title: Altering electromyography studies: importance of the electromyographer's perception of patient pain.
abstract: OBJECTIVE
  To determine the relation between the patient's actual pain, the electromyographer's perception of patient pain, and whether an electromyogram (EMG) is altered.
  
  
  METHODS
  Patients undergoing electromyography reported expected pain and procedure-related overall pain on a 100-mm visual analog scale (VAS). Blinded electromyographers estimated patient pain levels and indicated if they altered the study in any way because of this perception. Multivariable logistic regression was used to determine predictors of altering the EMG. Paired t tests were used to compare overall pain with expected pain and electromyographer perception of pain.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Referred sample of adult subjects (N=304).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Patient pain, electromyographer perception of patient pain, and whether an EMG was altered because of the electromyographer's perception of patient pain.
  
  
  RESULTS
  Mean VAS scores ± SD were 48±25mm for patient-expected pain (P<.001), 42±24mm for electromyographer perception of pain (P<.0001), and 36±25mm for actual overall pain. Electromyographers altered their study 31.7% of the time because of concerns about pain. For every 13-mm increase on the VAS (a prespecified clinically meaningful difference), the electromyographer perception of pain increased the odds of altering a study 2.36 times (95% confidence interval [CI], 1.71-3.26), whereas patient overall pain did not have a significant effect (odds ratio=1.12; 95% CI, .86-1.47).
  
  
  CONCLUSIONS
  Patients expect EMGs to be more painful than they are. Electromyographers overestimate patient pain and are more likely to alter their studies when they believe patients are experiencing more pain, independently of whether patients actually have more pain. Improving the communication between electromyographers and patients may prevent unnecessary alterations.
authors: Department of Neurology, University of Michigan, Ann Arbor, MI. Electronic address: zlondon@med.umich.edu.
authors: Zachary N
authors: ZN
authors: London
authors: Department of Neurology, University of Michigan, Ann Arbor, MI.
authors: Rebecca
authors: R
authors: Hazan
authors: Department of Neurology, University of Michigan, Ann Arbor, MI.
authors: James F
authors: JF
authors: Burke
authors: Department of Neurology, University of Michigan, Ann Arbor, MI.
authors: Brian C
authors: BC
authors: Callaghan
mesh_terms: D000328:Adult; D000368:Aged; D004576:Electromyography / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement; D010465:Perception
keywords: Electromyography; Pain; Rehabilitation; VAS; visual analog scale