Usefulness of a Visual Analog Scale for Measuring Anxiety in Hospitalized Patients Experiencing Pain: A Multicenter Cross-Sectional Study.

BACKGROUND: Anxiety is common in hospitalized patients and can worsen pain or lead to unsuccessful pain relief. AIMS: The purpose of this study was to evaluate the usefulness of measuring anxiety with a visual analog scale (VAS) in the hospitalized patient experiencing pain. DESIGN: We conducted a multiple-center cross-sectional study. PARTICIPANTS/SUBJECTS: Adult inpatients experiencing moderate to severe pain defined by a pain VAS score ≥40 of 100 were included. METHODS: Pain and anxiety data were collected using the following instruments: pain VAS, anxiety VAS, State Anxiety Scale of the Spielberger State-Trait Anxiety Inventory (STAI-YA) and Anxiety Subscale of the Hospital Anxiety and Depression Scale (HAD-A). RESULTS: Data were collected from 394 patients. Of those patients, 43.6% (171 of 392) and 36.6% (143 of 391) had significant anxiety according to STAI-Ya and HAD-A, respectively. Correlation was good between anxiety-VAS and STAI-YA (ρ = 0.67 [95% confidence interval 0.61-0.72]) and moderate between anxiety VAS and HAD-D (ρ = 0.48 [0.39-0.56]). The main factor predictive of situational anxiety was history of anxiety-depression symptoms (odds ratio = 2.95 [1.93-4.56]). For anxiety VAS score ≥ 40 of 100, the sensitivity for detecting anxiety was 81% with 70% specificity. CONCLUSION: This study confirmed the high prevalence of anxiety among inpatients experiencing pain, demonstrated the capacity of a VAS to assess this anxiety, determined an anxiety VAS cutoff level to screen for significant anxiety, and identified risk factors of anxiety in this population. Anxiety VAS has been found to be an easy-to-use method familiar to caregivers, with all the advantages needed for an effective screening instrument. An anxiety VAS score ≥40 of 100 would thus warrant particular attention to adapt care to the patient's anxiety-related pain and initiate specific therapeutic interventions.

Temporal pattern in consumption of the first drink of the day in alcohol-dependent persons.

Loss of control over drinking and the craving for alcohol are cardinal signs of alcohol dependence. Our clinical practice indicates that these cravings do not occur randomly during the day, but at the same times each day for the same patient. To validate this hypothesis that alcohol-dependent patients have a circadian rhythmic craving in their desire for their first drink of the day, we asked 217 persons diagnosed as alcohol-dependent according to DSM-IV criteria to complete a questionnaire that surveyed whether this craving occurred at a fixed time each day. Of the respondents, 82% reported it did; 87% of them could state the time of day they consumed their first daily drink; and 80% reported that the time of their first drink of the day did not vary much from one day to the next. The most frequent time of consuming the first drink of alcohol was between 09:00 and 11:00 h, and it was independent of the subjects' sleep-wake routine (the delay between the hours of wake-up and the time of the first urge for alcohol was 3:45 +/- 3:30 h) and lunch or dinner time. This rhythmicity seems to be a pertinent criterion for alcohol dependence syndrome.