Acil Servise Akut Ağrı Sebebiyle Başvuran Hastalarda Anksiyete Düzeyindeki Değişimin Ağrı Algısı Üzerindeki Etkisinin Saptanması: Randomize Kontrollü, Çift kör Çalışma
Abstract
Amaç: Çalışmanın amacı, acil servise akut ağrı sebebiyle başvuran hastaların ağrı ve anksiyete düzeylerini belirleyip standart ağrı kesici tedaviye ek olarak anksiyolitik tedavi vermenin ağrı ve anksiyete düzeyleri üzerindeki etkisini araştırmaktır.
Gereç ve Yöntemler: Bu çalışma prospektif, randomize, çift kör bir klinik çalışmadır. Çalışma grubuna deksketoprofen trometamol ve midazolam verilirken, kontrol grubuna sadece deksketoprofen trometamol verildi. Tedavinin 0, 30, 60 ve 120. dakikalarında hastanın ağrı ve anksiyete düzeyleri ölçüldü. Hastaların genel anksiyete düzeyleri ölçüldü. Birincil sonuç ölçümü hastaların 0-30. dakikalardaki ağrı değişimidir.
Bulgular: Çalışmada her gruba 90 hasta dahil edildi. Çalışma grubunda ağrı değişim medyanı 30 (IQR, 33), kontrol grubunda 33.5 (IQR, 38) tespit edildi. Ortalama değişim 3.5 (95% CI; -7.2 - 14.2) olarak saptandı. Çalışma grubunda anksiyete değişim medyanı 20 (IQR, 40), kontrol grubunda 9.5 (IQR, 41) tespit edildi. Ortalama değişim -10.5 (95% CI; -24.37 to 3.37) olarak saptandı. Kurtarıcı tedavi ihtiyacı, tedavi memnuniyeti ve uygulanan tedaviyi gelecekte de isteme oranları gruplar arasında benzerdi (26.7% vs 40%, p=0.058; 64% vs 57%, p=0.770; 90% vs 89%, p=0.802).
Sonuç: Acil servise akut ağrı şikayetiyle başvuran hastalarda ağrı kesici tedaviye anksiyolitik tedavi eklemek ağrı ve anksiyete düzeylerinin azalmasına katkı sağlamamaktadır.
Keywords
References
- Tanabe P, Buschmann M. A prospective study of ED pain management practices and the patient’s perspective. Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association. 1999 Jun;25(3):171–7.
- Karwowski-Soulié F, Lessenot-Tcherny S, Lamarche-Vadel A, Bineau S, Ginsburg C, Meyniard O, et al. Pain in an emergency department: an audit. European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 2006;13(4):218–24.
- Pasero C, Paice J, McCaffery M. Basic mechanisms underlying the causes and effects of pain. In: McCaffery M, editor. Pain: clinical manual. 2nd ed. Mosby; 1999. p. 15–34.
- Craven P, Cinar O, Madsen T. Patient anxiety may influence the efficacy of ED pain management. American Journal of Emergency Medicine. 2013;31(2):313–8.
- Ocañez K, McHugh RK, Otto MW. A meta-analytic review of the association between anxiety sensitivity and pain. Depression and anxiety. 2010;27(8):760–7.
- Ethier C, Burry L, Martinez-Motta C, Tirgari S, Jiang D, McDonald E, et al. Recall of intensive care unit stay in patients managed with a sedation protocol or a sedation protocol with daily sedative interruption: A pilot study. Journal of Critical Care. 2011;26(2):127–32.
- Behrbalk E, Halpern P, Boszczyk BM, Parks RM, Chechik O, Rosen N, et al. Anxiolytic Medication As an Adjunct to Morphine Analgesia for Acute Low Back Pain Management in the Emergency Department. Spine. 2014;39(1):17–22.
- Merskey H, Bogduk N. IASP Task Force on Taxonomy Part III: Pain Terms, A Current List with Definitions and Notes on Usage. IASP Task Force on Taxonomy. 1994;209–14.
- Aydemir Omer, Guvenir Taner, Kuey Levent KS. Hospital Anxiety and Depression Scale Turkish Form; validation and reliability study. Turk Psikiyatri Derg. 1997;8:280–7.
- Bonett DG, Price RM. Statistical inference for a linear function of medians: Confidence intervals, hypothesis testing, and sample size requirements. Psychological Methods. 2002;7(3):370–83. Kapoor S, White J, Thorn BE, Block P. Patients Presenting to the Emergency Department with Acute Pain: The Significant Role of Pain Catastrophizing and State Anxiety. Pain Med. 2016;17(6):1069-1078.
- Bilgel N, Bayram N. Turkish Version of the Depression Anxiety Stress Scale (DASS- 42): Psychometric Properties. Arshives of Neuropsychiatry. 2010;47(2):118–26.
- Barisa MT. Mood Disorders: Depression, Mania, and Anxiety. In: Kirk J. Stucky, Michael W. Kirkwood JD, editor. Clinical Neuropsychology Study Guide and Board Review. 1st ed. Oxford University Press; 2014. p. 528.
- Fosnocht D, Swanson E. Pain and Anxiety in the Emergency Department. Annals of Emergency Medicine. 2003;42(4):S1–109.
- Shillington K, Thompson C, Saraga S, Soch L, Asomaning N, Borgundvaag B, et al. The Effect of a Nurse Initiated Therapeutic Conversation Compared to Standard Care for Patients With Acute Pain in the ED: A Randomized Controlled Trial. Advanced Emergency Nursing Journal. 2021;43(3):217–24.
- Lefebvre JC, Jensen MP. The relationships between worry, happiness and pain catastrophizing in the experience of acute pain. European Journal of Pain. 2019;23(7):1358–67.
- Mok LC, Lee IFK. Anxiety, depression and pain intensity in patients with low back pain who are admitted to acute care hospitals. Journal of Clinical Nursing. 2008;17(11):1471–80.
- Oktay C, Eken C, Ozbek K, Ankun G, Eray O, Avci AB. Pain Perception of Patients Predisposed to Anxiety and Depressive Disorders in Emergency Department. Pain Management Nursing. 2008;9(4):150–3.
Determination of the Effects of Change in Anxiety Level on Pain Perception in Patients who Present to Emergency Department due to Acute Pain: A Double Blind, Randomized, Controlled Trial
Abstract
Aim: The aim of this study is to determine the level of pain and anxiety, and to investigate the effect of standard analgesic treatment and additional anxiolytic treatment on pain and anxiety in patients who presented to the emergency department due to acute pain.
Material and Methods: This is a prospective, randomized, controlled, double-blind study. As the study group received dexketoprofen trometamol plus midazolam, the control group received dexketoprofen trometamol alone. At 0th, 30th, 60thand 120th minutes of treatment, patients' pain and anxiety levels were measured. Patients' overall anxiety levels were measured. The primary outcome measure was the comparison of pain and anxiety change at 0-30 minutes.
Results: The study was conducted with 90 patients in each group. The median pain change was 33.5 (IQR, 38) for the control group and 30 (IQR, 33) for the study group, and the mean difference was 3.5 (95% CI; -7.2 to 14.2). The median anxiety change was 9.5 (IQR, 41) for the control group and 20 (IQR, 40) for the study group, and the mean difference was -10.5 (95% CI; -24.37 to 3.37). The rescue therapy needed, treatment satisfaction and preference to the same treatment in the future were similar between the control and the study group, respectively (26.7% vs 40%, p=0.058; 64% vs 57%, p=0.770; 90% vs 89%, p=0.802).
Conclusion: In patients who present to the emergency department due to an acute pain complaint, adding anxiolytic treatment to the analgesic treatment does not contribute to a reduction of pain and anxiety.
References
- Tanabe P, Buschmann M. A prospective study of ED pain management practices and the patient’s perspective. Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association. 1999 Jun;25(3):171–7.
- Karwowski-Soulié F, Lessenot-Tcherny S, Lamarche-Vadel A, Bineau S, Ginsburg C, Meyniard O, et al. Pain in an emergency department: an audit. European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 2006;13(4):218–24.
- Pasero C, Paice J, McCaffery M. Basic mechanisms underlying the causes and effects of pain. In: McCaffery M, editor. Pain: clinical manual. 2nd ed. Mosby; 1999. p. 15–34.
- Craven P, Cinar O, Madsen T. Patient anxiety may influence the efficacy of ED pain management. American Journal of Emergency Medicine. 2013;31(2):313–8.
- Ocañez K, McHugh RK, Otto MW. A meta-analytic review of the association between anxiety sensitivity and pain. Depression and anxiety. 2010;27(8):760–7.
- Ethier C, Burry L, Martinez-Motta C, Tirgari S, Jiang D, McDonald E, et al. Recall of intensive care unit stay in patients managed with a sedation protocol or a sedation protocol with daily sedative interruption: A pilot study. Journal of Critical Care. 2011;26(2):127–32.
- Behrbalk E, Halpern P, Boszczyk BM, Parks RM, Chechik O, Rosen N, et al. Anxiolytic Medication As an Adjunct to Morphine Analgesia for Acute Low Back Pain Management in the Emergency Department. Spine. 2014;39(1):17–22.
- Merskey H, Bogduk N. IASP Task Force on Taxonomy Part III: Pain Terms, A Current List with Definitions and Notes on Usage. IASP Task Force on Taxonomy. 1994;209–14.
- Aydemir Omer, Guvenir Taner, Kuey Levent KS. Hospital Anxiety and Depression Scale Turkish Form; validation and reliability study. Turk Psikiyatri Derg. 1997;8:280–7.
- Bonett DG, Price RM. Statistical inference for a linear function of medians: Confidence intervals, hypothesis testing, and sample size requirements. Psychological Methods. 2002;7(3):370–83. Kapoor S, White J, Thorn BE, Block P. Patients Presenting to the Emergency Department with Acute Pain: The Significant Role of Pain Catastrophizing and State Anxiety. Pain Med. 2016;17(6):1069-1078.
- Bilgel N, Bayram N. Turkish Version of the Depression Anxiety Stress Scale (DASS- 42): Psychometric Properties. Arshives of Neuropsychiatry. 2010;47(2):118–26.
- Barisa MT. Mood Disorders: Depression, Mania, and Anxiety. In: Kirk J. Stucky, Michael W. Kirkwood JD, editor. Clinical Neuropsychology Study Guide and Board Review. 1st ed. Oxford University Press; 2014. p. 528.
- Fosnocht D, Swanson E. Pain and Anxiety in the Emergency Department. Annals of Emergency Medicine. 2003;42(4):S1–109.
- Shillington K, Thompson C, Saraga S, Soch L, Asomaning N, Borgundvaag B, et al. The Effect of a Nurse Initiated Therapeutic Conversation Compared to Standard Care for Patients With Acute Pain in the ED: A Randomized Controlled Trial. Advanced Emergency Nursing Journal. 2021;43(3):217–24.
- Lefebvre JC, Jensen MP. The relationships between worry, happiness and pain catastrophizing in the experience of acute pain. European Journal of Pain. 2019;23(7):1358–67.
- Mok LC, Lee IFK. Anxiety, depression and pain intensity in patients with low back pain who are admitted to acute care hospitals. Journal of Clinical Nursing. 2008;17(11):1471–80.
- Oktay C, Eken C, Ozbek K, Ankun G, Eray O, Avci AB. Pain Perception of Patients Predisposed to Anxiety and Depressive Disorders in Emergency Department. Pain Management Nursing. 2008;9(4):150–3.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Original Articles |
| Authors | |
| Early Pub Date | March 9, 2023 |
| Publication Date | March 8, 2023 |
| Published in Issue | Year 2023 Volume: 6 Issue: 1 |
