Investigating the Effect of Arnica Ointment and Distraction on the Pain Caused by Fistula Needle Insertion in Hemodialysis Patients: A Clinical Trial

Abstract

Background: Fistula needle insertion constantly exposes dialysis patients to pain, mitigation of which improves acceptance of hemodialysis and quality of life in these patients. Objectives: Therefore, the present research was conducted to investigate the effect of Arnica ointment and distraction on the pain caused by fistula needle in hemodialysis patients. Methods: This double-blind clinical trial was performed on 93 hemodialysis patients attending the dialysis wards of Ali Ibn Abi Talib and Khatam-al Anbia hospitals. The participants were chosen using the convenience sampling method and randomly assigned to three groups of Arnica ointment, distraction, and placebo. The pain intensity caused by arteriovenous needle insertion in two hemodialysis sessions was measured by visual analogue scale (VAS). Then, the collected data were analyzed by SPSS, version 22. P value less than 0.05 was considered statistically significant. Results: We found a significant difference in pain intensity between the Arnica and placebo groups and between the distraction and placebo groups (P < 0.001). Further, pain intensity in the Arnica group was significantly lower than in the distraction group (P < 0.001). Conclusions: Arnica ointment and distraction are palliative and convenient methods, which are even trainable to patients themselves. Considering the low cost of these methods, they are recommended to be applied before inserting the fistula needle.

Management Strategies for Pain Associated with Arteriovenous Fistula Cannulation: An Integrative Literature Review

“…No studies were found prior to 2004. In 66% (n = 23) of the reviewed articles a visual analog scale (VAS) was used to assess pain, 5,8,10,12,[14][15][16][17][18][19][20][21][22][23]30,32,34,[36][37][38][39]42,44 while in 22% (n = 8) a numerical rating scale (NRS) was used 13,24,25,29,31,35,40,41 ; three studies (8%) used the Wong-Baker scale, 26,27,33 and one study (3%) used a structured interview questionnaire and a subjective pain assessment tool. 8,[12][13][14][15][16][17]19,20,22,24,[26][27][28]30,[32]…”

“…No studies were found prior to 2004. The designs of the selected studies were randomized controlled trials (n = 14; 40%), 5,10,18,21,23,25,[29][30][31][35][36][37][38][39] and observational studies (n = 21; 60%). 8,[12][13][14][15][16][17]19,20,22,24,[26][27][28]30,[32][33][34][40][41][42]44 The reviewed literature indicated that the majority of patients being dialyzed using arteriovenous fistulas or grafts reported a moderate degree of cannulation pain.…”

“…8,[12][13][14][15][16][17]19,20,22,24,[26][27][28]30,[32][33][34][40][41][42]44 The reviewed literature indicated that the majority of patients being dialyzed using arteriovenous fistulas or grafts reported a moderate degree of cannulation pain. In 66% (n = 23) of the reviewed articles a visual analog scale (VAS) was used to assess pain, 5,8,10,12,[14][15][16][17][18][19][20][21][22][23]30,32,34,[36][37][38][39]42,44 while in 22% (n = 8) a numerical rating scale (NRS) was used 13,24,25,29,31,…”

“…44 Another approach was to apply cold therapy (cryotherapy) 10 minutes before cannulation to the arm contralateral to the fistula arm, at an acupuncture point on the dorsum of the hand between the thumb and forefinger (the so-called "Hegu" point 45 ), and this method was found to reduce cannulation pain significantly. 39 Aromatherapy has also been tried. These included asking the patient to find the differences between two similar pictures while performing the cannulation.…”

“…33 Another report used music and imagery from natural settings to produce a distraction effect; this technique was reported to result in some reduction of cannulation pain. 39 Aromatherapy has also been tried. This method includes pouring a small amount of lavender essence onto a cotton ball and asks the patient to inhale with the ball in front of the nose, immediately prior to insertion of the arteriovenous fistula needle.…”