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To examine the effect of relaxation therapy on reducing patient anxiety and pain before and after total joint replacement.Despite the use of analgesics, patients may feel anxiety and pain before and after surgery, delaying their recovery.An experimental control group pretest–post-test quasi-experimental design was employed.Subjects (n = 93) recruited from a medical centre in Taipei, Taiwan, from November 2006–March 2007 were randomly assigned to experimental (n = 45) and control (n = 48) groups. Subjects in the experimental group received relaxation therapy from the day before surgery to the third postoperative day. Researchers helped participants listen to a breath relaxation and guided imagery tape for 20 minutes daily. A pain and anxiety scale questionnaire, the State-Trait Anxiety Inventory questionnaire, blood pressure and heart rate were monitored before and after intervention.The average age of the 93 patients was 71·0 (SD 11·1) years. The least pain severity scores in the experimental were lower than those in the control group (p < 0·05) but both experienced the same level of worst or average pain (p > 0·05). The mean difference in the pain score before and after intervention in the experimental group on the pre-op day (t = 2·675, p = 0·009) and post-op day one (t = 3·059, p = 0·003) was greater than that in the control group (0·48 SD 0·94 vs. 0·10 SD 0·30 and 0·93 SD 1·46 vs. 0·20 SD 0·71, respectively). The two groups differed significantly in systolic blood pressure (F = 6·750, p < 0·05) but not in mean blood pressure, heart rate, or State-Trait Anxiety Inventory scores (p > 0·05). Patients reported that relaxation therapy helped them relax and promoted sleep.Relaxation therapy could complement analgesics to help postoperative patients better manage pain and anxiety.Clinical practice should include complementary relaxation therapy to alleviate pain and anxiety in patients with joint replacement.