The effect of non-pharmacological interventions on anxiety and pain in patients undergoing coronary angiography: A systematic review and network meta-analysis

BackgroundPatients undergoing coronary angiography are susceptible to some discomforts, including anxiety and pain; hence, non-pharmacological interventions are being increasingly employed to alleviate these symptoms.ObjectiveOur aim was to investigate and contrast the effects of a number non-pharmacological therapies on alleviating anxiety and pain sensations, and to determine the most efficacious approach for patients experiencing anxiety and pain during coronary angiography.MethodsWe performed a systematic search of PubMed, Web of Science, Embase, the Cochrane Library, Scopus, Chinese National Knowledge Infrastructure, and Wan-fang Data, from the inception of each database until December 25, 2025. The principal end measure was anxiety level, with the secondary outcome encompassing pain level. Pairwise meta-analyses and network meta-analyses were performed using RevMan 5.4.1, Stata 17, and R 4.3.1.ResultsA total of 77 studies were included, comprising 71 randomized controlled trials and six quasi-experimental studies, with an aggregate of 8199 participants across 10 distinct interventions: virtual reality, relaxation therapy, music therapy, education, reflexology therapy, acupressure, aromatherapy, stress ball, psychotherapy, and bed angle changes. The findings indicated that reflexology therapy serves as an effective non-pharmacological intervention for individuals experiencing anxiety during coronary angiography, resulting in a significant reduction of anxiety symptoms when compared to the control group. For patients undergoing coronary angiography with anxiety symptoms, reflexology therapy, relaxation therapy, acupressure, and virtual reality, music therapy, and education all improve anxiety symptoms. In patients undergoing coronary angiography with painful symptoms, stress ball, virtual reality, acupressure, bed angle changes, and music therapy, demonstrated significant improvements in pain symptoms. Stress ball was prioritized in the rankings.ConclusionsThis study's findings demonstrate that the application of reflexology therapy, relaxation therapy, acupressure, virtual reality, music therapy, and education are effective interventions for alleviating anxiety symptoms during coronary angiography. Furthermore, the implementation of stress ball, virtual reality, acupressure, bed angle changes, and music therapy resulted in a decrease in pain symptoms in comparison to the control group. Especially, in the rankings, reflexology therapy and stress ball were prioritized for alleviating anxiety and pain symptoms in patients undergoing coronary angiography.RegistrationThe review protocol was registered at PROSPERO (CRD420251006401). © 2026 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.