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. 2000 Feb;24(2):163-8.
doi: 10.1016/s0210-4806(00)72423-5.

[Extracorporeal shock-wave lithotripsy: anxiety and pain perception]

[Article in Spanish]
C Torrecilla Ortiz  1 , L L Rodríguez Blanco, F Díaz Vicente, C González Satué, L M Marco Pérez, E Trilla Herrera, N Serrallach i Milá
Affiliations

[Extracorporeal shock-wave lithotripsy: anxiety and pain perception]

[Article in Spanish]
C Torrecilla Ortiz et al. Actas Urol Esp. 2000 Feb.

Abstract

Three factors in extracorporeal shock-wave lithotripsy (ESWL) result in pain: shock wave pressure, size of focal area and pressure distribution at entry in the skin. Our Lithotripsy Unit has performed 21,000 outpatient treatments (Dornier HM-4 Lithotripter) with no sedation or anaesthetics. Pain requiring treatment discontinuation resulted in 10% instances. Anxiety-associated pain increases the perceived intensity of pain and influences the emotional response to pain.

Objective: To determine whether the variability in the response to the pain stimulus caused by ESWL is related to the patient's status/trait of anxiety.

Method: Sample 20 patients; inclusion criteria: pyelic lithiasis > 2 cm, no previous SWEL and no obesity. One SWEL session (2500 pulses, 22 Kv). Anxiety was first evaluated using the status/trait of anxiety index (STAI) questionnaire; after treatment, pain was evaluated on a Numerical Analogic Scale.

Results: Pain scores ranged from 2 to 8, mean score 4.1 (S.D. = 1.67); mean score for trait of anxiety 21.8 (S.D. = 8.52), and status of anxiety 29 (S.D. = 5.89). A significant correlation was found between pain-anxiety trait (R = .51; p = .02), which was higher when compared to pain-anxiety status (R = .67; p = .001).

Conclusions: SWEL is a painful therapy (95% of sample had mild-to-moderate pain); pain perception is increased by status of anxiety (45% of pain variance) more than by the trait of anxiety (26.3%); therefore, usage of sedation-analgesia in patients with high anxiety status would improve the lithotripter efficacy ratio.

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