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 pre-procedural anxiety screening.