Pain and Anxiety during Interventional Radiologic Procedures: Effect of Patients' State Anxiety at Baseline and Modulation by Nonpharmacologic Analgesia Adjuncts

doi:10.1097/01.RVI.0000185418.82287.72

Journal of Vascular and Interventional Radiology

Volume 16, Issue 12, December 2005, Pages 1585-1592

https://doi.org/10.1097/01.RVI.0000185418.82287.72 Get rights and content

PURPOSE

To assess how patients' underlying anxiety affects their experience of distress, use of resources, and responsiveness toward nonpharmacologic analgesia adjunct therapies during invasive procedures.

MATERIALS AND METHODS

Two hundred thirty-six patients undergoing vascular and renal interventions, who had been randomized to receive during standard care treatment, structured empathic attention, or self-hypnotic relaxation, were divided into two groups: those with low state anxiety scores on the State–Trait Anxiety Inventory (STAI, scores < 43; n = 116) and those with high state anxiety scores (≥ 43; n = 120). All had access to patient controlled analgesia with fentanyl and midazolam. Every 15 minutes during the procedure, patients rated their anxiety and pain on a scale of 0–10 (0, no pain/anxiety at all; 10, worst possible pain/anxiety). Effects were assessed by analysis of variance and repeated-measures analysis.

RESULTS

Patients with high state anxiety levels required significantly greater procedure time and medication. Empathic attention as well as hypnosis treatment reduced procedure time and medication use for all patients. These nonpharmacologic analgesia adjunct treatments also provided significantly better pain control than standard care for patients with low anxiety levels. Anxiety decreased over the time of the procedure; patients with high state anxiety levels experienced the most significant decreases in anxiety with nonpharmacologic adjuncts whereas patients with low state anxiety levels coped relatively well under all conditions.

CONCLUSION

Patients' state anxiety level is a predictor of trends in procedural pain and anxiety, need for medication, and procedure duration. Low and high state anxiety groups profit from the use of nonpharmacologic analgesia adjuncts but those with high state anxiety levels have the most to gain.

Section snippets

Patients and Procedure

Patients were recruited from an original study of 241 patients that was designed to assess the effect of nonpharmacologic analgesia adjuncts on patients' comfort during interventional radiologic procedures (8). This study did not evaluate the influence of state anxiety level on performance during the procedure, procedure duration, and effectiveness of the nonpharmacologic intervention. Two hundred thirty-six patients in this institutional review board–approved study filled out STAI state

Analysis of Variance of Procedure Duration

There were significant main effects among the state anxiety groups and treatment groups. Patients with high state anxiety levels required significantly longer procedure times than those with low state anxiety levels (71 minutes vs 63 minutes), and procedures in the standard group lasted significantly longer than those in the attention and hypnosis groups (77 minutes vs 63 minutes; Table 2). There was no significant interaction between treatment condition and attribution to anxiety group.

Analysis of Variance of Medication Use

There

DISCUSSION

Patients with high state anxiety levels required more procedure time and requested and received more medication than patients with low state anxiety levels. These findings are consistent with previous studies that described a relationship between anxiety and analgesia consumption in PCA models (19, 26). One explanation for greater requests for drugs in anxious patients could be the greater fear of pain or the wish for sedation to overcome anxiety, as another investigator suggests (27).

Although

CONCLUSIONS

We conclude that patients' baseline anxiety level predicts trends of procedural anxiety, need for medication, and procedure duration. Patients with low and high state anxiety levels profit from the use of nonpharmacologic analgesia adjunct treatments, but those with high state anxiety levels have the most to gain because they require more resources and are at greater risk of having their anxiety and pain suboptimally addressed under standard care conditions.

Acknowledgments

This work was supported by the National Institutes of Health, National Center for Complementary and Alternative Medicine (NCCAM) 1RO1 AT 0002–05 and 1K24 AT 01074–01. The content is solely the responsibility of the authors and does not necessarily reflect the official views of NCCAM or the National Institutes of Health.

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The aim of this study was to examine the prevalence of raised state anxiety before and after medical imaging procedures, the prevalence of state anxiety trajectories, and factors associated with postprocedural raised state anxiety.
A prospective survey was administered to outpatients undergoing elective medical imaging procedures (CT, radiography, MRI, ultrasound, angiography, or fluoroscopy) recruited from one center. Participants completed a self-report survey preprocedure (time 1) and postprocedure (time 2). State anxiety was measured using the six-item State-Trait Anxiety Inventory. The point prevalence of raised state anxiety (State-Trait Anxiety Inventory score ≥33.16) at time 1 and time 2 was calculated, as was the prevalence of four state anxiety trajectories over time: persistent low anxiety, decreasing anxiety, increasing anxiety, and persistent raised anxiety. Factors predictive of raised state anxiety at time 2 were examined using logistic regression analysis.
Three hundred fifteen participants completed both surveys. The prevalence of raised state anxiety at time 1 (50%) and time 2 (51%) was similar. Most patients reported persistent raised anxiety (36%) and persistent low anxiety (34%) over time. Fewer patients reported increasing anxiety (15%) and decreasing anxiety (14%). Raised state anxiety (odds ratio, 4.84; 95% confidence interval, 2.48-9.48) and lower reported health status (odds ratio, 2.48; 95% confidence interval, 1.11-5.51) at time 1 were significantly associated with greater odds of raised anxiety at time 2.
Raised state anxiety related to medical imaging procedures is common among outpatients. Half of patients either developed or continued to experience raised anxiety after their procedures. Outpatients may benefit from evidence-based methods of alleviating anxiety before their procedures.
Effects of video-based patient preparation for MRI on clinical processes and patient experience
2023, European Journal of Radiology
To determine whether video-based informational or relaxational preparation reduces the number of unexpected patient-related events and scan duration more efficiently, and to assess how patients evaluate the interventions.
We randomized 142 adult patients (mean age: 48 ± 16 years) to three groups. The control group (n = 48, 33.8 %) received standard care. The intervention groups watched an informational (n = 50, 35.2 %) or relaxational (n = 44, 31.0 %) video while awaiting their MRI examination. We recorded scan duration, number of motion artifacts/sequence repetitions, and patient-related incidents (e.g., interruptions, premature termination). Subjective evaluation of the interventions was provided by the patients after MRI completion.
Mean scan duration for the control, relaxation, and information group was 39.38 ± 16.62 min, 32.59 ± 11.67 min, and 34.54 ± 11.91 min. Compared to the control group, scan duration was significantly shorter in the relaxation, but not in the information group (relaxation vs control: p =.019; information vs control: p =.082). The information and relaxation group did not differ significantly (p =.704). In 35 (24.6 %) patients, one or more sequences were repeated; incidents occurred in six (4.2 %) patients. Neither the frequency of repeated sequences nor incidents differed between the groups (all p >.239). Patients evaluated both videos very positively; the information video received even better evaluations (all p <.027).
Additional preparation, especially information, is perceived very positively by patients and at least relaxational preparation may have a positive impact on clinical operations.
Non pharmacological techniques in interventional radiology: The effects on patient pain, a littérature review
2022, Douleurs
Limiter la douleur est un véritable enjeu dans la prise en charge des patients en radiologie interventionnelle. Cette revue de littérature a pour but de regrouper l’ensemble des articles disponibles traitant de la prise en charge de la douleur des patients par des techniques non médicamenteuses (hypnose, réalité virtuelle, musique) en radiologie interventionnelle.
Un recueil d’articles sur trois bases de données scientifiques a été conduit : Google Scholar, EM premium, NCBI. Les articles jugés intéressants pour la revue ont ensuite été confrontés aux critères d’inclusion. Sur les 180 articles recueillis, et après suppression des doublons, 20 articles ont été confrontés aux critères d’inclusion.
Au final, 11 articles ont pu être analysés et confrontés entre eux. Les différentes techniques (musique, réalité virtuelle et hypnose) ont été étudiées séparément.
La majorité des études ont conclu à un réel intérêt de l’utilisation de ces techniques en radiologie interventionnelle.
Pain is a real priority of patient managing in interventional radiology. If pharmacological techniques are widespread currently, new techniques are established like hypnosis, virtual reality or music, always with the objective to reduce pain for the patient.
A systematic research of scientific and medical databases was conducted. After this, all articles collected during the search progress met the inclusion criteria to determine the selection for the discussion.
During this research, 11 studies were identified as right with the inclusion criteria. All of these were studied separately and after were faced with the other articles. For the discussion, the three different techniques (music, virtual reality and hypnosis) were studied separately.
The results of this review demonstrate a real interest of the utilisation of these techniques on patient pain management and a real positive effect on the pain during the interventions. All of these possibilities should be taken in account to improve the patient experience in the interventional imaging.
A systematic review of effectiveness of interventions applicable to radiotherapy that are administered to improve patient comfort, increase patient compliance, and reduce patient distress or anxiety
2020, Radiography
Citation Excerpt :
Only anxiety outcomes were synthesised as the outcome measures were validated and reported before and after clinical procedure (Table 2). This resulted to exclude another 17 RCTs.45,46,49,54,58,61,62,65,70,72,74,76,78,79,84–86 26 RCTs were included in the data synthesis.
The aim of this review was to search existing literature to identify comfort interventions that can be used to assist an adult patient to undergo complex radiotherapy requiring positional stability for periods greater than 10 min. The objectives of this review were to; 1) identify comfort interventions used for clinical procedures that involve sustained inactivity similar to radiotherapy; 2) define characteristics of comfort interventions for future practice; and 3) determine the effectiveness of identified comfort interventions. The Preferred Reporting Items for Systematic Reviews and meta-analyses statement and the Template-for-Intervention-Description-and Replication guide were used.
The literature search was performed using PICO criteria with five databases (AMED, CINAHL EMBASE, MEDLINE, PsycINFO) identifying 5269 titles. After screening, 46 randomised controlled trials met the inclusion criteria. Thirteen interventions were reported and were grouped into four categories: Audio–visual, Psychological, Physical, and Other interventions (education/information and aromatherapy). The majority of aromatherapy, one audio–visual and one educational intervention were judged to be clinically significant for improving patient comfort based on anxiety outcome measures (effect size ≥ 0.4, mean change is greater than the Minimal-Important-Difference and low-risk-of-bias). Medium to large effect sizes were reported in many interventions where differences did not exceed the Minimal-Important-Difference for the measure. These interventions were deemed worthy of further investigation.
Several interventions were identified that may improve comfort during radiotherapy assisting patients to sustain and endure the same position over time. This is crucial for the continual growth of complex radiotherapy requiring a need for comfort to ensure stability for targeted treatment.
Further investigation of comfort interventions is warranted, including tailoring interventions to patient choice and determining if multiple interventions can be used concurrently to improve effectiveness.
Attitudes of Preprocedural Patient Anxiety: A 2019 Cross-Sectional Study of Radiology Nurses
2020, Journal of Radiology Nursing
The optimal method of assessing and reducing preprocedural patient anxiety remains uncertain in radiologic procedures. Previous research suggests that the role of radiology nurses is critical to optimally address preprocedural anxiety, but the preferences of radiology nurses remain understudied. A questionnaire was adapted from a previous cross-sectional study of interventional radiology to determine the views of current preferences of nurses with regards to addressing preprocedural anxiety. The questionnaire was disseminated to an e-mail list maintained by the Association for Radiologic and Imaging Nursing (ARIN) from July to September 2019. The survey included questions about the assessment, importance, and reduction of preprocedural patient anxiety. A post hoc scale was used to quantify degree of responsibility allocated to radiology nurses, radiologists, patients, family members, and other health care providers. A total of 370 responses were obtained (18.1% response rate). Most respondents found preprocedural anxiety to be very important in practice (n = 237, 4.4%) and to patients (n = 300, 81.7%). Nurses indicated that anxiety interfered with delivery of care (n = 220, 60.3%) and most respondents formally assessed it in their patients (n = 227, 61.7%). A variety of methods to reduce preprocedural patient were endorsed: patient education (n = 341, 94.2%); empathetic communication (n = 333, 92.0%); anxiety medication (n = 239, 66.0%); permitting family presence (n = 228, 63.0%); familiarization with the facility (n = 97, 26.8%); traditional, complementary, and alternative medication (n = 69, 19.1%). Nurses held themselves most responsible to manage patient anxiety followed by radiologists, patients, family members, primary care providers, and mental health care providers. This study suggests that radiology nurses acknowledge the importance of assessing and reducing preprocedural patient anxiety. Furthermore, radiology nurses use a variety of methods to manage patient anxiety and hold themselves most responsible to reduce anxiety but also allocate responsibility to others such as radiologists and patients.
Notions of Preprocedural Patient Anxiety in the Realm of IR
2020, Journal of Vascular and Interventional Radiology
Citation Excerpt :
The principal finding of this study was that most respondents did not routinely assess anxiety, be that via rating scale or verbal discussion. Given that preprocedural anxiety has been linked to pain and increase in analgesic or sedative consumption, formal assessment of anxiety may be necessary to optimize patient care in the IR realm (4). Patients are routinely screened for risk to intravenous contrast agents, but despite the link to increased analgesic consumption, routine anxiety screening is not usually performed (9).
To determine the views and current practice preferences of interventional radiologists and allied healthcare providers regarding management of preprocedural anxiety.
From March to April 2018, members of the Society of Interventional Radiology were surveyed regarding their opinions in the assessment and management of patient anxiety. Degree of responsibility for the management of anxiety was also queried through the use of a scale (1 = no responsibility; 2 = some responsibility; 3 = major responsibility).
Of 1163 respondents (23.8% response rate), most described preprocedural anxiety as somewhat to very important in their practice (n = 961, 82.6%), somewhat to very important to the patients (n = 1087, 93.5%), and at least sometimes interfering with delivery of care (n = 815, 70.1%). Most respondents did not measure preprocedural anxiety directly (n = 953, 81.9%), but would address it if raised by the patient (n = 911, 82.9%). Patient education (n = 921, 79.1%), medications (n = 801, 68.8%), and therapeutic or empathetic interactions (n = 665, 56.4%) were most preferred to manage anxiety. Radiologists, nurses, patients, primary care providers, family members, and psychologists or psychiatrists were all allocated responsibility to reduce anxiety.
Interventional radiologists and other providers are aware of the importance of preprocedural anxiety. Despite the notion that most radiologists did not address anxiety directly, most indicated a willingness to discuss the issue if raised by patients. Patient education, medications, and several other techniques are preferred to manage preprocedural anxiety. Responsibility to reduce anxiety is perceived to be shared among radiologists, nurses, patients, family members, and other health care providers.

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: None of the authors have identified a conflict of interest.

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Clinical StudiesPain and Anxiety during Interventional Radiologic Procedures: Effect of Patients' State Anxiety at Baseline and Modulation by Nonpharmacologic Analgesia Adjuncts

PURPOSE

MATERIALS AND METHODS

RESULTS

CONCLUSION

Section snippets

Patients and Procedure

Analysis of Variance of Procedure Duration

Analysis of Variance of Medication Use

DISCUSSION

CONCLUSIONS

Acknowledgments

J Vasc Interv Radiol

Lancet

Pain

J Pain Symptom Manage

J Psychiatr Res

J Urol

J Vasc Interv Radiol

Pain

Pain

Pain

J Pediatr Adolesc Gynecol

Preparing patients for invasive medical and surgical procedures. 1: adding behavioral and cognitive interventions

Behav Med

State-Trait Anxiety Inventory (Form Y)

Clinicians' quick reference guide to acute pain management in infants, children, and adolescents: operative and medical procedures. Pain Management Guideline Panel. Agency for Health Care Policy and Research, US Department of Health and Human Services

J Pain Symptom Manage

Analgesia and sedation in interventional radiological procedures

Australas Radiol

Frequent hypoxemia and apnea after sedation with midazolam and fentanyl

Anesthesiology

Hypnosis for the treatment of burn pain

J Consult Clin Psychol

Clinical Studies
Pain and Anxiety during Interventional Radiologic Procedures: Effect of Patients' State Anxiety at Baseline and Modulation by Nonpharmacologic Analgesia Adjuncts