JMIR Publications

ABSTRACT

Background:

Pain is the most common symptom in patients admitted to the emergency room (about 80%). Medical procedures, such as venous or arterial blood sampling, can also cause pain and high stress levels. This is known as "pain in the course of care". Arterial blood gas (ABG) sampling is necessary to assess the severity of the patient's condition and is a routine procedure in the emergency room. In order to decrease the perceived pain of arterial blood sampling, several methods have been investigated, such as the application of a topical anaesthetic cream, a subcutaneous injection of lidocaine prior to the procedure or the use of ultrasound guidance. All these methods showed no difference in pain perception. Apart from the commonly used therapeutic tools, communication is a key element of management. It has also been shown that a communication strategy that includes the use of positive, kind or reassuring words can help to reduce pain, while conversely, the choice of negative words can increase the perception of pain and cause discomfort. The latter is known as the "nocebo effect".

Objective:

Although several studies have compared the impact of verbal attitudes, particularly in the field of anaesthesia and mainly with staff already trained in hypnosis, to our knowledge, none have investigated the effect of positive communication by carers or doctors with a patient population in the emergency setting. Given the limited therapeutic options for alleviating the pain and discomfort of blood sampling in the emergency department, in this study we would like to evaluate the potential benefit of positive therapeutic communication on pain and anxiety in patients requiring ABG, compared to nocebo or neutral communication.

Methods:

The Popain (POsitive therapeutic communication on PAIN ) trial is a randomised, parallel, single-centre, triple-blind study of patients undergoing arterial blood gas measurement during their emergency department visit. Patients were randomly assigned to one of three groups: ABG performed with a positive communication technique, negative communication (nocebo group), and neutral communication (neutral group). The primary endpoint was the onset of pain, measured using a numerical rating scale from 0 to 10, three minutes after the puncture.

Results:

On average, 2000 ABG procedures are performed each year at the ED of HFR . 250 patients are expected to be included. With a projected positive response rate of 80%, we intend to include 25 patients per month. The inclusion period will run from October 2022 to October 2023. Full trial results are expected to be published by January 2024

Conclusions:

This study will tell us whether the use of positive communication (easy to implement) can reduce pain and anxiety in routine emergency care or whether other methods (hypnosis training, medication, anaesthesia) should continue to be used. Clinical Trial: NCT05434169 on ClinicalTrials.gov N° BASEC 2022-00685 for CER-VD (Swiss ethics committee of the canton of Vaud )