Insertion pain in needle electromyography can be reduced by simultaneous finger slapping

Pain perception during electrodiagnostic studies and the impact of learners

INTRODUCTION/AIMS

Electrodiagnostic testing (EDX) may be perceived as painful, which may influence patient expectations and test completion. Our aim was to characterize which component of the EDX was more painful, and to determine if any factors, particularly performance by a learner, influenced this perception.

METHODS

Participants were prospectively recruited and completed a brief questionnaire to rate their perception of pain before and after each component of the EDX. Demographic information and information about the test itself was collected.

RESULTS

A total of 251 participants were recruited, 55.3% female, with a mean age of 52.9 years. Most participants rated pain after nerve conduction studies (NCS) and needle electromyography (EMG) as mild to moderate with a similar number rating each component as more painful than the other. There was no effect of sex on overall ratings, although females felt that the test was more painful than anticipated more often than males. If a learner performed the EMG, it was more likely that the test would be rated as moderately to severely painful, and more likely for the EMG to be rated as more painful than the NCS (p<0.05).

DISCUSSION

The finding that NCS and EMG perceived pain were similar may help accurately inform patients of test expectations, guide test planning and help reduce the likelihood of incomplete or canceled testing. More effort might be required to help mitigate EMG pain when learners are involved.

The provision of written information and its effect on levels of pain and anxiety during electrodiagnostic studies: A randomised controlled trial

Objective

The provision of written information is a low-cost and readily available intervention that has been found to reduce pain and anxiety in a variety of clinical settings. The current study was undertaken to determine if information provision may improve patients’ experience during conventional electrodiagnostic studies.

Methods

128 participants were recruited from a tertiary teaching hospital who were referred for electrodiagnostic studies. They were randomized into 2 groups where the intervention group was provided with written information about the electrodiagnostic testing. Patients were invited to complete a questionnaire that included pain and anxiety using a visual analogue scale (VAS) following the testing. All participants underwent nerve conduction studies (NCS) whilst a subset also underwent subsequent needle electromyography (EMG).

Results

Those who received information had a statistically significant lower perception of anxiety during NCS, whilst only females who received information had a statistically significant lower perception of pain to both NCS and EMG.

Conclusions

The provision of written information can reduce the degree of pain and anxiety experienced during electrodiagnostic testing.

Significance

Improving patient comfort and tolerability during electrodiagnostic testing may have practical implications towards more reliable and accurate results obtained from such investigations that may in turn improve patient diagnosis and management.

A systematic review of measures for reducing injection pain during adult immunization

OBJECTIVE

To evaluate the effectiveness of different pain-relieving interventions to reduce pain from immunization in adults.

DATA SOURCES

MEDLINE (1950 to October Week 3 2008) PsycINFO (1967 to December Week 1 2008), CINAHL (1982 to October Week 4 2008), EMBASE (1980 to 2008 Week 43) and the Cochrane Central Register of Controlled Trials (3rd Quarter 2008).

REVIEW METHODS

Databases were searched for trials of pharmacological, behavioural, physical or operator-dependant techniques to reduce pain from immunization in adults. The primary outcome was pain as assessed by visual analogue scale or other numeric rating scale.

RESULTS

Six studies representing 853 participants were identified. One study evaluating pharmacological interventions (lidocaine-prilocaine) found them to be effective in reducing pain from immunization. Similarly, two studies evaluating physical pain relieving techniques, either skin cooling interventions (Fluori-Methane) or tactile stimulation (manual pressure at the site of injection) found them to reduce pain. One study of jet injectors found them to be more painful than conventional needle and syringe. Neither freezing needles nor warming vaccines was found to be effective in reducing pain. No studies investigated psychological interventions or oral analgesics (acetaminophen and ibuprofen).

CONCLUSION

There was limited evidence to support the use of lidocaine-prilocaine, Fluori-Methane and manual pressure for reducing immunization pain in adults. There was limited evidence of more pain with jet injectors compared to needle and syringe. Due to limited data, we recommend further investigation of methods to reduce immunization pain in adults, primarily psychological and physical techniques.

Prospective double-blind crossover trial of ibuprofen in reducing EMG pain

To test the efficacy of ibuprofen in reducing needle electromyography (EMG) pain we studied 30 healthy volunteers randomized to receive placebo or ibuprofen (400 mg) 2 h before EMG using concentric needle electrodes in four muscles. The electromyographer and volunteer were both blinded. Immediately after EMG, subjects reported their experience of pain on a visual analog scale (VAS). A day later, they filled a VAS for their memory of pain during EMG and a VAS for the residual pain at needle sites. A week later, subjects were crossed over and the same procedure was repeated on the same muscles of the contralateral limbs. Immediate recall of pain was significantly decreased by ibuprofen, but memory of pain and residual needle site pain a day after EMG were not decreased. We conclude that ibuprofen is effective in reducing EMG pain as perceived immediately after the procedure. Premedication with ibuprofen before EMG is useful.