively, including postoperative morning and evening care, Chinese medicine fumigation, postoperative dressing change, acupoint application, and health guidance.

Patients in the study group 1 were added with moxibustion treatment on the basis of the control group.The operator selected Shenque acupoint and Erbai acupoint with reference to the previous literature review and doctor’s guidance and used the method of Baixiao moxibustion on those acupoints according to the operation mode of moxibustion in the “Chinese Medicine Nursing Routine Technical Operation Regulations”.Patients were in the supine position, 2 times/day, each moxibustion for 30 min, a total of 10 days of intervention.During the moxibustion process, keep warm and quiet.Closely observe the patients’ condition; if there was any discomfort, adjust the position of moxibustion, the distance from the moxa stick to the skin, and the moxibustion method according to the patient’s sense.Avoid burns.

Patients in the study group 2 were added with moxibustion combined with five-element music therapy on the basis of the control group.The operation method of moxibustion is the same as the study group 1.Patients listened to the selected music while receiving moxibustion treatment.The audio material comes from Chinese medicine health maintenance music albums “Heavenly Five Elements Music” published by Beijing Higher Education Audio and Video Publishing House.There are 10 pure musics in this version, and every one lasts 25-30 min.Each mode has two rhythms: “Yang rhythm” and “Yin rhythm”.According to the syndrome type, damp-heat invading lower energizer type belongs to Yang, and “damp” corresponds to the “Gong” tune; thus, the music “Yuye Huandan” is determined.

Observation indicators

The visual analog scale (VAS) was used to assess the degree of pain during the dressing change on the 1st, 3rd, 5th, 7th, and 10thpostoperative day and to assess the degree of pain of the patients in the resting state at 6 h and on the 1st, 3rd, 5th, 7th, and 10thday after surgery.

Statistical methods

SPSS 20.0 software was used.Measurement data were expressed as mean ± standard deviation, multiple groups were compared using analysis of variance, and least significance difference (LSD) method was used for comparison between groups.The test level = 0.05,P＜ 0.05 was considered statistically significant.

RESULTS

General data

All patients finished the study.There was no significant difference among three groups regarding gender, age, profession, residence, education background, monthly income, payment options, and marital status of patients (P＞ 0.05), as shown in Table 1; the data of three groups were comparable.

Table 1: General data of three groups

Comparison of patients’ pain conditions of three groups during dressing change

The pain evaluation results of the patients of the three groups on the 1st, 3rd, 5th, 7th, and 10thday after the operation are shown in Table 2.The data of the three groups were normally distributed and analyzed using repeated measures analysis of variance.The results showed that there was a statistically significant difference regarding interaction effect (Finteraction= 5.553,P＜ 0.001) and time effect (Ftime= 1244.578,P＜ 0.001), but there was no statistical significance among the three groups (Fintergroup= 0.525,P= 0.992).

Table 2: Patients’ pain score of three groups during dressing change (±s, points)

Table 2: Patients’ pain score of three groups during dressing change (±s, points)

Patients in control group received routine nursing care only; patients in study group 1 were intervened by moxibustion treatment on the basis of control group; patients in study group 2 were intervened by moxibustion plus five-element music therapy on the basis of control group

Time points Control group(n=53)Study group 1(n=53)Study group 2(n=53)On the 1st day after surgery 7.47±0.50 7.49±0.51 7.46±0.51 On the 3rd day after surgery 7.32±0.61 7.42±0.50 7.28±0.59 On the 5th day after surgery 6.38±0.63 6.36±0.65 6.34±0.59 On the 7th day after surgery 6.04±0.76 5.89±0.64 5.70±0.70 On the 10th day after surgery 4.89±0.82 5.26±0.76 5.08±0.73

Comparison of pain scores in patients of three groups at rest

The pain evaluation results of the patients in the three groups at rest at 6 h and on the 1st, 3rd, 5th, 7th, and 10thday after operation are shown in Table 3.The data of the three groups were normally distributed and analyzed using repeated measures analysis of variances.The results showed that there were statistically significant differences regarding interaction effect (Finteraction= 14.12,P＜ 0.001), different time points (Ftime= 5167.307,P＜ 0.001), and different groups (Fintergroup= 4.767,P= 0.010).And then, multivariate analysis of variance was also performed.The VAS scores of the three groups at rest were statistically significant on the 3rd, 5th, and 7thday postoperatively (P＜ 0.001).

Table 3: Comparison of patients’ pain score of three groups at rest (±s, points)

Table 3: Comparison of patients’ pain score of three groups at rest (±s, points)

Patients in control group received routine nursing care only; patients in study group 1 were intervened by moxibustion treatment on the basis of control group; patients in study group 2 were intervened by moxibustion plus five-element music therapy on the basis of control group

Time points Control group (n=53) Study group 1 (n=53) Study group 2 (n=53) F P At 6 h after surgery 8.08±0.55 8.04±0.59 8.06±0.38 0.076 0.927 On the 1st day after surgery 7.04±0.90 7.11±0.78 6.94±0.82 0.554 0.576 On the 3rd day after surgery 6.66±0.71 6.21±0.77 5.91±0.74 14.014 ＜0.001 On the 5th day after surgery 6.25±0.76 5.89±0.67 5.45±0.82 14.751 ＜0.001 On the 7th day after surgery 3.98±1.01 3.34±1.04 3.17±1.03 9.212 ＜0.001 On the 10th day after surgery 2.19±0.88 2.00±1.00 2.04±0.92 0.606 0.547

The LSD test was used to compare the two pairs.On the 3rdand 5thday after the operation, the pain VAS score of the study group 2 was lower than that of the study group 1 and the control group; the difference was statistically significant (P＜ 0.05).On the 7thday after surgery, the VAS scores of the study group 1 and the study group 2 were lower than that of the control group (P＜ 0.05), but the difference between the study group 1 and the study group 2 was not statistically significant (P＞ 0.05).

DISCUSSION

Mixed hemorrhoid is a common clinical rectal and anal disease.Most patients choose to go to the hospital for treatment in the event of complications.The most effective and most common treatment for it is surgery.Pain is a common complication after mixed external dissection and internal ligation, and it is also the main reason for patients to refuse surgery.Therefore, seeking for postoperative pain intervention methods with good curative effect and few adverse reactions is helpful for promoting rehabilitation and improving postoperative quality of life.[9]

In this study, based on the basic theory of traditional Chinese medicine, we use moxibustion plus five-element music therapy to resolve the postoperative pain problem of patients with mixed hemorrhoids of damp-heat invading lower energizer type, for moxibustion has the functions of dredging meridians, regulating qi and blood, yin and yang, strengthening healthy qi and promoting absorption of acupoint application drugs by generating the warm stimulation acting on the corresponding acupoints,[10]thus enhancing the efficacy of drugs and improving the analgesic effect; meanwhile, listening to the selected five-element music, mainly the “Gong” tune that corresponds to the syndrome can make the patients easily relax and ease the patients' sufferings.[11]From Table 2, it is found that after 10 days of inventions, moxibustion or moxibustion plus five-element music therapy has an good analgesic effect on patients with mixed hemorrhoid.However, there is no significant difference in pain VAS scores among the three groups at the time of postoperative dressing change (P＞ 0.05), it may be because changing dressing gives a direct stimulation to the wound surface which brings a great suffering to the patients of the three groups, so the pain level of patients of the three groups is not different during dressing changes after different intervention methods.

After comparing the pain levels in the three groups of patients at 6 h after surgery and on the 1st, 3rd, 5th, 7th, and 10thpostoperative days at rest, the results showed that the difference in pain VAS scores of the three groups was statistically significant at rest at 3, 5, and 7 days after surgery (P＜ 0.001), but was not significant at 6 h and on the 1st and 10th postoperative day.The reasons lay in that: (1) at 6 h after operation, anaesthetic did not work, patients were sensitive to pain due to rich perianal nerve; (2) on the 1st postoperative day, though the inventions started, the effect was not significant; (3) at 6 h after operation and on the 1st postoperative day close to the operation time, patients were weak after they underwent colon cleanse twice and lavage for 3 times before operation and felt powerlessness because they had to urinate in the bed due to anesthesia after operation, which made patients more sensitive to pain; (4) on 3rd, 5th, 7thpostoperative days, the effect of moxibustion and five-element music therapy gradually improved, so the difference of the groups became increasingly evident; and (5) after 10 days of treatment and nursing, there was no significant difference in pain among the three groups (P＞ 0.05).It may be due to the repair of the body itself, the wounds basically healed after surgery, so the degree of pain of the three groups on the 10thday after surgery is at a low level.

The results of the pairwise comparison showed that the pain VAS score of the study group 2 was lower than that of the study group 1 and the control group on the third and fifth postoperative status; the difference was statistically significant (P＜ 0.05), suggesting that moxibustion combined with five-element music therapy can further reduce postoperative pain in patients and showed a better analgesic effect than moxibustion alone.On the 7thday after surgery, the VAS score of the control group was higher than that of the study group 1 and the study group 2 at rest, but there was no significant difference between the study group 1 and the study group 2 (P＞ 0.05).By talking to the patients later, this may be related to the single music selected by five-element music therapy.For the rigor of the research, the five-element music selected for this intervention was a fixed piece of music, the long-term listening of this piece made the patient feel auditory fatigue, and the patient could not listen carefully in the calm state at the end of the intervention.

In summary, moxibustion combined with five-element music therapy can effectively reduce the degree of pain in patients in a resting state, and the method is safe and feasible, worthy of clinical promotion.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms.In the form, the patients have given their consent for clinical information to be reported in the journal.The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.