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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 ).

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.

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 Early and continuous exposure to painful stimuli in premature infants leads to short-and long-term complications. Listening to white noise is an accessible and inexpensive non-invasive method that can be used as a safe nursing intervention in hospitals. This study aimed to assess white noise’s effect on premature Infants’ physiological parameters during peripheral intravenous catheter insertion. Methods The present experimental study was conducted on 40 premature Infants. From 5 min before Indwelling catheters to 10 min after, white noise was played through headphones to infants at a controlled volume in the test group. Using a monitor, physiological parameters were recorded from 10 min before to 30 min after the Indwelling catheter. Statistical analysis was done through the SPSS version 27 software program. Results Regarding respiratory rate, there was no statistically significant difference between the two groups in the first, second, and sixth stages ( p  < 0.05). However, in the third, fourth, and fifth stages, RR in the control group was significantly higher than the test group ( p  ≤ 0.05). In terms of mean arterial blood pressure, there was no statistically significant difference between the two groups in any of the stages ( p  < 0.05). In terms of heart rate, there was no statistically significant difference between the two groups in the first, second, and sixth stages ( p  < 0.05). However, in the third, fourth, and fifth stages, HR in the control group was significantly higher than the test group ( p  ≤ 0.05). Regarding oxygen saturation percentage, there was no statistically significant difference between the two groups in the first, second, third, and sixth stages ( p  < 0.05). In contrast, in the fourth and fifth stages, the oxygen saturation percentage in the test group was significantly higher than in the control group ( p  < 0.05). Conclusions Although in both groups the painful procedure led to an increase in physiological variables (respiratory rate, heart rate, mean arterial blood pressure) and a decrease in blood oxygen saturation, in the test group these variables approached their initial state more quickly within half an hour after exposure to white noise. This confirms that the effect of white noise on the improvement of physiological variables is gradual. Clinical trial number Not applicable.

Aromatherapy with essential oils can be used to relieve children. The aim of this study was to evaluate the correlations between psychological and physiologic findings after lavender oil inhalation among children assigned to undergo tooth extraction. A total of 126 children aged between 6 and 12 years were enrolled in the study. The groups were randomly divided into control and lavender groups. The lavender group inhaled 100% lavender oil for 3 min before the interventions, the control group received no prior application. Psychological assessments were made using face image scale (FIS), Face, Legs, Activity, Cry, Consolability (FLACC) and Wong-Baker pain rating scale (WBS). Physiologic changes were assessed using vital signs evaluations. All parameters were noted prior to applications, after inhalation, anesthesia injection, and tooth extraction. The lavender group showed significant lower anxiety and pain scores after tooth extraction (p < 0.05). Significantly lower levels of blood pressures and a significant pulse rate drop were found after inhalation in the lavender group. A statistically significant increase in heart rate was observed after anesthesia injection and tooth extraction in the control group (p < 0.05).Conclusion: Lavender oil can be preferred as a treatment of choice in routine pediatric dentistry.Trial registration number: NCT04115891 (Lavender Oil Inhalation Help to Overcome Dental Anxiety Among Children)What is Known:• Dental anxiety is the most common factor that causes children to have difficulty with the dentist and their parents during treatment.• Aromatherapy with essential oils can be used to relieve children.What is New:• Aromatherapy with lavender oil relieves the child by reducing the level of anxiety and facilitates dental treatment.• During surgical procedures such as local anesthesia and tooth extraction, lavender oil inhalation decreases pain levels of children.

Background Pain and anxiety are frequent among critically ill patients undergoing unplanned invasive procedures, and pharmacological pain relief is not always possible. Although hypnosis is widely used in planned painful procedures, studies are lacking in this specific setting. Thus, we aimed to assess whether hypnosis plus standard care reduced pain and anxiety in critically ill patients undergoing an unplanned invasive procedure in comparison to standard care. Methods The HYPIC trial was a randomized, single-blind, multicenter clinical trial of hypnosis during unplanned invasive procedures versus standard care for critically ill patients conducted in two French intensive care units (ICUs) from December 27, 2019, to January 25, 2022. Patients were randomly assigned to receive hypnosis plus standard care by trained healthcare providers or standard care. The hypnotherapists were in the room for both arms to maintain blindness. The primary endpoint was the difference in pain level experienced during the invasive procedure assessed immediately after the end of the procedure between the two groups. The secondary outcomes were anxiety level, lidocaine consumption and stress experienced by the ICU nurses in charge of the patients. Results We included 78 patients. The pain level, assessed with a numeric pain scale (range, 0–10), was not significantly different between the two groups (2.2 ± 2.9 vs. 2.2 ± 3, difference 0 pts [95% CI -1.3; 1.3], p  = 0.89). The level of anxiety was significantly lower in the hypnosis group (2.4 ± 2.8 vs. 4.1 ± 3, difference − 1.7 [-3; -0.4], p  = 0.01), as was the level of stress experienced by the ICU nurses (0.1 ± 0.4 vs. 0.9 ± 1.5, difference − 0.8 [-1.3;-0.3], p  = 0.003), and the patients were three times less likely to require increased lidocaine consumption (odds ratio: 0.3 [0.13–0.84], p  = 0.02) in the hypnosis group. Conclusion While hypnosis did not result in a statistically significant reduction in unplanned procedural pain, it seems to reduce anxiety, increase comfort, and reduce the stress level of healthcare providers. Trial registration: The study was registered on ClinicalTrials.gov (NCT04129333) on 14 October 2019, before the first patient was enrolled.

Background Orally administered sucrose is effective and safe in reducing pain intensity during single, tissue-damaging procedures in neonates, and is commonly recommended in neonatal pain guidelines. However, there is wide variability in sucrose doses examined in research, and more than a 20-fold variation across neonatal care settings. The aim of this study was to determine the minimally effective dose of 24% sucrose for reducing pain in hospitalized neonates undergoing a single skin-breaking heel lance procedure. Methods A total of 245 neonates from 4 Canadian tertiary neonatal intensive care units (NICUs), born between 24 and 42 weeks gestational age (GA), were prospectively randomized to receive one of three doses of 24% sucrose, plus non-nutritive sucking/pacifier, 2 min before a routine heel lance: 0.1 ml (Group 1; n  = 81), 0.5 ml (Group 2; n  = 81), or 1.0 ml (Group 3; n  = 83). The primary outcome was pain intensity measured at 30 and 60 s following the heel lance, using the Premature Infant Pain Profile-Revised (PIPP-R). The secondary outcome was the incidence of adverse events. Analysis of covariance models, adjusting for GA and study site examined between group differences in pain intensity across intervention groups. Results There was no difference in mean pain intensity PIPP-R scores between treatment groups at 30 s ( P  = .97) and 60 s ( P  = .93); however, pain was not fully eliminated during the heel lance procedure. There were 5 reported adverse events among 5/245 (2.0%) neonates, with no significant differences in the proportion of events by sucrose dose ( P  = .62). All events resolved spontaneously without medical intervention. Conclusions The minimally effective dose of 24% sucrose required to treat pain associated with a single heel lance in neonates was 0.1 ml. Further evaluation regarding the sustained effectiveness of this dose in reducing pain intensity in neonates for repeated painful procedures is warranted. Trial registration ClinicalTrials.gov : NCT02134873. Date: May 5, 2014 (retrospectively registered).

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.