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BackgroundUp to 30% of patients with knee osteoarthritis (KOA) have evidence of sensitization, with a similar proportion experiencing severe pain during procedures. Most patients with KOA are elderly and often develop side effects from intravenous sedation. Our study investigated the effectiveness of a methoxyflurane inhaler combined with local anesthesia in reducing procedural pain from genicular nerve block compared with local anesthesia alone.Methods42 adults with refractory KOA were randomized into two groups. Methoxyflurane group received a self-titrated methoxyflurane inhaler with local anesthesia whereas lidocaine group received local anesthesia only. The primary outcome was pain score on a 0–10 verbal numerical rating scale (VNRS) during the procedure. Secondary outcomes included changes in VNRS and behavioral pain scale (critical care pain observational tool) during the procedure, hemodynamic changes, anxiety level, sedation score, and adverse events.Results42 patients with a mean age of 66±12 years participated in this study. There were no significant baseline differences. During the procedure, the methoxyflurane group experienced a significantly greater VNRS pain reduction from baseline (2 (1, 4) vs −1 (−2, 0); p<0.01) and greater VNRS reduction over time (p=0.01) compared with the lidocaine group, with a higher sedation score (p<0.01). Immediately postprocedure, anxiety levels were lower in the methoxyflurane group compared with the lidocaine group (median State-Trait Anxiety Inventory score 21 (IQR 20, 24) vs 27 (23, 29); p=0.02), but the median reduction in anxiety level was not significant (6 (1, 12) vs 5 (0, 14); p=0.61). There were no differences in behavioral pain scores, hemodynamic parameters, recovery or discharge times, and adverse effects between the two groups.ConclusionA methoxyflurane inhaler combined with local anesthesia provided better procedural pain control than local anesthesia alone with no observable differences in adverse effects. Future studies evaluating the impact of a methoxyflurane inhaler on different types of painful procedures are warranted.

Purpose Pain and anxiety-inducing interventions have a major impact on pediatric patients. Pain reduction by virtual reality (VR) during port and vein punctures is well studied. This study investigates peri-interventional reduction of pain, anxiety and distress using VR compared to the standard of care (SOC) in a pediatric oncology outpatient clinic. Methods In a randomized, controlled cross-over design, patients aged 6–18 years experience potentially painful interventions accompanied by VR. Observational instruments include NRS, FPS-r, BAADS, mYPAS-SF, PedsQL and SSKJ3-8R. All patients undergo two observations: SOC (A) and VR (B) in a randomized order. In addition, parents and staff are interviewed. Specific conditions for VR in an outpatient clinic setting derived from interprofessional focus group discussion are being explored. Results Between July 2021 and December 2022 57 eligible patients were included and randomized to the orders A/B ( n  = 28) and B/A ( n  = 29). Thirty-eight patients completed both observations. Characteristics in both groups did not differ significantly. More than half of the patients had no previous experience with VR, 5% decided to discontinue VR prematurely. Peri-interventional pain, anxiety and distress were significantly reduced by VR compared with SOC. 71% of patients and 76% of parents perceived punctures with VR to be more relaxed than previous ones. 95% of patients perceived fun with VR goggles. Detailed questionnaires on individual stress and anxiety were returned from 26 of 38 patients. Focus group discussion with staff yielded evidence for successful implementation of VR in an outpatient clinic. Conclusions The present study shows that VR can be used for peri-interventional reduction of pain, anxiety, and distress in the special environment of a pediatric outpatient clinic. Specific conditions must be met for successful implementation. Further studies are needed to identify particularly susceptible patients and to illuminate alternatives for distraction that are feasible to implement with limited resources. Trial registration number (ClinicalTrials.gov ID): NCT06235723; 01/02/2024; retrospectively registered. This study adheres to the standard checklist of CONSORT guidelines. Key messages What is known • Interventions in pediatrics cause anxiety, distress and pain. • Pain-reducing methods require specific conditions in the context of an outpatient clinic. • Virtual reality has the potential to reduce anxiety and pain in addition to other methods. What is new • VR enjoys great popularity among pediatric oncology patients, parents, and staff. • Self- and peer-assessment tools for pain, anxiety, and stress can be used for intra- and inter-individual comparison. • For the implementation of VR to succeed in an outpatient clinic, specific conditions need to be taken into account. • Questionnaires could be used to identify particularly susceptible patients in advance.

BackgroundSedation increases colonoscopy risks and prolongs recovery time. We examined whether virtual reality (VR) can substitute for sedation. The primary outcome was the overall satisfaction of patients who underwent colonoscopy with VR headset compared with patients who underwent standard sedation. Pain during the procedure, polyp detection rate (PDR), colonoscopy duration, post-colonoscopy adverse events, post-colonoscopy recovery, time-to-return to daily functions, and turnaround time at the endoscopy unit were secondary outcomes.MethodsThe study was approved by Sheba Medical Center’s ethics committee IRB number 21-8177-SMC. Sixty patients were sequentially enrolled in a 1:1 ratio to either standard sedated colonoscopy or VR-unsedated procedure, and all patients signed a written informed consent. 28/30 patients successfully completed the colonoscopy using VR headset. Overall satisfaction score was comparable between the groups.ResultsThere was no difference between VR and controls in colonoscopy duration, or PDR. VR patients had numerically lower rate of post-colonoscopy adverse events than controls. The proportion of VR patients who reported resuming daily activities on the day of the procedure was significantly higher than in the control group. The VR group patients spent significantly less time in the hospital compared to the control group.ConclusionsVR technology can provide adequate substitution for sedation for most patients undergoing colonoscopy and offers comparable patient satisfaction and faster return to daily activities.

Needle-related procedures can cause pain and fear in children and may lead to avoidance of future medical care. The aim of this study is to investigate whether virtual reality hypnosis (VRH) is non-inferior to medical hypnosis (MH) by a trained healthcare provider in reducing pain in children. This non-inferiority randomized trial was conducted at a teaching hospital in the Netherlands. Children aged 6 to 18 years were randomized to treatment with VRH or MH. The primary outcome was self-reported pain, using the Wong-Baker FACES Scale (WBFS) with the non-inferiority margin defined as a difference of 1.5 points. Secondary outcomes included observer-reported pain (Numeric Rating Scale), fear (scored by children and observers with the Children’s Fear Scale), blood pressure, heart rate, treatment satisfaction, and adverse effects. We randomized 138 children to VRH or MH treatment and included 114 children in the analyses (VRH n  = 60, MH n  = 54). We found non-inferiority for VRH compared to MH on patient-reported pain (mean difference =  − 0.17, 95%CI − 1.01;0.66). Secondary outcomes were comparable between VRH and MH groups. Both treatments scored high on patient satisfaction (VRH median = 9.0, MH median = 10.0, p  = 0.512). Conclusion : VRH may be an effective and safe treatment option besides MH for reducing patient-reported pain in children during a needle-related procedure. VRH was non-inferior to MH in patient-reported fear and both treatments were comparable in terms of patient-reported fear, observer-reported pain and fear, physical distress, and patient satisfaction. Trial registration : ICTRP https://trialsearch.who.int/ , trial ID NL9385; date registered: 03/04/2021. What is Known: • Medical hypnosis is effective in reducing procedural distress in children during needle-related procedures. • Virtual reality (VR) is an audiovisual electronic device that guides users into an immersive three-dimensional environment. What is New: • This study shows that VR hypnosis is non-inferior to medical hypnosis in reducing pain and fear in children undergoing a needle-related procedure. • Both VR hypnosis and medical hypnosis were appreciated highly by children to distract them during needle-related procedures.

Introduction The aim of this study; is to determine the level of pain and anxiety experienced by pediatric patients with operated humeral supracondylar fractures during pin removal, and to investigate the effectiveness of animated video impressions. Materials and methods This randomized controlled study included 180 patients aged between 4 and 12 years. The patients were divided into four groups: Group 1—control; Group 2—watched the introductory animation video before the procedure; Group 3—using analgesic before the procedure (ibuprofen 10 mg/kg); Group 4—watched the introductory animation video and used analgesic before the procedure. To assess pain before randomization, before-during-after procedure, and at outpatient clinic controls; the Wong-Baker Pain Scale (WBS), modified CHEOPS (Children’s Hospital of Eastern Ontario Pain Scale), and the child's heart rate were used. To assess anxiety; the Children's Anxiety Meter (CAM), The Short State Anxiety Inventory Scale (SAIS), and The Children's Emotion Management Scales (CEMS) were used. Results While a significant difference was detected between the groups in the tests performed at certain intervals (p < 0.001), no significant difference was detected between Groups 1–3 and Groups 2–4. The Modified CHEOPS and CEMS values obtained during the procedure showed significant variability between the groups (p < 0.001). Similarly, While a significant difference was detected between the groups in the WBS scores measured during the procedure (p < 0.001), it was observed that there was no significant relationship between Groups 1–3 and Groups 2–4 (p = 0.892, p = 0.820). Conclusions Watching an introductory animated video before pin removal is an effective method to relieve the anxiety and pain felt in children with supracondylar fractures.

The purpose of this study was to examine the effects of an easy listening music intervention on satisfaction, anxiety, pain, sedative and analgesic medication requirements, and physiological parameters in Chinese adult patients undergoing colonoscopy in Hong Kong. Patients undergoing colonoscopy, aged 45 or older, able to communicate in Chinese, and hemodynamically stable were invited for the study. A randomized controlled trial was adopted. Eligible patients were randomly assigned either to a music group, which received standard care and additional easy listening music (a series of 15 popular non-rock Chinese songs) through earphones and MP3 for 20 mins before and during the procedure, or to a control group which received standard care only. Standard care comprised of all nursing and medical care provided for patients undergoing colonoscopy. Measures comprised of the State-Trait Anxiety Inventory, visual analog scales of pain level, procedure satisfaction and satisfaction with pain management, the use of sedative and analgesic drugs, heart rate, and blood pressure data were collected at baseline (T0), during (T1) and 30 mins after the procedure (T2). Eighty participants (40 music vs 40 control) completed the study with no attrition. Participants in the music group reported significantly higher levels in both procedure satisfaction ( =0.043) and satisfaction with pain management ( =0.045) than those in the control group. No significant difference was found between groups on anxiety, pain, additional sedative and analgesic use, heart rate, and systolic and diastolic blood pressure ( >0.05). Nevertheless, most participants appreciated the songs provided in MP3 and found it helpful for relaxation during the procedure and would prefer it again ( <0.001). Easy music listening can enhance patients' satisfaction in both procedure and pain management for adults undergoing a colonoscopy procedure.

Background: Coronary angiography, an invasive diagnostic procedure, often induces pain and anxiety in patients. Despite the potential for alleviating discomfort, the use of stress balls as a nonpharmacological intervention during angiography remains underexplored. Objective: This study is aimed at investigating the impact of stress ball application on pain and anxiety levels in patients undergoing angiography. Methods: This randomized controlled trial was conducted on adult patients undergoing angiography at a Cardiovascular Surgery Clinic in Eastern Turkey between January 2023 and June 2023. A total of 120 patients were randomly assigned to receive stress ball application in addition to routine care. Data collection utilized the Numerical Rating Scale (NRS), Patient Information Form, and State‐Trait Anxiety Inventory (STAI). Results: Analysis revealed a significantly lower increase in mean NRS posttest scores among patients in the experimental group compared to the control group ( p < 0.05). Additionally, the mean STAI posttest score demonstrated a significant decrease ( p < 0.05) in the experimental group. A positive and significant correlation was observed between the mean NRS and STAI posttest scores among study group patients ( p < 0.05), indicating a reduction in anxiety levels with decreasing pain. Conclusion: The application of stress balls during angiography was associated with decreased anxiety and pain levels in patients. Stress ball intervention may serve as a beneficial adjunct to pharmacological treatments. This study underscores the potential of nonpharmacological interventions in enhancing patient comfort during invasive procedures. Trial Registration: ClinicalTrials.gov Identifier: NCT06131606 ( http://clinicaltrials.gov ).

Background Using non-pharmacological methods to reduce the pain of hospitalized infants is one of the most important priorities in the health of newborns. Pain relief during painful procedures can help prevent unwanted physical and psychological effects. This study was conducted with the aim of investigating the effect of combined non-pharmacological interventions on venous blood sampling pain in preterm infants. Methods In this clinical trial study, 88 preterm infants admitted to the Neonatal Intensive Care Unit of Rouhani Hospital was randomly assigned to four groups of sucrose (S), the combined group of sucrose and non-nutritive sucking (NS), the combined group of swaddle and sucrose (SS) and the combined group of sucrose, non-nutritive sucking and swaddling (NSS). In order to collect information, were used the premature Infant Pain Profile Scale (PIPP) and demographic characteristics questionnaire. Results This study showed that during blood sampling, the difference in the mean pain score of two groups of S and NS was equal to 3.54 (95% CI = 1.85, 5.24) and in two groups S and NSS was equal to 4.68 (95% CI = 2.99, 6.38), and these differences were significant ( P  < 0.001). In addition, the mean pain difference in all study groups was significant in two time periods before-during and during-after blood sampling ( P  < 0.001). Also, the mean pain difference in the two time periods before-during and during-after in NS and NSS groups was significant compared to the control group (sucrose) ( P  < 0.001). Conclusions Based on the results of this study, the use of combined non-pharmacological interventions of NSS has been more effective in reducing the pain caused by venous blood sampling than other conditions where two or one non-pharmacological intervention were used.

In the neonatal intensive care unit (NICU), premature neonates frequently endure painful procedures that can lead to long-lasting sequelae, underscoring the critical need for safe and effective pain management strategies. Auricular massage has demonstrated significant benefits for children, including anxiety and stress relief. Investigating its effectiveness in alleviating pain in neonates could introduce a valuable nonpharmacological approach to pain management, enhancing the overall care and comfort of these vulnerable infants. This research is aimed at studying the effectiveness of a 3-min session of auricular massage in reducing pain caused by nasal and oral suctioning among premature neonates in the NICU in Jordan. A randomized controlled trial employing a single-blind crossover design was conducted in a single hospital. Preterm neonates were randomly assigned to one of two conditions. In Condition I, neonates initially received auricular massage treatment after suctioning, followed, after 2 days, by no massage after suctioning. Conversely, in Condition II, neonates had the reversed sequence, starting with no massage and then receiving auricular massage treatment after 2 days. Pain levels in the neonates were assessed using the Premature Infant Pain Profile-Revised (PIPP-R) scale. Data from 60 preterm neonates were analyzed using the SPSS Version 28. Chi-square and independent -tests revealed no significant differences between neonates in the study conditions based on gender ( = 0.43), gestational age ( = 0.41), and body weight ( = 0.35). Paired -test results indicated a significant difference in pain scores when comparing periods of auricular massage to periods without massage. The mean pain score following auricular massage was 3.63 (SD = 2.36), whereas it was 10.23 (SD = 2.40) in the absence of massage. Auricular massage for a 3-min duration is an effective nursing intervention that warrants consideration as a nonpharmacological method of pain relief for premature neonates during admission to the NICU.

Background To evaluate the best maternal point of visual focusing (PVF) for minimizing pain and anxiety during amniocentesis. Methods A prospective randomized study was conducted to compare pain and anxiety levels assessed by a visual analogue scale (VAS) on anticipated and perceived pain after amniocentesis between three groups of pregnant women who underwent amniocentesis with three different PVF. Differences between means of anticipated and perceived pain in each maternal PVF were also evaluated. Results A total of 105 participants were enrolled and randomly assigned to covered maternal eyes, independent PVF and adapted visual reality (VR) groups, respectively. The mean VAS scores of anticipated pain and perceived pain were not significantly different between each different maternal PVF. The mean VAS of perceived pain was significantly lower than that of anticipated pain in all maternal PVF groups. The different mean VAS scores (95% confidence interval: CI) were 1.50 (0.28–2.71), p-value 0.017 in the maternal covered eyes group, 1.17 (0.16–2.18), p-value 0.025 in the independent PVF group and 0.96 (0.06–1.86), p-value 0.037 in the adapted VR group. Conclusion Covered maternal eyes, independent PVF and adapted VR can all be similarly recommended as the best maternal PVF during amniocentesis. Trial registration Srinakharinwirot ethics committee (SWUEC/E/M-059/2565) and Thai Clinical Trials Registry TCTRID20221022003 (19 October2022).