SRF058: Testing the effects of hand-holding with a supportive other on anxiety and pain related to injection procedures

Sarah Woods, PhD; Angela Hiefner, PhD, LMFT, LPC; Alexis Goswitz; Turya Nair, MD


Context: Prior research has demonstrated a powerful effect of social support on pain, especially hand-holding with supportive significant others in lab-created pain scenarios. Hand-holding has been shown to reduce distress, anxiety, and pain in experimental research. Hand-holding thus has the propensity to decrease joint injection pain and anxiety, and increase acceptability and efficacy of this type of treatment. However, this association has yet to be tested in a clinical setting, despite its promise as a low-cost pain intervention for use in primary care. Objective: The purpose of the present project is to test the effects of hand-holding with a supportive other on anxiety and pain specifically related to large joint injection procedures, compared to treatment as usual. Human Subjects Review: Subject to full-board IRB review and approval. Design: Randomized controlled trial. Setting: The setting for this project includes a primary care ambulatory practice in a large, southern metropolitan area. Patient participants between the ages of 18 and 80 are recruited when scheduled for a first-time shoulder or knee steroidal injection for pain. Patients are excluded if they or their support person spoke a language other than English or had an educational level less than 8th grade. Patients are also excluded if they were diagnosed with dementia or cognitive limitations, or if they were unable to bring a support person (pre-randomization). Intervention: Participants are randomly assigned to one of three conditions: (1) holding hands with a support person, (2) presence of a support person without hand-holding, or (3) treatment as usual. Prior to the injection procedure, all patient participants complete a demographic questionnaire and survey. All support persons also complete the demographic questionnaire and survey. Main Outcome Measures: In order to assess intervention-related differences in injection pain and anxiety, participants complete the brief State Trait Anxiety Inventory and a pain visual analog scale. Anticipated Results: Data will demonstrate significantly less anxiety and pain during a steroid injection for patients in the support person hand-holding condition, compared to treatment-as-usual. Conclusions: The presence, and touch, of a support person may reduce patients’ experiences of joint injection-induced anxiety and pain, representing a no-cost primary care treatment option easily adapted from lab-based research.
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Bill Kerns 11/21/2020

Great project. Would love to know results. Also wonder about hand-holding with a support person from within the medical practice, if a previous relationship with that person. Thank you!

Jack 11/21/2020

this is a great study and really asks the question about how we are present with our patients and what is the impact. i was intrigued when i had small children that kissing their "owie" made the pain go away and they often felt better. While we can't kiss patients, what are the physical components of care that provide relief from suffering? thanks for this research.

Bill Phillips 11/23/2020

Great research question and study. It stimulates lots of additional questions. I'll be interested to see if the shoulder versus knee injections are different, as the shoulder pain may somehow blocks the handholding effect. Will the support person hold the injected side or the other side or maybe you can randomize that if you have enough pts. I also want to know about the difference in effect between a personal/family support person and a" neutral"person, perhaps an office staff member. Interested in your results. (Hope to see them here at NAPCRG next year.)

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