Abstract
Although sedatives can defuse anxiety and relieve pain, Esophagogastroduodenoscopy (EGD) still is uncomfortable and threatening for some patients. Identifying patients who tolerate digestive endoscopy less well remains difficult. Using a prospective design and a multimodal assessment of pain, the present study evaluated how anxiety-related variables predicted subsequent pain outcomes. Sixty-two consecutive patients referred for elective EGD were assessed for intolerance of uncertainty (IU), procedure-related worries, anxiety sensitivity and health distress before endoscopy. During endoscopy, a doctor rated patients’ pain behavior. After complete recovery from sedation, the patients retrospectively rated endoscopy pain and situation specific catastrophizing thoughts. Descriptive analyses showed that patients undergoing EGD for the first time were more distressed and anxious than patients accustomed to the procedure and needed a higher sedative dose. Notwithstanding sedation, the behavioral rating of pain was above the cut-off value for probable pain for more than half of the patients. IU assessed before endoscopy predicted situational pain catastrophizing (PC) and self-reported pain after endoscopy through procedure related worries. Situational PC not only mediated the effect of worry, but also female gender and younger age were associated with self-reported pain through increased catastrophizing thoughts. Health distress and anxiety sensitivity predicted PC only for women, younger patients, and those not accustomed to the procedure. Our study showed that psychological preparation before sedation is needed especially for first-timers, women, and younger patients, addressing maladaptive cognitive beliefs and acquainting patients with the somatic sensations that they might experience during the procedure.
Highlights
Esophagogastroduodenoscopy (EGD) is a diagnostic procedure carried out using a flexible probe equipped with a camera, which allows the mucous membrane of the esophagus, stomach, and duodenum to be explored visually
Being focused on anxiety symptoms, previous research has overlooked the role of their cognitive antecedents, which lead patients to experience overwhelming anxiety before EGD, misinterpret uncomfortable physical sensations, and increase the risks and the costs associated with over-sedation (Jones et al, 2004; Essink-Bot et al, 2007; Pontone et al, 2015; Behrouzian et al, 2017)
Using a two-stage prospective design, the present study adds to the extant literature showing that intolerance of uncertainty (IU), anxiety sensitivity, health distress, and worry are associated with subsequent clinical outcomes in the pain domain
Summary
Esophagogastroduodenoscopy (EGD) is a diagnostic procedure carried out using a flexible probe equipped with a camera, which allows the mucous membrane of the esophagus, stomach, and duodenum to be explored visually. EGD is well tolerated, the patients may experience mild to moderate discomfort, and the prospect of inserting the probe through the oral cavity, sliding it into the stomach, may evoke fears such as that of unpleasant physical sensations, adverse diagnostic outcomes (e.g., cancer), and insufficient sedation (Brandt, 2001). Because of these concerns, the most anxious patients become distressed to the point of preventing EGD from being performed or continued (e.g., Trevisani et al, 2004; El-Hassan et al, 2009; Mitsonis et al, 2011). Psychological preparation for EGD is an effective non-pharmacological intervention to defuse pre-procedural anxiety before sedation (Maguire et al, 2004; García Sierra et al, 2013; Kowsalya et al, 2015; Behrouzian et al, 2017; Liu et al, 2018; Ghonaem and Ibrahim, 2019) but can be time-consuming and may cause a delay in the flow of patients, especially if performed routinely the same day of endoscopy (e.g., Behrouzian et al, 2017)
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