Relaxing Environment Lowers Anxiety During Chemodenervation: a Randomized Trial.

Purpose: To evaluate the correlation between pain during cataract surgery and preoperative anxiety. Methods: This prospective observational masked study included 103 eyes of 103 consecutive patients who underwent routine clear corneal incision phacoemulsification surgery at the Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel. Patients were interviewed prior to surgery and 5 min following surgery by two separate independent interviewers. Anxiety level was measured by the Visual Analog Scale for Anxiety (VASA) and pain by the Visual Analog Scale (VAS). The main outcome measure was the maximum amount of pain endured during the procedure using VAS. Results: The mean participant age was 68.9 ± 8.9 years, and 46.6% were male. Severe anxiety (VASA ≥ 7) and pain (VAS ≥ 7) were documented in 18.5 and 17.5% of patients, respectively. There was a statistically significant positive correlation between VAS and VASA (r = 0.62, p < .001) as well as between VAS and duration of surgery (r = 0.20, p = .04). There was no association between VAS and all other investigated parameters in the univariate analysis. In backward regression analysis, VASA was the only parameter that was significantly associated with VAS (R2 = 36.61%, p < .001). Patients with severe anxiety were >10 times more likely to experience severe pain, and a VASA > 4 predicted severe pain with a sensitivity of 88.9% and a specificity of 69.4%. Conclusions: One-fifth of patients experienced severe anxiety and pain. Preoperative anxiety levels were the only significant predictor of pain. Reducing preoperative anxiety in cataract patients is warranted.

The purpose of this single-blinded randomized clinical trial was to determine whether therapeutic touch (TT) versus sham TT could produce greater pain relief as an adjunct to narcotic analgesia, a greater reduction in anxiety, and alterations in plasma T-lymphocyte concentrations among burn patients. Therapeutic touch is an intervention in which human energies are therapeutically manipulated, a practice conceptually supported by Rogers' (1970) theory of unitary human beings. Data were collected at a university burn centre in the south-eastern United States. The subjects were 99 men and women between the ages of 15 and 68 hospitalized for severe burns, and they received either TT or sham TT once a day for 5 days. Baseline data were collected on day 1, data were collected before and after treatment on day 3, and post-intervention data were collected on day 6. Instruments included the McGill Pain Questionnaire, Visual Analogue Scales for Pain, Anxiety and Satisfaction with Therapy, and an Effectiveness of Therapy Form. Blood was drawn on days 1 and 6 for lymphocyte subset analysis. Medication usage for pain in mean morphine equivalents, and mean doses per day of sleep, anxiety and antidepressant medications were recorded. Subjects who received TT reported significantly greater reduction in pain on the McGill Pain Questionnaire Pain Rating Index and Number of Words Chosen and greater reduction in anxiety on the Visual Analogue Scale for Anxiety than did those who received sham TT. Lymphocyte subset analyses on blood from 11 subjects showed a decreasing total CD8 + lymphocyte concentration for the TT group. There was no statistically significant difference between groups on medication usage.

This study aimed to investigate patients' expectative pain of spinal anesthesia puncture and anxiety pre-anesthesia, and to examine the effect of lidocaine-prilocaine cream and remimazolam prior to spinal anesthesia puncture on pain relief and anxiety release. Patients undergoing spinal anesthesia were divided into control, lidocaine-prilocaine cream, and lidocaine-prilocaine cream with remimazolam groups. A questionnaire consisting of The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and patient's concerns and Visual Analog Scale (VAS) was used to evaluate patient's anxiety and pain. The primary outcomes were differences in VAS and anxiety scores. Patient's spinal anesthesia-related concerns, advent events and hemodynamic index were also recorded. The expected spinal anesthesia puncture pain was 5.34±0.27 and anxiety scores before spinal anesthesia was 10.88 ± 0.64. A statistically significant positive correlation of 31.3% was detected between VAS and APAIS scores (r = 0.313; P=0.003). The VAS score at the time of puncture decreased by 29.7% (3.78±0.40, P=0.001) in lidocaine-prilocaine cream group and 29.2% (3.75±0.39, P=0.001) in lidocaine-prilocaine cream with remimazolam group compared with the expected VAS score. Lidocaine-prilocaine cream combined with or without remimazolam reduced the percentage of moderate pain (21.4% and 31.3% vs 50.0%, P=0.0001) and increased mild pain (60.7% vs 59.4% vs 22.7%, P=0.03). Anxiety score in lidocaine-prilocaine cream group was reduced by 2.84 (8.04±0.76 vs 10.88 ± 0.46, P=0.05) when compared with pre-anesthesia. Concerns about postoperative pain (P=0.03) and fear of the needle or intervention (P=0.000) both decreased post-anesthesia among groups. Approximately half of the patients scheduled for spinal anesthesia experienced a moderate level of preoperative anxiety. The patient's pain expectation from the spinal anesthesia puncture was moderate, which was higher than the actual pain. Lidocaine-prilocaine cream with or without remimazolam sedative before spinal anesthesia puncture reduced the patient's pain and anxiety scores after surgery.

Cardiac catheterization is associated with patient anxiety. Benzodiazepines are often used to relieve anxiety in this setting. The association between anxiety level and C-reactive protein (CRP) remains equivocal. We sought to determine whether anxiety and CRP levels in patients undergoing elective left heart catheterization differ when routine sedation with midazolam is administered. Patients undergoing elective left heart catheterization were randomly assigned to receive 2 mg of midazolam intravenously or placebo before access insertion in a double-blinded manner. Levels of anxiety were assessed using the State-Trait Anxiety Inventory for Adults (short form) and high-sensitivity CRP at the time of admission and discharge. Surrogate markers for anxiety, such as blood pressure and pulse, were recorded before and after the procedure. Patient-perceived discomfort was measured with a visual analog scale (VAS) on a 0-10 scale. One hundred patients (52 receiving treatment, 48 receiving placebo) participated in the study. Baseline demographic characteristics and previous medical conditions were well balanced between groups. Anxiety level, systolic blood pressure, and diastolic blood pressure were all higher at procedure start than post procedure, but did not differ between the groups. CRP levels were similar at both time points for patients in both groups (0.77 ± 2.53 mg/L pre procedure and 0.70 ± 2.08 mg/L post procedure in the midazolam group vs 0.79 ± 1.39 mg/L pre procedure and 0.83 ± 1.45 mg/L post procedure in the placebo group). Discomfort level assessment was also alike (2.6 ± 2.4 in the treatment group vs 3.4 ± 2.5 in the placebo group; P=.12). Intravenous midazolam administration does not seem to relieve patient discomfort and anxiety nor does it influence CRP level. Therefore, an approach tailored to the patient is advisable.

The primary aim of this paper is to discuss the relationship between the Visual Analog Scale-Anxiety (VAS-A) and the Spielberger State Anxiety Inventory (SAI) in patients receiving mechanical ventilatory support. A secondary aim is to provide suggestions for the nurse-researcher to consider when selecting an instrument to measure anxiety. Anxiety is a common experience for critically ill patients receiving mechanical ventilatory support. It is a challenge, however, for nurse-researcher to select an instrument to measure anxiety that is valid and reliable yet does not cause great response burden for participants. Visual analog scales may reduce response burden, but lack sound validation in research participants receiving mechanical ventilatory support. This study used a correlational design. A convenience sample of critically ill patients receiving mechanical ventilatory support (n = 200) were asked to rate their current level of anxiety on the 20-item Spielberger SAI and a 100-mm VAS-A. Eight participants were unable to complete the Spielberger SAI; 100% completed the VAS-A. The two instruments were found to be significantly correlated at r = 0.50; P = 0.01. The VAS-A was found to be less burdensome for research participants than the Spielberger SAI, resulting in no missing data on the VAS-A. Findings from this study provide initial validation of the VAS-A as a justifiable instrument to measure anxiety in patients receiving mechanical ventilatory support. Researchers are advised to balance reliability and validity properties with response burden when selecting an instrument to measure anxiety in patients with communication challenges and energy limitations.

Discussing defaecating disorders is difficult for patients and many view anal physiology investigations (ultrasound, manometry, electromyography and pudendal nerve studies) as distasteful. This pilot study sought to assess whether present information sheets supplied to patients and the visit to the colorectal Pelvic Floor Clinic itself influenced patients' knowledge and anxiety. Thirty Pelvic Floor Clinic patients from Auckland City Hospital were included. Each patient filled in a questionnaire before and after the clinic. This included objective questions about their knowledge of the structure and function of the pelvic floor and satisfaction with and understanding of the information sheet. Both visual analogue scale (VAS) and multiple choice questions (MCQ) were used. Their subjective and objective knowledge were compared. Anxiety was assessed on a visual analogue anxiety scale (VAAS). Results were expressed as VAS scores or percentage correct and relationships were tested using Fisher's Exact test and paired T-test. Subjective knowledge increased in 93% of the patients. The doctor's explanation led to a greater increase in subjective knowledge than the information sheet (35/100 mm, P<0.001 and 10/100 mm, P=0.01, respectively). Subjective improvement in knowledge did not however, translate into an increase in objective knowledge (P=0.63). The information sheet was read by 87% of the patients. The information sheet had reduced anxiety only in 23% of the patients and increased in 10%. Anxiety levels were not significantly influenced by the information sheet, but reduced significantly by the clinic visit in 87% of patients (P<0.001). The mean anxiety level reduced from 44/100 to 12/100 after the clinic visit. Anxiety levels are high in those visiting the Pelvic Floor Clinic. It appears that it is the interaction with the doctor that has a profound influence on anxiety levels and subjective knowledge rather than written information.

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The Effect of Music Therapy on Pain, Anxiety, Agitation and Sedation in Cardiac Intensive Care Patients: Randomized Controlled Study.

Patients undergoing colonoscopy often experience anxiety related to bowel preparation, procedural pain, and fear of cancer, which can adversely affect their vital signs. This study aimed to evaluate the effect of virtual reality intervention on anxiety and cardiac vital signs (including systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate) of patients before the colonoscopy procedure. This study was designed as a randomised, controlled, and double-blind trial. The sample of this study consisted of 70 patients undergoing colonoscopy in the endoscopy unit of the general surgery service of a public hospital. Patients were randomly assigned to the groups (intervention group or control group) and were evaluated twice before the colonoscopy procedure. Patients in the intervention group watched a relaxing video via virtual reality glasses for 15 min between the first and second evaluation stages. The Visual Analog Scale for Anxiety was used to evaluate the patients' anxiety levels before colonoscopy, while cardiac vital signs were evaluated using a digital sphygmomanometer. In the intervention group, anxiety level of the patients significantly decreased during the second evaluation stage compared to the control group (p < 0.001). Additionally, systolic blood pressure, diastolic blood pressure, and mean arterial pressure scores showed significant reductions in the intervention group at the same stage (p < 0.05). Although patients in the intervention group had lower heart rate scores at the second evaluation stage, there was no statistically significant difference between groups (p > 0.05). Virtual reality intervention has an improving effect on patients' systolic blood pressure, diastolic blood pressure, and mean arterial pressure. It is also effective in reducing patients' anxiety levels. Virtual reality intervention can be used as a distraction method before colonoscopy procedure. In this study, patients actively participated in the process of evaluating their anxiety levels and vital signs. ClinicalTrials.gov identifier: NCT06407531.

Objective. To assess the factors related to perioperative state anxiety in paediatric patients and their parents. Methods. A cohort study was conducted on paediatric patients 9–17 years of age, who underwent the modified Ravitch procedure (n = 96), and their parents (n = 96). The level of anxiety was measured using the State-Trait Anxiety Inventory questionnaire. Multivariable linear regression models were calculated to find the relationships between the pre- and postoperative state anxiety of the patients/parents and the independent variables, both demographic (age, gender) and clinical (e.g., postoperative pain, trait anxiety). Results. Preoperative anxiety in the paediatric patients was positively correlated with their trait anxiety (β = 0.47; 95% CI: 0.29 to 0.64) and preoperative parental anxiety (β = 0.24; 95% CI: 0.07 to 0.42). The high level of preoperative anxiety (vs. low and moderate) (β = 0.40; 95% CI: 0.22 to 0.58), trait anxiety (β = 0.22; 95% CI: 0.04 to 0.40) and average postoperative pain at rest (β = 0.18; 95% CI: 0.01 to 0.34) had a positive impact on the postoperative anxiety in patients. However, the patients’ age was negatively correlated with postoperative anxiety (β = −0.19; 95% CI: −0.35 to −0.02). Three variables were found to predict preoperative parental anxiety: their trait anxiety (β = 0.41; 95% CI: 0.23 to 0.59), female gender (β = 0.18; 95% CI: 0.002 to 0.36) and the intravenous route for the postoperative pain management in the patients (β = −0.18; 95% CI: −0.36 to −0.001). The parental postoperative anxiety was influenced by their trait anxiety (β = 0.24; 95% CI: 0.04 to 0.43), preoperative anxiety in patients (β = 0.21; 95% CI: 0.02 to 0.40) and female gender of children (β = 0.19; 95% CI: 0.001 to 0.39). Conclusions. Trait anxiety was a strong factor positively affecting the perioperative state anxiety. In addition, paediatric patient anxiety before surgery was related to their parents’ anxiety, and, after surgery, this was associated with high preoperative anxiety, pain and age. The parents’ anxiety before surgery was influenced by gender and the type of postoperative analgesia in the patients, while, after surgery, this was influenced by the patients’ preoperative anxiety/gender.

Background: Preoperative anxiety is a common challenge that can negatively impact surgical outcomes and patient well-being. Physiological symptoms of anxiety, such as increased heart rate, blood pressure, and sweating, highlight the need for effective management strategies. Murottal therapy, which involves listening to Qur'anic recitations, offers a non-pharmacological method for anxiety reduction. Purpose: Evaluate murottal therapy’s effectiveness in reducing preoperative anxiety. Methods: A cohort of 30 patients scheduled for spinal anesthesia was recruited for this community service initiative. Anxiety levels were measured using the Visual Analog Scale for Anxiety (VAS-A) before and after the intervention. Participants underwent murottal therapy, which involved listening to Qur'anic recitations for a designated period. Pre- and post-therapy anxiety levels were compared to evaluate the effectiveness of the intervention. Findings: Prior to murottal therapy, 60% of participants exhibited severe anxiety, and 40% had moderate anxiety. Post-therapy results showed a significant improvement: 90% of participants reported moderate anxiety, 6.7% continued to experience severe anxiety, and 3.3% reported mild anxiety. Additionally, a pocket book detailing the murottal therapy procedure was developed as a resource for implementation. Conclusions: Murottal therapy significantly reduced anxiety levels among preoperative patients, demonstrating its potential as an effective, non-invasive approach to anxiety management in surgical settings.

Preoperative anxiety, which can affect postoperative recovery, is often present in patients undergoing surgery under loco-regional anaesthesia (LRA). Minimising preoperative anxiety with premedication can be effective but results in drug-related side effects. Therefore, the use of non-pharmacological techniques should be encouraged. We evaluated whether a virtual reality (VR) incorporating music and a hypnosis session, provided during the performance of LRA, can reduce preoperative anxiety. Fifty patients scheduled for elective hand surgery under an axillary plexus block were enrolled (March-June 2019). The primary outcome measure was the change in the Amsterdam Anxiety and Preoperative Information Scale (APAIS) questionnaire 5min after the VR session as compared to before the VR session. The secondary outcome measures were the visual analog scale (VAS) for anxiety before and 2h after the surgery and the Evaluation du Vécu de l'ANesthésie-LocoRégionale (EVAN-LR) satisfaction score. Data from 48 patients were analysed. The APAIS score as well as VAS for anxiety were significantly reduced after a VR session (p<.001 for both scores). Patients were very satisfied (EVAN-LR: 92 (88, 94)). The use of VR incorporating music and a hypnosis session could be an effective tool in the management of a patient's preoperative anxiety during the performance of an axillary plexus block.

e21713 Background: Art therapy is a mental health modality that uses art-making to improve the physical, mental, and emotional wellbeing of individuals for a variety of purposes. The primary purpose of the trial is to assess the effect of art therapy on cancer patients' mood, anxiety, and pain levels. Secondary endpoints include exploring difference in response to art therapy by specific patient characteristics. Methods: Trial enrolled 50 cancer patients receiving chemotherapy. They participated in an hour long art therapy session with Art Therapist. Patients completed four visual analog scales (VAS) at three different time points: pre-treatment, post treatment (immediately after session) and 48-72 hours after session. Primary end points are pre and post session changes in the VAS for distress, depression, anxiety and pain. Secondary endpoints include differences in VAS scores by ethnic groups (Hispanic vs non-Hispanic), race (white vs non-white), age, gender, and marital status. Analysis was performed using repeated measures, mixed models, and pairwise means comparisons for the four measurements using the Tukey-Kramer adjustments for multiple comparisons. Results: Study revealed a statistically significant difference between pre treatment and post treatment as well as pre-treatment and follow up across distress, depression, anxiety and pain. There was no statistically significant difference between post treatment and follow up. The only significant correlation seen among patient characteristics was that Hispanic patients had higher depression scores at all time points vs non-Hispanics. Conclusions: Art therapy improved mood, anxiety and pain among all patients. Benefits were seen immediately after session and persisted at least 48-72 hours across all groups equally. Hispanic patients had higher depression scores compared to non-Hispanics. Clinical trial information: NCT02659345. [Table: see text]

Women with breast cancer are prone to moderate to severe preoperative anxiety. Effective measures for preventing and managing preoperative anxiety include drug therapy and non-drug intervention. The main evaluation method is scale assessment, which has certain limitations and may involve human concealment or evaluation errors. In this study, resting-state electroencephalography (EEG) was used to explore changes in power spectrum during the alleviation of preoperative anxiety in breast cancer patients, which is of great significance for objectively identifying and evaluating preoperative anxiety in patients. 40 breast cancer patients were randomly divided into two groups (20 patients per group), receiving either psychological intervention (PI) or intravenous midazolam (MID) before surgery. Visual Analog Scale for Anxiety (VAS-A) and Observer's assessment alert/Sedation (OAA/S) scores, clinical monitoring indexes and EEG data were measured before and after intervention. VAS-A scores significantly decreased in both groups (p < 0.05), the power in the theta band of the frontal parietal regions decreased (p < 0.05) and was positively correlated with VAS-A scores (p < 0.001). Network analysis revealed that the three highest centrality measures in the PI group were located in the alpha band frontal parietal region, frontal central region, and gamma band parietal region, while the OAA/S scores showed the highest centrality for all three measures in the MID group. Both PI and intravenous MID can effectively alleviate preoperative anxiety in breast cancer patients, but their neuroelectrophysiological mechanisms were not entirely the same. Regarding the relationship between brain region power and monitoring indexes, the power of three specific regions in certain frequency bands was the primary factor in the PI group, while the level of sedation was the determining factor in the MID group.

Pain and anxiety are common in emergency department (ED) patients, yet their management is often focused on pharmacological interventions. Art therapy, a non-pharmacological approach, has shown promise in alleviating psychological distress, but its effectiveness in acute care settings remains understudied. This study aimed to evaluate the impact of art therapy on pain and anxiety in ED patients presenting with acute pain. A randomized controlled trial was conducted in a single ED with patients randomized to art therapy or a control group. Participants in the intervention group engaged in a 15–20-minutes art therapy session, while the control group waited without intervention. Pain and anxiety were measured using the Visual Analog Scale (VAS) and the State-Trait Anxiety Inventory (STAI-Y) at baseline and after the intervention. Exploratory analyses examined interactions between morphine use, baseline pain, and art therapy effectiveness. Of the 340 patients screened, 103 completed the study (48 in the AT group, 55 in the control group). There were no significant differences in anxiety levels between the art therapy and control groups (mean difference − 2 mm, p = 0.610). Pain intensity was significantly lower in the control group (p = 0.011). In exploratory analyses, patients treated with morphine and experiencing high baseline pain levels had a significant reduction in anxiety (VAS − 18.6 mm, p = 0.004). Art therapy did not significantly reduce anxiety or pain in the general ED population. However, it showed potential as an adjunctive therapy for patients with severe pain and anxiety, particularly those receiving morphine. Further research is needed to explore the effectiveness of art therapy in this subset of patients and its potential as part of non-pharmacological pain management strategies in acute care settings. The study was approved by the regional ethic committee (CERVD 2021 − 01344) and registered on https://clinicaltrials.gov (NCT04997434) on 19 July 2021.