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

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.