Anxiety and pain perception using a speculum-free eyelid retraction technique for intravitreal injection

2022 ◽  
Author(s):  
Lauren M. Wasser ◽  
Eduardo Roditi ◽  
Adina R. Weiss ◽  
Yishay Weill ◽  
Meni Koslowsky ◽  
...  
Keyword(s):  
Intravitreal Injection ◽  
Pain Perception ◽  
Eyelid Retraction

scholarly journals Can Needle Bevel Tip Orientation Influence Pain Perception Associated with Intravitreal Injection?

2021 ◽  
Author(s):  
Rakesh Kumar Jha ◽  
Sankalp Seth
Keyword(s):  
Intravitreal Injection ◽  
Macular Oedema ◽  
Pain Perception ◽  
Tertiary Care ◽  
Diabetic Macular Oedema ◽  
Age Related Macular Degeneration ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Age Related ◽  
Oriented Parallel

Introduction: Reduction of pain perception associated with intravitreal injections is crucial factor for improving compliance of the patient to the planned subsequent injections. Aim: This study aimed to evaluate relation of pain perception with initial needle bevel tip orientation during intravitreal injection. Materials and Methods: A prospective interventional study conducted on 120 eyes of 120 patients at the single tertiary care centre between December 2017 to January 2020 , who never underwent any intravitreal injection and were planned for their first intravitreal injection of ranibizumab in either of their clinically indicated eye for conditions such as Neo-vascular Age Related Macular Degeneration (ARMD), central Diabetic Macular Oedema (DME) and macular oedema secondary to Retinal Vein Occlusion (RVO). Fifty per cent (50%) of the patients received intravitreal injection with needle bevel tip oriented parallel to limbus margin and fifty per cent (50%) of patient received intravitreal injection with needle bevel tip oriented perpendicular to the limbus margin. The primary outcome was to compare the level of pain perception of the subject patients by using Visual Analogue Scale (VAS) in the immediate postprocedure period. Data collected in MS excel and analysed by using SPSS Version 24.0. Independent t-test was used for the comparison of the two groups. Chi-square test was used for the comparison of nominal variables of subject groups. Pearson’s correlation test was used to evaluate the relationship between quantitative variables and pain scores. The p-values smaller than (<0.05) were considered as statistically significant. Results: Pain perception scores assessed on the VAS (0-100mm) ranged from 0.8 to 39, with a mean of 18.13±7.65. Significant correlation was found with two different mode of orientation of needle bevel tip. Patients perceived less pain with needle bevel tip oriented perpendicular to the limbus margin compared to parallel to limbus margin (p=0.0001). Conclusion: Pain perception associated with intravitreal injection can be further minimised by orientating the bevel needle tip as perpendicular to limbus margin while initiating the insertion of injection into the indicated eye.

Lid splinting eyelid retraction technique: a minimised sterile approach for intravitreal injections

2017 ◽  
Vol 102 (9) ◽  
pp. 1254-1258 ◽  
Author(s):  
Monique Munro ◽  
Geoff R Williams ◽  
Anna Ells ◽  
Michael Fielden ◽  
Amin Kherani ◽  
...  
Keyword(s):  
Intravitreal Injection ◽  
Povidone Iodine ◽  
Case Series ◽  
Surface Preparation ◽  
Intravitreal Injections ◽  
Subconjunctival Injection ◽  
Vascular Endothelial ◽  
Eyelid Retraction ◽  
Retrospective Case ◽  
Endothelial Growth Factor

Background/aimsTo describe an alternative technique for avoiding contact with the lids and lashes, without the use of a lid speculum, during intravitreal anti-vascular endothelial growth factor injections.MethodsRetrospective case series of all patients undergoing intravitreal injections of bevacizumab and ranibizumab, with the lid splinting retraction technique from January 2010 to December 2015. Injections performed by six vitreoretinal specialists were included. The key preinjection ocular surface preparation includes topical anaesthetic, 5% povidone-iodine and a subconjunctival injection of 2% lidocaine with epinephrine. A second instillation of 5% povidone-iodine is given and the intravitreal injection is then performed. No lid speculum is used. A search of the electronic medical records identified patients diagnosed with postinjection endophthalmitis and charts were reviewed to ensure inclusion criteria were met. The main outcome measure was incidence of postinjection endophthalmitis.ResultsA total of 78 009 consecutive intravitreal injections were performed, of which 22 207 were bevacizumab and 55 802 were ranibizumab. In this cohort of patients (n=6320), 12 cases of endophthalmitis developed, corresponding to a rate of 0.015%.ConclusionsThe technique of eyelid retraction for intravitreal injection has a low rate of endophthalmitis, similar to the reported rates using a metal lid speculum. This is beneficial for both the physician and the patient as it minimises patient discomfort as well as the duration of the procedure. To our knowledge, this is one of the largest studies performed to date evaluating intravitreal injection-related endophthalmitis.

Effect of Ketorolac 0.5% Drops on Patients' Pain Perception During Intravitreal Injection Procedure

2012 ◽  
Vol 28 (5) ◽  
pp. 455-458 ◽  
Author(s):  
Constantine D. Georgakopoulos ◽  
Panagiotis T. Vasilakis ◽  
Olga E. Makri ◽  
Eleni Beredima ◽  
Nikolaos M. Pharmakakis
Keyword(s):  
Intravitreal Injection ◽  
Pain Perception ◽  
Injection Procedure

Chronic Pain: Fundamental Scientific Considerations, Specifically for Legal Claims

2013 ◽  
Vol 18 (1) ◽  
pp. 1-18 ◽  
Author(s):  
Robert J. Barth
Keyword(s):  
Health Outcomes ◽  
Pain Perception ◽  
Driving Forces ◽  
Psychological Treatment ◽  
Dominant Role ◽  
Meta Analysis ◽  
General Medicine ◽  
Pain Syndrome ◽  
Problematic Relationship

Abstract Scientific findings have indicated that psychological and social factors are the driving forces behind most chronic benign pain presentations, especially in a claim context, and are relevant to at least three of the AMA Guides publications: AMA Guides to Evaluation of Disease and Injury Causation, AMA Guides to Work Ability and Return to Work, and AMA Guides to the Evaluation of Permanent Impairment. The author reviews and summarizes studies that have identified the dominant role of financial, psychological, and other non–general medicine factors in patients who report low back pain. For example, one meta-analysis found that compensation results in an increase in pain perception and a reduction in the ability to benefit from medical and psychological treatment. Other studies have found a correlation between the level of compensation and health outcomes (greater compensation is associated with worse outcomes), and legal systems that discourage compensation for pain produce better health outcomes. One study found that, among persons with carpal tunnel syndrome, claimants had worse outcomes than nonclaimants despite receiving more treatment; another examined the problematic relationship between complex regional pain syndrome (CRPS) and compensation and found that cases of CRPS are dominated by legal claims, a disparity that highlights the dominant role of compensation. Workers’ compensation claimants are almost never evaluated for personality disorders or mental illness. The article concludes with recommendations that evaluators can consider in individual cases.

Reduction in Pain Sensitivity from Pharmacological Elevation of Blood Pressure in Persons with Chronically Low Blood Pressure

2009 ◽  
Vol 23 (3) ◽  
pp. 104-112 ◽  
Author(s):  
Stefan Duschek ◽  
Heike Heiss ◽  
Boriana Buechner ◽  
Rainer Schandry
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Pain Sensitivity ◽  
Pain Threshold ◽  
Pain Perception ◽  
Drug Effects ◽  
Pressure Effects ◽  
Double Blind ◽  
Low Blood Pressure ◽  
Present Trial

Recent studies have revealed evidence for increased pain sensitivity in individuals with chronically low blood pressure. The present trial explored whether pain sensitivity can be reduced by pharmacological elevation of blood pressure. Effects of the sympathomimetic midodrine on threshold and tolerance to heat pain were examined in 52 hypotensive persons (mean blood pressure 96/61 mmHg) based on a randomized, placebo-controlled, double-blind design. Heat stimuli were applied to the forearm via a contact thermode. Confounding of drug effects on pain perception with changes in skin temperature, temperature sensitivity, and mood were statistically controlled for. Compared to placebo, higher pain threshold and tolerance, increased blood pressure, as well as reduced heart rate were observed under the sympathomimetic condition. Increases in systolic blood pressure between points of measurement correlated positively with increases in pain threshold and tolerance, and decreases in heart rate were associated with increases in pain threshold. The findings underline the causal role of hypotension in the augmented pain sensitivity related to this condition. Pain reduction as a function of heart rate decrease suggests involvement of a baroreceptor-related mechanism in the pain attrition. The increased proneness of persons with chronic hypotension toward clinical pain is discussed.

Interactive Effects of Acute Suicidal Affective Disturbance and Pain Persistence on Suicide Attempt Frequency and Lethality

Crisis ◽  
2019 ◽  
Vol 40 (6) ◽  
pp. 413-421 ◽  
Author(s):  
Megan L. Rogers ◽  
Thomas E. Joiner
Keyword(s):  
Suicide Attempt ◽  
Suicidal Behavior ◽  
Pain Perception ◽  
Suicide Attempts ◽  
Pain Tolerance ◽  
Self Report ◽  
Interactive Effects ◽  
Physical Pain ◽  
Affective Disturbance ◽  
The Relationship

Abstract. Background: Acute suicidal affective disturbance (ASAD) has been proposed as a suicide-specific entity that confers risk for imminent suicidal behavior. Preliminary evidence suggests that ASAD is associated with suicidal behavior beyond a number of factors; however, no study to date has examined potential moderating variables.  Aims: The present study tested the hypotheses that physical pain persistence would moderate the relationship between ASAD and (1) lifetime suicide attempts and (2) attempt lethality. Method: Students ( N = 167) with a history of suicidality completed self-report measures assessing the lifetime worst-point ASAD episode and the presence of a lifetime suicide attempt, a clinical interview about attempt lethality, and a physical pain tolerance task. Results: Physical pain persistence was a significant moderator of the association between ASAD and lifetime suicide attempts ( B = 0.00001, SE = 0.000004, p = .032), such that the relationship between ASAD and suicide attempts strengthened at increasing levels of pain persistence. The interaction between ASAD and pain persistence in relation to attempt lethality was nonsignificant ( B = 0.000004, SE = 0.00001, p = .765). Limitations: This study included a cross-sectional/retrospective analysis of worst-point ASAD symptoms, current physical pain perception, and lifetime suicide attempts. Conclusion: ASAD may confer risk for suicidal behavior most strongly at higher levels of pain persistence, whereas ASAD and pain perception do not influence attempt lethality.

Ocular Changes after Intravitreal Injection of Methanol, Formaldehyde, or Formate in Rabbits

2001 ◽  
Vol 89 (2) ◽  
pp. 74-78 ◽  
Author(s):  
Yoriko Hayasaka ◽  
Seiji Hayasaka ◽  
Yasunori Nagaki
Keyword(s):  
Intravitreal Injection ◽  
Ocular Changes

Social, Psychological, and Pharmacological Factors in Pain Perception

1969 ◽  
Author(s):  
Ronald Melzack ◽  
William T. Beaver ◽  
Frederick J. Evans ◽  
Ernest R. Hilgard ◽  
James J. Lynch ◽  
...  
Keyword(s):  
Pain Perception ◽  
Social Psychological
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