The Effect of 4-7-8 Breathing Technique on Pain and Anxiety During Electromyography Procedure in Individuals With Type 2 Diabetes Who Have Diabetic Neuropathy: A Randomized Controlled Study

Diabetes is a progressive, chronic disorder characterized by β-cell damage in the pancreas and insulin resistance, leading to persistently elevated blood glucose levels. Genetic predisposition, along with factors such as insufficient physical activity and unhealthy diet, play a role in the development of diabetes. Type 2 diabetes is the most common type among all diabetes cases. This deterioration, if not effectively managed, leads to significant complications. Diabetic neuropathy is one of the most common complications of diabetes and is a neurodegenerative disorder of the peripheral nervous system. It presents with pain starting distally in the lower extremities, and controlled glycemic control plays a crucial role in its progression. Methods used in the definition of diabetic peripheral neuropathy include: Monofilament testing includes the assessment of needle prick sensation, temperature perception, ankle reflexes, and evaluation perception, as well as nerve conduction studies and electromyography (EMG).

Electromyography (EMG) is a clinical diagnostic method that evaluates the physical details of the muscular and nervous systems, and most patients may experience a certain level of pain and psychological discomfort, including anxiety and worry. According to the literature, the pain experienced by patients undergoing EMG varies depending on their age and education level. In addition, although the music played during EMG does not significantly reduce pain, it has been observed that the average pain relief, the lifespan of the device during the procedure, and the cost of the procedure are not negatively affected. A study found that written information study before the procedure and stress during electrodiagnostic tests reduced pain and anxiety. The International Association for the Study of Pain defines pain as an unpleasant sensory and emotional experience resulting from actual or potential tissue damage. Pain can be classified according to time, the region of origin, and parameters. Acute pain is a type of pain that begins suddenly with tissue damage, usually lasts less than three to six months, and decreases with the healing process, but can lead to anxiety, restlessness, and changes in vital functions in individuals. Non-pharmacological pain management methods can be divided into two main categories: peripheral techniques (massage, hot-cold application, TENS, acupuncture, menthol application, vibration, and therapeutic touch) and behavioral therapeutic methods (breathing exercises, relaxation, distraction, music). These methods are effective in both reducing pain perception and alleviating stress effects. These interruptions increase pain intensity and improve patient comfort through gate control theory, endorphin release, and distraction. One such strategy, the 4 7 8 breathing technique, involves interrupting the breath, optimizing tissue oxygenation by increasing oxygen uptake, and this mechanism contributes to prolonged muscle tension and reduced pain temperature. 478 breaths are performed as a four-second deep inhalation through the nose, a seven-second breath-hold, and an eight-second controlled exhalation through the mouth; this structure can relax vagal tone, add parasympathetic activity, and increase pain tolerance. Additionally, randomized controlled trials have shown that 478 breaths have positive outcomes in terms of psychological stress and functional impairment. Furthermore, non-pharmacological 478 breaths not only reduce patients' pain but also empower caregivers to manage their pain independently, enabling them to manage patient education and care practices; this holistic approach is enhanced for both the patient and caregiver.

H01: The 4-7-8 breathing technique applied during EMG procedures in individuals with type 2 diabetes and diabetic neuropathy has no effect on pain levels.

H11: The 4-7-8 breathing technique applied during EMG procedures in individuals with type 2 diabetes and diabetic neuropathy has an effect on pain levels.

H02: The 4-7-8 breathing technique applied during EMG procedures in individuals with type 2 diabetes and diabetic neuropathy has no effect on anxiety levels.