Impact of Anxiety Levels and Sleep Patterns on Perceived Pain During Intravitreal Bevacizumab Injections

BACKGROUND AND OBJECTIVE: To evaluate the impact of anxiety and sleep patterns on intravitreal injection pain. PATIENTS AND METHODS: This prospective, non-interventional study surveyed patients scheduled for intravitreal injection by two retinal surgeons. A standard intravitreal injection technique was used. Patients filled out pre-procedure General Anxiety Disorder-7 (GAD-7) and Pittsburgh Sleep Quality Index (PSQI) questionnaires. Post-procedural pain was assessed with a visual analogue scale. Quality and hours of sleep and anxiety levels were correlated with perceived intravitreal injection pain. RESULTS: A total of 140 patients met inclusion criteria. Mean +/- standard deviation scores were 4.9 +/- 5.6 for the GAD-7, 6.3 +/- 4.1 for the PSQI, and 3.69 +/- 2.64 for intravitreal injection pain. Anxiety correlated with intravitreal injection pain (rho = 0.25; P = .003). Previous night's sleep (rho = -0.16; P = .057) and poor sleep quality (rho = 0.14; P = .11) were weakly correlated. Regression analysis revealed anxiety was the only significant predictor of intravitreal injection pain. A 1-point increase in anxiety predicted a 0.10-point increase in intravitreal injection pain (B = 0.10, P = .032). CONCLUSIONS: Anxiety level was the best predictor of perceived pain. This has implications for preprocedural anxiety screening.

Automated summary

Anxiety level was found to be the best predictor of perceived pain during intravitreal injection, while sleep quality and hours showed weaker correlations with injection pain. These findings suggest the importance of preprocedural anxiety screening in managing pain perception.