Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Division of Urology, Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Medicine (Baltimore). 2022 Sep 16;101(37):e30425. doi: 10.1097/MD.0000000000030425.
Pain control is a major determinant for successful stone clearance in extracorporeal shockwave lithotripsy (ESWL) for urolithiasis. Pain perception during ESWL may be influenced by patient factors like gender, age, body habitus and anxiety level, and stone related factors like size, laterality and location of stone. We investigated in general, the confounding patient and stone factors influencing pain perception during ESWL with importance given to procedural anxiety in first and the subsequent session of ESWL. This was a prospective observational study of all new consecutive patients who underwent ESWL for a period of 1 year at a tertiary Urological Centre. Demographic and stone anthropometry were analyzed. Pre-procedural anxiety was assessed prior to procedure using hospital anxiety and depression score (HADS) and pain was scored using numerical rating scale-11 at baseline, 30-minutes (i.e., during) and 24 hours after ESWL. Univariate and multivariate analysis for confounding factors included HADs were performed for pain perception. A P value < .05 was considered to be statistically significant. For the study duration, 119 patients were recruited and 72 of them returned for a second session. Procedural anxiety was the only independent factor affecting pain score in ESWL for the first session in multivariate analysis. A statistically significant reduction of mean procedural anxiety score from 6.7 ± 4.5 to 3.2 ± 2.7 (P < .05) for the second ESWL session was observed (n = 72). This was in conjunction with statistical reduction of mean pain score 30 minutes after ESWL from 5.2 ± 2.1 to 4.2 ± 2.1 (P < .05). Patients with HADS ≥ 8 had statistically significant higher mean pain score at all 3 intervals in the first ESWL session. This study has shown that pre-procedural anxiety mainly anticipatory, reduces and shows reduction in pain intensity among patients undergoing repeat ESWL. Hence, anxiety reducing methods should be explored in patients undergoing ESWL to avoid unnecessary analgesic use.
疼痛控制是体外冲击波碎石术 (ESWL) 治疗尿路结石成功排石的主要决定因素。ESWL 过程中的疼痛感知可能受到患者因素的影响，如性别、年龄、体型和焦虑水平，以及结石相关因素，如结石的大小、侧位和位置。我们总体上研究了影响 ESWL 过程中疼痛感知的混杂患者和结石因素，特别关注首次和后续 ESWL 治疗过程中的程序性焦虑。这是一项在一家三级泌尿科中心进行的为期 1 年的新连续患者前瞻性观察研究。分析了人口统计学和结石人体测量学。使用医院焦虑和抑郁量表 (HADS) 在术前评估术前焦虑，并使用数字评分量表-11 在基线、30 分钟（即期间）和 ESWL 后 24 小时对疼痛进行评分。进行了单变量和多变量分析，以评估 HADS 等混杂因素对疼痛感知的影响。P 值<.05 被认为具有统计学意义。在研究期间，共招募了 119 名患者，其中 72 名患者返回进行第二次治疗。在多变量分析中，程序性焦虑是影响首次 ESWL 治疗疼痛评分的唯一独立因素。在第二次 ESWL 治疗中，观察到平均程序性焦虑评分从 6.7±4.5 显著降低至 3.2±2.7（P<.05）（n=72）。这与 ESWL 后 30 分钟平均疼痛评分从 5.2±2.1 显著降低至 4.2±2.1（P<.05）同时发生。HADS≥8 的患者在首次 ESWL 治疗的所有 3 个间隔的平均疼痛评分均显著较高。这项研究表明，术前焦虑主要是预期性的，可减轻患者在重复 ESWL 治疗过程中的疼痛强度，并减轻疼痛强度。因此，应该在接受 ESWL 治疗的患者中探索减轻焦虑的方法，以避免不必要的镇痛药物使用。
