Assessment and Treatment of Pain during In‐Office Otolaryngology Procedures: A Systematic Review

Abstract

Objective To qualitatively assess practices of periprocedural pain assessment and control and to evaluate the effectiveness of interventions for pain during in-office procedures reported in the otolaryngology literature through a systematic review. Data Sources PubMed, CINAHL, and Web of Science searches from inception to 2018. Review Methods English-language studies reporting qualitative or quantitative data for periprocedural pain assessment in adult patients undergoing in-office otolaryngology procedures were included. Risk of bias was assessed via the Cochrane Risk of Bias or Cochrane Risk of Bias in Non-Randomized Studies of Interventions tools as appropriate. Two reviewers screened all articles. Bias was assessed by 3 reviewers. Results Eighty-six studies describing 32 types of procedures met inclusion criteria. Study quality and risk of bias ranged from good to serious but did not affect assessed outcomes. Validated methods of pain assessment were used by only 45% of studies. The most commonly used pain assessment was patient tolerance, or ability to simply complete a procedure. Only 5.8% of studies elicited patients’ baseline pain levels prior to procedures, and a qualitative assessment of pain was done in merely 3.5%. Eleven unique pain control regimens were described in the literature, with 8% of studies failing to report method of pain control. Conclusion Many reports of measures and management of pain for in-office procedures exist but few employ validated measures, few are standardized, and current data do not support any specific pain control measures over others. Significant opportunity remains to investigate methods for improving patient pain and tolerance of in-office procedures.

Virtual Reality for Pain Management During High‐Resolution Manometry: A Randomized Clinical Trial

“…21 GSR, or electrodermal activity, measures the electrical activity conducted through sweat glands in the skin. 22 Electrodermal activity is thought to reflect the activity of the sympathetic nervous system (i.e., physiological arousal). Skin sympathetic nerves are activated in response to stress or other stimuli, increasing the permeability of eccrine sweat glands, resulting in changes in skin conductivity.…”

“…HR is known to increase when patients experience pain 21 . GSR, or electrodermal activity, measures the electrical activity conducted through sweat glands in the skin 22 . Electrodermal activity is thought to reflect the activity of the sympathetic nervous system (i.e., physiological arousal).…”

Flexible versus rigid laryngoscopy: A randomized crossover study comparing patient experience

“…A systematic review by Frank et al 13 found that adequate pain control is the cornerstone of success for in-office procedures in otolaryngology. Accurate pain measurement was also found to improve self-reported patient satisfaction.…”

Patient Perception and Duration of Pain after Microdirect Laryngoscopy

“…[10][11][12][13] The otolaryngology literature is still catching up, with recent publications on pain and tolerance of in office procedures, such as vocal fold injections and laryngeal electromyography. [14][15][16] In certain otolaryngologic surgeries, such as tonsillectomy, pain plays quite a significant role in the postoperative experience. 17 There is, however, a paucity of studies evaluating pain after other otolaryngologic surgeries, such as MDL.…”

“…Pain has been evaluated more extensively in other specialties, such as dentistry and obstetrics 10–13 . The otolaryngology literature is still catching up, with recent publications on pain and tolerance of in office procedures, such as vocal fold injections and laryngeal electromyography 14–16 . In certain otolaryngologic surgeries, such as tonsillectomy, pain plays quite a significant role in the postoperative experience 17 .…”