Issue 24-4, 2025

Original article

https://doi.org/10.38025/2078-1962-2025-24-4-67-75

Response of Arteriovenous Fistula Puncture-Related Pain to Different Cryotherapy Applications in Hemodialysis Patients: a Randomized Controlled Study

View article (Download PDF file)



Download XML file

ORCIDSara F. Ghoneem1,*, ORCIDNagwa Hamed2, ORCIDSahier O. El-Khashab2, ORCIDAlaa M. El-Moatasem2

1 Cairo University Hospitals Al-kasr Alainy, Cairo, Egypt
2 Cairo University, Giza, Egypt


ABSTRACT

INTRODUCTION.  Patients receiving continuous hemodialysis commonly experience pain associated with arteriovenous fistula puncture. Relieving the pain may increase their appreciation of the procedure and hence their quality of life.

AIM.  To find out how different ways of applying cryotherapy changed the pain of arteriovenous fistula punctures in hemodialysis patients.

MATERIALS AND METHODS.  During the seven weeks of this randomized controlled study, ninety hemodialysis patients of both sexes with end-stage renal disease who had received medical treatment were allocated to one of three groups at random: ipsilateral (received cryotherapy at the site of needle insertion), contralateral (received cryotherapy at the site opposite to the needle insertion), or control (followed medical treatment without cryotherapy application). Cryotherapy was applied for five to ten minutes, three times a week. Prior to and following the seven-week intervention period, assessments of upper limb function (by Arm Motor Ability Test), pain severity (by Visual Analogue Scale), beside anxiety and depression (by Hospital Anxiety and Depression Scale) were carried out.

RESULTS AND DISCUSSION.  The final results showed that all evaluated outcomes improved after the intervention, with no statistically significant difference between the ipsilateral and contralateral groups (p ≥ 0.05). Yet, when comparing the contralateral or ipsilateral groups to the control group, all parameters had statistically significant differences (p < 0.05).

CONCLUSION.  For hemodialysis patients, cryotherapy is one of the best ways to manage pain from arteriovenous fistula punctures, upper limb dysfunction, depression, and anxiety.

REGISTRATION:  Clinicaltrials.gov identifier No. NCT06520631, registered 04.08.2024.


KEYWORDS: anxiety, arteriovenous fistula, cryotherapy, pain measurement, renal dialysis

FOR CITATION:

Ghoneem S.F., Hamed N., El-Khashab S.O., El-Moatasem A.M. Response of Arteriovenous Fistula Puncture-Related Pain to Different Cryotherapy Applications in Hemodialysis Patients: a Randomized Controlled Study. Bulletin of Rehabilitation Medicine. 2025; 24(4): 67–75. https://doi.org/10.38025/2078-1962-2025-24-4-67-75

 

FOR CORRESPONDENCE:

Sara Fathy Ghoneem, Е-mail: saraghoneem581@gmail.com, alaamotasem@cu.edu.eg


References:

  1. Dinis M., Sousa J.P. A Pilot Randomised Controlled Trial on the Effectiveness of an Anti-Stress Ball Technique for Pain Reduction during Vascular Access Cannulation in Haemodialysis Patients. Nurs Rep. 2023; 13(2): 731–739. https://doi.org/10.3390/nursrep13020064
  2. Bello A.K., Okpechi I.G., Osman M.A., et al. Epidemiology of peritoneal dialysis outcomes. Nat Rev Nephrol. 2022; 18(12): 779–793. https://doi.org/10.1038/s41581-022-00623-7
  3. Duncanson E.L., Chur-Hansen A., Le Leu R.K., et al. Dialysis Needle-Related Distress: Patient Perspectives on Identification, Prevention, and Management. Kidney Int Rep. 2023; 8(12): 2625–2634. https://doi.org/10.1016/j.ekir.2023.09.011
  4. Back Y., Lee Y. Optimal Time of Thermotherapy for Reducing Pain, Anxiety, and Side Effects in Arteriovenous Fistula Puncture Patients: A Randomized Controlled Trial. Int J Environ Res Public Health. 2020; 17(19): 7147. https://doi.org/10.3390/ijerph17197147
  5. Harris T.J., Nazir R., Khetpal P., et al. Pain, sleep disturbance and survival in hemodialysis patients. Nephrol Dial Transplant. 2012; 27(2): 758–765. https://doi.org/10.1093/ndt/gfr355
  6. Montenegro J., Klein M.R.S.T., Bregman R., et al. Osteosarcopenia in patients with non-dialysis dependent chronic kidney disease. Clin Nutr. 2022; 41(6): 1218–1227. https://doi.org/10.1016/j.clnu.2022.04.017
  7. Jafari-Koulaee A., Moosazadeh M., Bagheri Nesami M., Goudarzian A.H. Effect of cryotherapy on arteriovenous fistula puncture-related pain in hemodialysis patients: A systematic review and meta-analysis. Complement Ther Med. 2020; 49: 102326. https://doi.org/10.1016/j.ctim.2020.102326
  8. Kortobi L., Belymam H., Chkairi N.M., et al. Management of pain at arteriovenous fistula puncture: Cryotherapy versus lidocaine/prilocaine. Saudi J Kidney Dis Transpl. 2020; 31(3): 597–603. https://doi.org/10.4103/1319-2442.289446
  9. Koushki B., Khajeh M., Bagheri H., et al. Comparing the Effect of Local Application of Peppermint and Cold Compresses on the Severity of Pain from Venipuncture in Dialysis Patients: A Parallel Randomized Clinical Trial Study. Saudi J Kidney Dis Transpl. 2023; 34(4): 288–296. https://doi.org/10.4103/1319-2442.395444
  10. Delgado D.A., Lambert B.S., Boutris N., et al. Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults. J Am Acad Orthop Surg Glob Res Rev. 2018; 2(3): e088. https://doi.org/10.5435/JAAOSGlobal-D-17-00088
  11. Page S.J., Levin L., Hermann V., et al. Longer versus shorter daily durations of electrical stimulation during task-specific practice in moderately impaired stroke. Arch Phys Med Rehabil. 2012; 93: 200–206. https://doi.org/10.1016/j.apmr.2011.09.016
  12. Singer B.J., Vallence A.M., Cleary S., et al. The effect of EMG triggered electrical stimulation plus task practice on arm function in chronic stroke patients with moderate-severe arm deficits. Restor Neurol Neurosci. 2013; 31: 681–691. https://doi.org/10.3233/rnn-130319
  13. Wong A.W., Danoff S.K. Providing Patient-Centered Care in Interstitial Lung Disease. Clin Chest Med. 2021; 42(2): 337–346. https://doi.org/10.1016/j.ccm.2021.03.003
  14. Brekelmans A.C.M., Ramnarain D., Pouwels S. Bereavement Support Programs in the Intensive Care Unit: A Systematic Review. J Pain Symptom Manage. 2022; 64(3): e149–e157. https://doi.org/10.1016/j.jpainsymman.2022.05.008
  15. Sheha M. Effectiveness of cryotherapy related pain management among patients undergoing hemodialysis at the site of arteriovenous fistula puncture. World J Nurs Sci. 2019; 5(3): 97–103. https://doi.org/10.5829/idosi.wjns.2019.97.103
  16. Gerogianni G. Factors Affecting Pain in Hemodialysis and Non-pharmacological Management. Cureus. 2023; 15(2): e35448. https://doi.org/10.7759/cureus.35448
  17. Sabitha P.B., Khakha D.C., Mahajan S., et al. Effect of cryotherapy on arteriovenous fistula puncture-related pain in hemodialysis patients. Indian J Nephrol. 2008; 18(4): 155–158. https://doi.org/10.4103/0971–4065.45290
  18. Yan L.J., Zhang F.R., Ma C.S., et al. Arteriovenous Graft for Hemodialysis: Effect of Cryotherapy on Postoperative Pain and Edema. Pain Manag Nurs. 2019; 20(2): 170–173. https://doi.org/10.1016/j.pmn.2018.07.002
  19. Melzack R., Wall P.D. Pain mechanisms: A new theory. Science. 1965; 150: 171–179. https://doi.org/10.1126/science.150.3699.971
  20. Melzack R., Jeans M.E., Stratford J.G., Monks R.C. Ice massage and transcutaneous electrical stimulation: Comparison of treatment for low-back pain. Pain. 1980; 9: 209–217. https://doi.org/10.1016/0304-3959(80)90008-1
  21. Hochberg J. A randomized prospective study to assess the efficacy of two cold-therapy treatments following carpal tunnel release. J Hand Ther. 2001; 14(3): 208–215. https://doi.org/10.1016/s0894-1130(01)80055-7
  22. Knobloch K., Kraemer R., Lichtenberg A., et al. Microcirculation of the ankle after Cryo/Cuff application in healthy volunteers. Int. J. Sports Med. 2006; 27(03): 250–255.
  23. Abdrabouh M.A., Abd Allah E.S., Mohamed R.A., Alam R.R. Pain and Anxiety among Hemodialysis Elderly Patients after Cryotherapy Intervention. Tob Regul Sci. 2022; 2744–2756.
  24. Lu H.Y., Lin M.Y., Tsai P.S., et al. Effectiveness of Cold Therapy for Pain and Anxiety Associated with Chest Tube Removal: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Manag Nurs. 2024; 25(1): 34–45. https://doi.org/10.1016/j.pmn.2023.04.016
  25. Sajedi-Monfared Z., Rooddehghan Z., Haghani H., et al. Cold Therapy and Respiratory Relaxation Exercise on Pain and Anxiety Related to Chest Tube Removal: A Clinical Trial. Iran J Nurs Midwifery Res. 2021; 26(1): 54–59. https://doi.org/10.4103/ijnmr.IJNMR_228_19
  26. Sheng J., Liu S., Wang Y., et al. The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Neural Plast. 2017; 2017: 9724371. https://doi.org/10.1155/2017/9724371
  27. Garcia C., Karri J., Zacharias N.A., Abd-Elsayed A. Use of Cryotherapy for Managing Chronic Pain: An Evidence-Based Narrative. Pain Ther. 2021; 10(1): 81–100. https://doi.org/10.1007/s40122-020-00225-w
  28. Oswald G., Francis J., Dhakal S. Behavioral and Physiological Interventions for Anxiety and Depression: An Overview of Nontraditional Methods. J. Creat. Ment. Health. 2019; 14(4): 455–464. https://doi.org/10.1080/15401383.2019.1626314
  29. Feys P., Duportail M., Kos D., et al. Effects of Peripheral Cooling on Upper Limb Tremor Severity and Functional Capacity in Persons with MS. J Clin Med. 2023; 12(13): 4549. https://doi.org/10.3390/jcm12134549
  30. Kalli K., Fousekis K. The effects of cryotherapy on athletes’ muscle strength, flexibility, and neuromuscular control: A systematic review of the literature. J Bodyw Mov Ther. 2020; 24(2): 175–188. https://doi.org/10.1016/j.jbmt.2019.11.001
  31. Durairaj S., Dhaneshkumar K.U., Rajasenthil K., Thakur A. A study to find the effectiveness of cryotherapy with task oriented training in improving upper limb function in hemiplegic cerebral palsy. Int J Physiother Res 2018; 6(1): 2595–2599. https://doi.org/10.16965/ijpr.2017.260
  32. Zampieri N., de Nooij J.C. Regulating muscle spindle and Golgi tendon organ proprioceptor phenotypes. Curr Opin Physiol. 2021; 19: 204–210. https://doi.org/10.1016/j.cophys.2020.11.001
  33. Pogatzki-Zahn E.M., Segelcke D., Schug S.A. Postoperative pain-from mechanisms to treatment. Pain Rep. 2017; 2(2): e588. https://doi.org/10.1097/PR9.0000000000000588



Creative Commons License
The content is available under the Creative Commons Attribution 4.0 License.

©


This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.