Pain and anxiety during interventional radiologic procedures: effect of patients' state anxiety at baseline and modulation by nonpharmacologic analgesia adjuncts.
OBJECTIVE
To assess how patients' underlying anxiety affects their experience of distress, use of resources, and responsiveness toward nonpharmacologic analgesia adjunct therapies during invasive procedures.


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 (> or = 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.


CONCLUSIONS
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.
Schupp
Christine J
CJ
Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, WCC 308, Boston, Massachusetts 02215, USA.
Berbaum
Kevin
K
Berbaum
Michael
M
Lang
Elvira V
EV
D000223:Adaptation, Psychological; D000368:Aged; D016058:Analgesia, Patient-Controlled; D000704:Analysis of Variance; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D001007:Anxiety / Q000517:prevention & control* / Q000523:psychology; D001288:Attention; D004645:Empathy; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D006990:Hypnosis; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D010146:Pain / Q000517:prevention & control* / Q000523:psychology; D010147:Pain Measurement; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D015641:Radiography, Interventional / Q000523:psychology*; D013997:Time Factors; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous; D008874:Midazolam; D005283:Fentanyl