Complementary approaches to decreasing discomfort during shockwave lithotripsy (SWL)

Abstract

Shock wave lithotripsy (SWL) is an established treatment for renal stones. Although non-invasive, it can cause significant pain and anxiety during the procedure. Our purpose was to review the literature to look at the effect of complimentary therapy in patients undergoing SWL and whether it led to a reduction in the requirement of analgesics and anxiolytics. A systematic review was performed on the use of acupuncture, auricular acupressure, transcutaneous electrical nerve stimulation (TENS) and music during SWL. Only prospective randomized controlled trials were selected. Two reviewers independently extracted the data from each study. Outcomes relating to analgesia requirement, anxiety and stone-free rates (SFR) were compared. Seven papers were identified reporting on 591 patients (acupuncture-3, TENS-1 and music-3). Pain control/analgesia requirement was significantly better in four studies (music-2, acupuncture-1, TENS-1). Significantly lower anxiety was noted in one study with music and two using acupuncture. No difference in SFR was noted with the use of complementary therapy. No major or minor side effects were noted. Complementary therapy for SWL can help lower analgesia requirement and the anxiety associated with it. However, it does not have any effect on the SFR.

Does TENS Reduce the Intensity of Acute and Chronic Pain? A Comprehensive Appraisal of the Characteristics and Outcomes of 169 Reviews and 49 Meta-Analyses

“…Cochrane reviews evaluating TENS for oocyte retrieval [ 189 ], pain during orthodontic treatment and amniocentesis or chorionic villus sampling [ 190 ] failed to find any studies. A review on TENS for discomfort during shockwave lithotripsy [ 191 ] included only one study.…”

The Effect of Pre-Procedure Anxiety on Pain Perception During First Session of Shock Wave Lithotripsy

“…Immediately after the procedure, while patients were on the table, the degree of pain due to SWL was evaluated by using a 10-point visual analogue scale (VAS/0-10). All relevant data, such as age, sex, stone size, BMI, anxiety score, VAS score, were analysed by dividing the patients into three groups as low (0-3), intermediate (4)(5)(6) and high (8 and above), and total energy level of the lithotripter, skin-to-stone distance, and the number of the total shock wave were recorded. We performed statistical analysis in order to evaluate the effect of anxiety on pain perception during SWL by using all these data.…”

“…This may be one of the reasons for some patients to hesitate in preferring SWL treatment (3). At the same time, it is known that SWL procedure can cause significant anxiety influencing the success of the SWL treatment by decreasing patient compliance (4). Several clinical factors, such as sex, body mass index (BMI), delivery of shock wave energy for stone fragmentation and stone location, have been determined as predictive factors for SWL-related pain (5,6).…”