Non-pharmacological Interventions for Pain-Related Anxiety and Distress in Emergency Department Patients: A Systematic Review With Narrative Synthesis.

Pain-related anxiety, fear, and distress are common challenges in emergency departments and may influence pain perception, patient cooperation, satisfaction, and the overall care experience. This systematic review and narrative synthesis examined evidence on non-pharmacological interventions for pain intensity, emotional distress, patient experience, and analgesic-related outcomes among emergency department patients. A structured search was conducted from database inception to May 2026 using PubMed/MEDLINE, Semantic Scholar, Google Scholar, Elicit, publisher webpages, DOI checking, and citation tracking. Only English-language reports with sufficient extractable data were included. Eligible studies included original interventional, feasibility, pilot, quasi-experimental, quality improvement, and qualitative studies conducted in emergency department settings. Twenty-five studies were included in the qualitative synthesis, including randomized, pilot randomized, non-randomized, quality improvement, feasibility, and qualitative evidence. Interventions were grouped into music and sound-based interventions, virtual reality and distraction-based interventions, and acupuncture-based interventions, reflecting the main non-pharmacological approaches identified in the included emergency department literature. Overall, findings were more consistently favorable for short-term anxiety, fear, distress, coping, comfort, satisfaction, and patient experience than for pain intensity, which remained variable across studies. No pooled effect estimate was calculated because of substantial clinical and methodological heterogeneity, and individual study findings varied by intervention type, comparator, population, setting, outcome measure, and timing of assessment. Music and sound-based interventions showed possible short-term benefits for anxiety, comfort, and patient experience, but pain findings were mixed. Virtual reality and distraction-based interventions showed the most consistent favorable findings in pediatric and procedural contexts, particularly for anxiety, fear, coping, and distress, although analgesic effects were heterogeneous. Acupuncture showed preliminary favorable findings mainly in selected adult acute pain settings, but the evidence was limited by feasibility, quality improvement, and qualitative designs. Risk-of-bias concerns included small samples, limited blinding, subjective outcomes, heterogeneity in measurement tools, and short follow-up periods. Because GRADE was not performed, certainty of evidence was interpreted narratively and should be considered limited. Current evidence suggests possible short-term benefits from non-pharmacological interventions for pain-related emotional distress and patient experience in selected emergency department contexts, but definitive analgesic effectiveness, sustained benefit, and analgesic-sparing effects remain uncertain. Further adequately powered pragmatic trials are needed to determine clinically meaningful effects, analgesic-use and opioid-sparing outcomes, and real-world implementation feasibility.