The Effects of a Bio-behavioral Intervention on the Release of Cytokines


Name: Donna Burge

Rank: LT

Organization: The Henry M. Jackson Foundation for the Advancement of Military Medicine

Performance Site: National Naval Medical Center, Bethesda, MD; Walter Reed Army Medical Center, Washington, DC; Wright-Patterson AFB - 74th Medical Group, Wright-Patterson, OH

Year Published: 2009

Abstract Status: Final


Purpose: The purpose of this study was examining effects of guided imagery on the release of pro-inflammatory cytokines and neuropeptides as well as anxiety and pain perioperatively.  

Design: Study design was a two-group randomized controlled trial study.     

Methods: Participants were randomly assigned into two groups. The experimental group listened to guided imagery recordings immediately before and during the surgical procedure. The control group underwent usual perioperative care. Participants were randomly placed in treatment or control groups. Treatment group participants listened to an audio guided imagery intervention 30 minutes prior to and continuing through the surgery. Control group participants received usual perioperative care. All participants completed the anxiety and pain scales in the preoperative holding area, immediately postoperatively, and at scheduled intervals during the initial 48 hours following surgery. Blood samples were drawn pre-, intra- (30 minutes after skin incision), and postoperatively (30 minutes after transfer to the post anesthesia care unit) to monitor IL-6, IL-8, and Substance P levels. Anxiety scale, pain scale, cytokines IL6 and IL8, and Substance P values were analyzed for changes over time and between study groups.

Sample: Sample consisted of sixty-eight adult females (ASA Classes I-III) undergoing laparoscopic gynecological procedures under general anesthesia. 

Analysis: A linear random coefficient regression model was utilized.  It is a hierarchical mixed effects model permitting estimation of subject and population level change over time in the presence of both autocorrelation, as within-subject repeated measures and missing data.

Findings: Higher preoperative anxiety levels appeared to be associated with increased IL-6 and IL-8 levels over time in both groups.  Both groups reported higher levels of pain postoperatively.

Implications for Military Nursing: Pain impacts operational readiness and wartime functionality.  This investigation provides data on a practical intervention to decrease pain medication needs, hospital stays and earlier return of service members to work.


Final Report is available at NTRL at: