Patient-Reported and Physiologic Markers of Pain and Anxiety during High-Resolution Manometry: An Exploratory Study

Abstract

Abstract Introduction Although HRM is widely considered a well-tolerated and minimally invasive procedure, pain and anxiety are reported by patients. We aimed to investigate whether patient-reported and physiologic indicators of procedure-related pain and anxiety are associated with high-resolution manometry (HRM) findings at rest and during swallowing. Methods HRM data and patient-reported measures and physiologic indicators of pain and anxiety were collected from 36 outpatient adults. Multivariable linear regression models were used to assess the associations between pain/anxiety and upper esophageal sphincter (UES)/lower esophageal sphincter pressures and esophageal motility outcomes. Predictor variables included (1) a validated visual analogue scale (VAS) of self-reported pain; (2) the State Trait Anxiety Inventory (STAI) sum score; (3) the Short-Form McGill Pain Questionnaire (SFMPQ); (4) heart rate before the procedure (HR); and (5) average slope of galvanic skin response (GSRslope). Relationships were assessed both at rest for basal measures and during swallowing for peristaltic measures. Results Few statistically significant relationships were observed between patient-reported measures or physiologic indicators of anxiety/pain with esophageal or sphincter measures. However, UES mean residual pressure during swallowing was negatively associated with VAS pain ratings (p = 0.04) and the GSRslope (p = 0.01). Additionally, as SF-MPQ increased, the percentage of intact swallows decreased (adjusted R2 = 0.146; p = 0.012). Conclusion UES resting pressure during HRM procedures was not significantly associated with patient-reported anxiety or pain. However, we saw a small statistically significant inverse association between UES mean residual pressure and patient-reported pain and physiologic arousal (GSRslope). Future research may benefit from continuous physiologic monitoring throughout HRM procedures and from inclusion of a larger sample with more diverse pathology.