Music during interventional radiological procedures, effect on sedation, pain and anxiety: a randomised controlled trial

Influence of visual objects and music on anxiety levels and imaging process in patients undergoing coronary CT angiography

OBJECTIVE

High anxiety during coronary computed tomography angiography (CCTA) can compromise imaging quality, increase radiation exposure, and elevate medication use. Therefore, optimizing waiting room environments to reduce patient anxiety is important for clinical outcomes. This study examines the effects of music and visual stimuli in the waiting rooms on patients' anxiety levels, heart rate, radiation dose, and beta-blocker use prior to CCTA.

METHODS

This study, designed as a prospective and randomized trial, was conducted between April 15 and August 15, 2024, with 216 patients randomized into two groups: a standard waiting room (SWR) and a designed waiting room (DWR) featuring music and visual objects. Anxiety and depression levels were measured using the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI). Additional parameters, such as heart rate, radiation dose, and beta-blocker requirement, were also recorded.

RESULTS

In the DWR group, anxiety scores and heart rates were significantly lower compared to the SWR group (p < 0.001). Additionally, a notable reduction in radiation dose and beta-blocker use was observed in the DWR group (p < 0.05). In the general patient population, higher anxiety scores were associated with poorer imaging quality. Imaging quality was significantly better in the DWR group (p < 0.001).

CONCLUSION

It has been demonstrated that waiting room designs enriched with music and visual stimuli reduce anxiety during CCTA scanning, enhancing patient comfort, improving imaging quality, and enabling imaging with lower radiation doses. The design of such waiting rooms can improve patient experience while optimizing outcomes.

KEY POINTS

Question Can a waiting room with music and visual stimuli reduce anxiety and heart rate in CCTA patients, improving imaging quality and reducing beta-blocker use? Findings Music and visual stimuli reduced anxiety and heart rate, lowering beta-blocker use and radiation doses while improving imaging quality in CCTA. Clinical relevance Integrating music and visual stimuli in waiting rooms helps reduce anxiety and heart rate, leading to less medication use and radiation exposure while enhancing imaging quality. This simple, cost-effective approach improves patient comfort and optimizes outcomes in CCTA procedures.

Effects of a music-based intervention on psychophysiological outcomes of patients undergoing medical imaging procedures: A systematic review and meta-analysis

INTRODUCTION

Musical intervention (MI) is a valuable strategy for addressing the psychological and emotional challenges faced by patients undergoing imaging procedures. This study explores MI's impact on psychophysiological outcomes during imaging procedures, detailing the sound repertoire and technical characteristics employed in MI.

METHODS

A systematic review (SR) and meta-analysis (MA) were conducted. Electronic database searches of PubMed, Web-of-Science, and Scopus were performed encompassing original randomised research and quasi-experimental articles published until June 2023.

RESULTS

Thirteen articles were included in this SR, scoring between 23 and 68 on the Joanna Briggs Institute (JBI) Checklist. Four articles were included to perform a MA concerning anxiety and heart rate (HR) outcomes. Most studies utilised digital playlists as the medium for MI. Headphones were commonly used, with an average volume of 50-60 dB and a musical frequency of 60-80 beats/min. While authors generally preferred selecting musical genres for the repertoire, two articles specifically chose Johann Pachelbel's "Canon in D major" as their musical theme. In terms of psychological parameters, the experimental groups exhibited lower anxiety values than the control groups, with further reductions after MI. However, MA shows that this trend is only marginally significant. Patient comfort and overall examination experience showed improvement with MI. Regarding physiological parameters, HR, especially in the final phase of the examination, was significantly lower in the experimental group compared to the control group.

CONCLUSION

Across multiple studies, MI demonstrated the ability to reduce anxiety and HR. However, no specific music repertoire emerged as the most effective.

IMPLICATIONS FOR PRACTICE

MI arises as a painless, reliable, low-cost, and side-effect-free strategy, presenting imaging departments with a practical means to enhance patient comfort and mitigate anxiety and stress during medical procedures.

Effect of Music on Anxiety and Pain Levels of Patients Undergoing Thyroid Fine Needle Aspiration Biopsy: A Randomized Controlled Study

RATIONALE AND OBJECTIVES

Despite being a minimally invasive procedure, biopsy can cause pain and anxiety in patients. Therefore, it is important to reduce the pain and anxiety levels of patients. The present study aims to investigate the effect of music on patient anxiety and pain levels during thyroid fine needle aspiration biopsy.

MATERIALS AND METHODS

In this randomized controlled single-blind study, a validated State-Trait Anxiety Inventory (STAI) consisting of 40 questions in total was used to evaluate patient anxiety rates. The STAI consists of two sections: the state anxiety scale (SAS) measuring instant anxiety and the trait anxiety scale measuring general anxiety. Patients were divided into two groups: Group 1 those who did not listen to music during a biopsy and group 2 those who listened to music. The Visual Analogue Scale was used to evaluate patient pain levels.

RESULTS

Group 1 consisted of 46 patients and Group 2 consisted of 45 patients. After the procedure, the mean SAS scores of Groups 1 and 2 were not significantly different (p = 0.24). However, The state anxiety scale differences, which represents the decrease in pre-procedure and post-procedure anxiety levels (SAS1-SAS2) was statistically different among the groups (p = 0.01). There was a significant difference between the two groups in terms of VAS score distribution (p = 0.01).

CONCLUSION

Music therapy is an easily applicable, cheap, and safe method that can be used to decrease anxiety and pain levels in patients during thyroid biopsy as evidenced by this research.

Improving the patient experience during musculoskeletal interventional procedures

In the patient-centered practice of musculoskeletal interventional radiology, pre-procedure, intra-procedure, and post-procedure factors impact the patient's overall experience. Opportunities to improve the patient experience begin before the patient procedure starts, with smooth scheduling of the appointment, a positive office environment, and appropriate communication by the musculoskeletal interventional radiology staff before the procedure, including clear expectations regarding wait times. The initial conversation between the radiologist and the patient, including the informed consent process, is a crucial opportunity for creating rapport with the patient and generating trust in the radiologist. Being able to interpret a patient's verbal and non-verbal cues during this conversation can reduce anxiety and enhance relaxation. During the procedure, there are interventions which can decrease anxiety and reduce the perception of pain by the patient. These include psychological interventions such as self-induced hypnosis, communication-based interventions such as empathic communication to mold a patient's interpretation of anxiety and painful stimuli, and the use of ancillary tools such as music or video stimulation. Finally, clear post-procedure expectations regarding post-procedure pain and its management and assurances of access to the musculoskeletal interventional radiology team can facilitate an uncomplicated post-procedure recovery.

"This Won't Hurt a Bit": Is There a Role for Music in Bedside Procedures?

Music has played a long and storied role in clinical healing. However, the integration of music into clinical practice has been slow to gain traction, despite a recent meta-analysis demonstrating association of music interventions with clinically meaningful improvements in health-related quality of life. There is growing evidence that music has an active role in reducing patient pain and anxiety as well as affecting physiologic parameters, such as heart rate and blood pressure, in an ICU setting. Past studies have shown that incorporation of music into procedures in the operating room, radiology suites, and catheterization labs has reduced concurrent pharmacologic sedation requirements. In the age of patient-centered personalized medicine, we propose a call to action to implement an easily accessible, attainable checklist item offering a personal choice of music for patients during standardized bedside procedural training, to reduce anxiety, pain, and pharmacologic sedation and potentially improve clinical outcomes.

The effect of alpha binaural beat music on orthodontic pain after initial archwire placement: A randomized controlled trial

OBJECTIVE

The objective of this article was to evaluate the effect of alpha binaural beat music on pain level after initial placement of a maxillary fixed appliance, compared to music without binaural beats (placebo) and no music (control).

METHODS

60 patients undergoing maxillary fixed orthodontic appliance and initial archwire placement were randomly allocated into the three aforementioned groups. The pain level experienced was monitored for the following seven days, using the short-form McGill pain questionnaire (SF-MPQ).

RESULTS / DESCRIPTORS

Intensity of both sensory and psychological aspects of pain reduced significantly in the binaural beat music (BBM) group, compared to the control, after the 5th day. Statistically significant lower affective and total pain scores were also found on day 6 for the placebo group, compared to the control. Present Pain Intensity (PPI): Statistically significant lower scores were found between the BBM group and the control group from days 3 to 7. Statistically significant lower scores were also found between the placebo and the control groups on days 4, 5 and 6. Visual Analog Scale (VAS): Compared to the control group, the placebo group had a lower VAS score on day 4, and the BBM group had lower scores on days 6 and 7.

CONCLUSIONS

There was a significant reduction of pain demonstrated in the BBM group, compared to the control, toward the end of the first week of treatment. There was no difference in reported pain between the BBM and placebo groups for any of the scores.

Does Music during Image-Guided Procedures Reduce Patient Anxiety Levels?

Anxiety is a psychological condition that can affect anyone at any given point of time. Patients undergoing interventions are especially prone to anxiety. Several studies have shown that music can be efficacious in calming patients in the hospital setup. In this study, we studied the effect of music in the context of image-guided interventions such as biopsies, fine-needle aspiration cytology, thoracocentesis, and paracentesis. It was found that there was a substantial reduction in the rise of systolic blood pressure, diastolic blood pressure, heart rate, and a reduction in the State-Trait Anxiety Inventory state anxiety inventory scale values in the music group as compared with the control group during the procedure which was also statistically significant (p = 0.001). Music can be an exceptional tool in patient anxiety reduction as it is widely available, economical, and easy to dispense. Based on these results, we can conclude that patients undergoing image-guided procedures should be offered a choice to listen to music of their preference to reduce situational anxiety levels.

A prospective randomized controlled trial assessing the effect of music on patients' anxiety in venous catheter placement procedures

The aim of the study was to assess the influence of music on anxiety levels compared to standard patient care in patients undergoing venous catheter placement procedures. This prospective randomized controlled trial included patients undergoing placement procedures for peripherally inserted central venous catheters (PICC), ports and central venous catheters (CVC). Patients were randomly assigned to a music intervention group (MIG) and a control group (CTRL). State and trait anxiety levels were assessed as primary outcome using the state-trait anxiety inventory (STAI) before and after the procedures. Secondary outcomes comprised averaged heart rate for all participants and time of radiological surveillance for port placement procedures exclusively. 72 participants were included into the final analysis (MIG n = 40; CTRL n = 32). All procedures were successful and no major complications were reported. Mean levels for post-interventional anxieties were significantly lower in the MIG compared to the CTRL (34.9 ± 8.9 vs. 44 ± 12.1; p < 0.001). Mean heart rate in the MIG was significantly lower than in the CTRL (76.1 ± 13.7 vs. 93 ± 8.9; p < 0.001). Procedure time for port implantation was significantly longer in the MIG by 3 min 45 s (p = 0.031). Music exposure during central venous catheter placement procedures highly significantly reduces anxiety and stress levels and can be used to improve patients’ overall experience in the angio suite.

Impact of Acoustic Noise Reduction on Patient Experience in Routine Clinical Magnetic Resonance Imaging

OBJECTIVES

Acoustic noise emission from MRI scanners is considered a major factor of patient discomfort during routine MRI examinations. We prospectively evaluated the impact of acoustic noise reduction using software implementations in routine clinical MRI on subjective patient experience and image quality.

METHODS

Two-hundred consecutive patients undergoing one of four MRI examinations (brain, lumbar spine, shoulder, and knee) at a single center were prospectively randomized into two groups at a 1 to 1 ratio: standard MRI examination and MRI examination with acoustic noise reduction. After the examination, patients were asked to complete a questionnaire aimed at defining their subjective experience (primary endpoint). Two readers assessed subjective image quality of all patient studies in consensus (secondary endpoint). Nonparametric tests and logistic regression models were used for statistical analysis.

RESULTS

Hundred-seventy-four patients were included in the final study. Patients in the intervention group felt less discomforted by the acoustic noise (p = 0.01) and reported increased audibility of music through the headphones (p = 0.03). No significant difference in subjective image quality was found.

CONCLUSION

Our study indicates that the effects of acoustic noise reduction in routine clinical MRI can be translated into reduced patient discomfort from acoustic noise and improved audibility of music. Acoustic noise reduction thus significantly contributes to increased patient comfort during MRI examinations.

Music reduces patient-reported pain and anxiety and should be routinely offered during flexible cystoscopy: Outcomes of a systematic review

Objective: To conduct a systematic review of the literature to assess whether music reduces the use of analgesics and anxiolytics during flexible cystoscopy.

Methods: The systematic review was performed in line with the Cochrane guidelines and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. The databases searched included the Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Clinicaltrials.gov, the Excerpta Medica dataBASE (EMBASE), Cochrane library, Google Scholar, and Web of Science from inception of the databases to February 2020. The primary outcome measure was the effect of music on pain and anxiety, and secondary outcome measures were patient heart rate and blood pressure.

Results: The initial search yielded 234 articles and after going through titles and abstracts, four studies (399 patients, 199 in the music group and 200 in no music group) were included for the final review. There were three randomised controlled trials and one prospective study published between 2014 and 2017. These studies were done in China, the USA and Italy, with the study duration between 9 and 24 months. All patients had 2% topical lignocaine jelly given per-urethra before the procedure. The choice of music was classical in three studies and a mixture of different music types in one study. Three of the four studies showed significantly reduced pain and anxiety with the use of music for flexible cystoscopy procedures. Heart rate was noted to be higher for the no music group, reflecting a higher pain perceived by these patients.

Conclusion: The present review showed that listening to music was associated with reduced anxiety and pain during flexible cystoscopy. Listening to music is therefore likely to increase procedural satisfaction and willingness to undergo the procedure again, considering repeated flexible cystoscopy is often needed for surveillance. As music is simple, inexpensive and easily accessible, it should be routinely offered to patients for outpatient and office-based urological procedures.

Abbreviations: IQR: interquartile range; NRS: numerical rating scale; PTSD: post-traumatic stress disorder; RCT: randomised control trial; STAI: State–trait Anxiety Inventory; VAS: visual analogue scale

Music's effect on pain relief during outpatient urological procedures: a single center, randomized control trial focusing on gender differences

Background

Listening to preferred music can provide distraction and reduce the feeling of pain and negative emotions associated with an uncomfortable experience. Several studies have examined how music can reduce pain and anxiety related to urological procedures that are not typically performed under anesthesia, such as cystoscopy, cystoscopy with stent pull, and urodynamic studies. To our knowledge, no studies have been done to examine the effect of listening to preferred music generalized across a variety of these procedures. Therefore, we looked to combine multiple factors from prior studies to determine if listening to music of a patient’s choice would decrease pain during various outpatient clinic urological procedures, and to examine differences between men and women.

Methods

This was a single investigator series randomized controlled trial with 91 subjects in an academic outpatient urology clinic. After applying exclusion criteria, eligible patients were randomized to a music group or non-music group via coin flip. Fifty-three patients were in the music group (16 men, 37 women) and 38 patients were in the non-music group (16 men, 22 women). Subjects in the music group selected a song to play during the procedure, which was stopped at the conclusion of the procedure. Pre- and post-procedure Visual Analog Pain Scale were completed by the subjects of each group and subsequently analyzed. Where appropriate either Pearson’s Chi-Square or Independent-Sample t-test were used to compare the groups as well as randomized-repeated analysis of variance (ANOVA).

Results

For men, pain scores worsened in both groups, however the music group experienced a statistically significant increase in pain (mean change =1.0, P=0.05), while the non-music group only clinically worsened (mean change =0.38, P=0.459). For women, the music group noticed an improvement in the pain score (mean change =−0.14, P=0.590), while the non-music group significantly worsened (mean change =1.14, P=0.008).

Conclusions

Women who listened to music of their choosing experienced significant improvement in overall perceived pain compared to women who did not listen to music. Women may benefit from music as a novel tool to alleviate pain during outpatient clinic urological procedures.

Effects of anxiety-related psychological states on music-induced analgesia in cold pressor pain responses

CONTEXT

The analgesic effect of music has long been reported.

OBJECTIVE

To assess how anxiety-related psychological states affect the analgesic effect of music using the cold pressor task (CPT).

DESIGN

A 3-period × 3-sequence crossover design was adopted; three conditions were used: "no sound," "music-listening," and "news-listening."

SETTING

PARTICIPANTS: Forty-nine participants were included.

INTERVENTIONS

After completing five anxiety-related psychological instruments (Anxiety Sensitivity Index [ASI]-16, ASI-Revised, State-Trait Anxiety Inventory [STAI]-S, STAI-T, and Pain Anxiety Symptoms Scale-20), the participants were allocated to the low- or high-anxiety group. The high- and low-anxiety groups were defined based on cutoff points according to the distributions and characteristics of the five instruments.

MAIN OUTCOME MEASURES

Pain responses, such as pain tolerance time, pain intensity, and pain unpleasantness, were measured on the CPT. Pain responses in the music-listening condition were also compared to those in the other two conditions via pairwise comparisons within each anxiety group.

RESULTS

The Cronbach alpha of the five instruments ranged from 0.866 to 0.95, indicating that they were reliable. Pain responses in the music-listening condition in the low-anxiety groups based on any of the five scales were significantly different from those in the other conditions, but this effect was not found in the high-anxiety groups. This study demonstrates that anxiety-related psychological states can predict the analgesic effect of music on pain responses measured by the CPT and suggests that music may be beneficial as a pain management tool in low-anxiety groups.

Effect of differential music tempo on post-exercise cardiovascular recovery parameters in hypertensive individuals: a randomised control trial

Hypertensive individuals tend to have autonomic dysfunction indicated by sympathetic dominance or delayed parasympathetic reactivation. A complimentary therapy such as music following exercise is considered to be beneficial in improving autonomic recovery. The purpose of this study was to assess the effect of differential music tempo on post-exercise cardiovascular recovery parameters in hypertensive individuals. Thirty hypertensive individuals were recruited for the present study which were randomly allocated to no music (n=10), slow music (n=10) and fast music (n=10) group. Participants in all three groups were subjected to submaximal exercise bout by Harvard step test. The cardiovascular recovery parameters i.e. heart rate recovery (HRR), blood pressure recovery (BPR) and rating of perceived exertion recovery (RPER) were assessed in all three groups after 1 min, 2 min and 3 min following termination of exercise. A significant decline was observed in HRR (P=0.002) and RPER (P=0.008) following exercise in slow music group as compared to fast and no music while no significant differences were observed in BPR between the three groups. The study concluded that music accelerates post-exercise recovery and slow music has greater effect as compared to fast or no music. These findings may have potential implications in the cardiovascular recovery dynamics in hypertensive individuals participating in submaximal exercise.

Music during image-guided breast biopsy reduces patient anxiety levels

PURPOSE

Interventions to decrease anxiety associated with image-guided breast biopsy are needed. Music intervention has been shown to be helpful in other outpatient procedural settings but data are limited regarding its effectiveness in the setting of breast biopsy. The purpose of this study was to determine whether listening to self-selected music during image-guided breast biopsy lowers anxiety.

MATERIALS AND METHODS

This randomized controlled trial was approved by the institutional review board and was HIPAA-compliant. 157 women between 18 and 75 (mean, 49.7 years) years of age, undergoing stereotactic or ultrasound-guided core biopsy, were enrolled in the study and were prospectively randomized to music or usual care. Patients in the music group listened to music of their choice during the biopsy. All patients completed the State Trait Anxiety Inventory (STAI) before and after the biopsy. Differences in pre-biopsy and post-biopsy anxiety levels were compared between the two groups using the Mann-Whitney U test.

RESULTS

Baseline trait anxiety scores in the two groups were similar (34.0 music, 31.5 control, p = .11). Patients in both groups showed lower state anxiety levels after the biopsy (45.6 to 34.3 music, 41.0 to 33.8 control, p < .001 for both). Patients who listened to music showed a greater reduction in anxiety (mean decrease 11.2 music, 7.3 control, p = .03). Post-biopsy anxiety levels were similar to normative values for working women in the same age group.

CONCLUSION

Listening to self-selected music reduces anxiety in patients undergoing breast biopsy.

The effect of music on pain and subjective experience in image-guided musculoskeletal corticosteroid injections: a randomized controlled trial

PURPOSE

To investigate the role of music on subjects undergoing routine image-guided musculoskeletal corticosteroid injections and its effect on post-procedure pain and subjective overall experience.

MATERIALS AND METHODS

This prospective study was IRB-approved and HIPAA-compliant. A total of 126 subjects referred for outpatient image-guided musculoskeletal corticosteroid injections were enrolled in the study and randomized into a music offered group ((+)MO) and a no music offered group ((-)MO). (+)MO subjects were given the opportunity to listen to music during their corticosteroid injection. All subjects were then given an anonymous survey on which they recorded their pre-procedural and post-procedural pain on a scale from 0 to 9 and rated their overall experience and how likely they were to recommend our department for musculoskeletal procedures on scales from 1 to 5.

RESULTS

(+)MO subjects had significantly lower post-procedural pain (p = 0.013) and significantly greater decrease in pain (p = 0.031) compared to (-)MO subjects. Among the (+)MO subjects, there was no statistically significant difference in post-procedure pain (p = 0.34) or change in pain (p = 0.62) if music was accepted or declined. However, subjects who listened to music did have lower post-procedural pain compared to those who did not listen to music (p = 0.012), although the differences in the decrease of pain between the two groups did not quite reach statistical significance (p = 0.062).

CONCLUSIONS

Playing music during image-guided musculoskeletal corticosteroid injections may reduce patients' post-procedure pain. Offering patients some measure of control over their procedure may be a factor that contributes to decreased post-procedure pain as well.

Immersive virtual reality as analgesia for women during hysterosalpingography: study protocol for a randomized controlled trial

BACKGROUND

Hysterosalpingography (HSG) is an accepted radiologic diagnostic modality for initial infertility workup, and is generally considered uncomfortable and painful. However, the management of pain related to HSG remains inefficient. As an emerging nonpharmacologic and noninvasive pain control strategy, virtual reality (VR) distraction has been successfully used in areas such as burns, blunt force trauma, hospital-based needle procedures, dental/periodontal procedures, and urological endoscopy patients. This study aims to evaluate the analgesic effect of VR during HSG.

METHODS/DESIGN

A single-center, parallel-group, randomized controlled trial will be carried out in the Radiology Department of Yinchuan Women and Children Healthcare Hospital, Yinchuan. A total of 200 participants who are scheduled for HSG will be enrolled in this study. The participants will be randomized (1:1) into two groups: a VR group and a blank control group. The VR group will receive routine care plus immersive VR intervention and the blank control group will receive routine care. Outcomes will be monitored at baseline, immediately after HSG and 15 min after HSG for each group. The primary outcome is the worst pain score during HSG by a visual analog scale (VAS). The secondary outcomes include: affective pain, cognitive pain, and anxiety during the HSG procedure; worst pain within 15 min after HSG; patient satisfaction and acceptance with pain management; physiological parameters; adverse effects; HSG results; and immersion perception score of the VR system (for the VR condition only).

DISCUSSION

This study will focus on exploring a simply operated, noninvasive and low-cost analgesia during the HSG procedure. The results of this trial will provide data on the feasibility and safety of VR distraction therapy during HSG.

TRIAL REGISTRATION

Chinese Clinical Trial Register, ChiCTR1900021342. Registered on 16 February 2019.

Reporting quality of music intervention research in healthcare: A systematic review

INTRODUCTION

Concomitant with the growth of music intervention research, are concerns about inadequate intervention reporting and inconsistent terminology, which limits validity, replicability, and clinical application of findings.

OBJECTIVE

Examine reporting quality of music intervention research, in chronic and acute medical settings, using the Checklist for Reporting Music-based Interventions. In addition, describe patient populations and primary outcomes, intervention content and corresponding interventionist qualifications, and terminology.

METHODS

Searching MEDLINE, PubMed, CINAHL, HealthSTAR, and PsycINFO we identified articles meeting inclusion/exclusion criteria for a five-year period (2010-2015) and extracted relevant data. Coded material included reporting quality across seven areas (theory, content, delivery schedule, interventionist qualifications, treatment fidelity, setting, unit of delivery), author/journal information, patient population/outcomes, and terminology.

RESULTS

Of 860 articles, 187 met review criteria (128 experimental; 59 quasi-experimental), with 121 publishing journals, and authors from 31 countries. Overall reporting quality was poor with <50% providing information for four of the seven checklist components (theory, interventionist qualifications, treatment fidelity, setting). Intervention content reporting was also poor with <50% providing information about the music used, decibel levels/volume controls, or materials. Credentialed music therapists and registered nurses delivered most interventions, with clear differences in content and delivery. Terminology was varied and inconsistent.

CONCLUSIONS

Problems with reporting quality impedes meaningful interpretation and cross-study comparisons. Inconsistent and misapplied terminology also create barriers to interprofessional communication and translation of findings to patient care. Improved reporting quality and creation of shared language will advance scientific rigor and clinical relevance of music intervention research.

Music Listening Among Postoperative Patients in the Intensive Care Unit: A Randomized Controlled Trial with Mixed-Methods Analysis

Background:

Music listening may reduce the physiological, emotional, and mental effects of distress and anxiety. It is unclear whether music listening may reduce the amount of opioids used for pain management in critical care, postoperative patients or whether music may improve patient experience in the intensive care unit (ICU).

Methods:

A total of 41 surgical patients were randomized to either music listening or controlled non-music listening groups on ICU admission. Approximately 50-minute music listening interventions were offered 4 times per day (every 4-6 hours) during the 48 hours of patients’ ICU stays. Pain, distress, and anxiety scores were measured immediately before and after music listening or controlled resting periods. Total opioid intake was recorded every 24 hours and during each intervention.

Results:

There was no significant difference in pain, opioid intake, distress, or anxiety scores between the control and music listening groups during the first 4 time points of the study. However, a mixed modeling analysis examining the pre- and post-intervention scores at the first time point revealed a significant interaction in the Numeric Rating Scale (NRS) for pain between the music and the control groups (P = .037). The Numeric Rating Score decreased in the music group but remained stable in the control group. Following discharge from the ICU, the music group’s interviews were analyzed for themes.

Conclusions:

Despite the limited sample size, this study identified music listening as an appropriate intervention that improved patients’ post-intervention experience, according to patients’ self-report. Future mixed methods studies are needed to examine both qualitative patient perspectives and methodology to improve music listening in critical care units.

The Effects of Music on Pain: A Meta-Analysis

BACKGROUND

Numerous meta-analyses have been conducted on the topic of music and pain, with the latest comprehensive study published in 2006. Since that time, more than 70 randomized controlled trials (RCTs) have been published, necessitating a new and comprehensive review.

OBJECTIVE

The aim of this meta-analysis was to examine published RCT studies investigating the effect of music on pain.

METHODS

The present study included RCTs published between 1995 and 2014. Studies were obtained by searching 12 databases and hand-searching related journals and reference lists. Main outcomes were pain intensity, emotional distress from pain, vital signs, and amount of analgesic intake. Study quality was evaluated according to the Cochrane Collaboration guidelines.

RESULTS

Analysis of the 97 included studies revealed that music interventions had statistically significant effects in decreasing pain on 0-10 pain scales (MD = -1.13), other pain scales (SMD = -0.39), emotional distress from pain (MD = -10.83), anesthetic use (SMD = -0.56), opioid intake (SMD = -0.24), non-opioid intake (SMD = -0.54), heart rate (MD = -4.25), systolic blood pressure (MD = -3.34), diastolic blood pressure (MD = -1.18), and respiration rate (MD = -1.46). Subgroup and moderator analyses yielded additional clinically informative outcomes.

CONCLUSIONS

Considering all the possible benefits, music interventions may provide an effective complementary approach for the relief of acute, procedural, and cancer/chronic pain in the medical setting.

Sedation shared decision-making in ambulatory venous access device placement: Effects on patient choice, satisfaction and recovery time

This study was undertaken to determine the impact of shared decision-making when selecting a sedation option, from no sedation (local anesthetic), minimal sedation (anxiolysis with a benzodiazepine) or moderate sedation (benzodiazepine and opiate), for venous access device placement (port-a-cath and tunneled catheters) on patient choice, satisfaction and recovery time. This is an IRB-approved, HIPPA-compliant, retrospective study of 198 patients (18-85 years old, 60% female) presenting to an ambulatory vascular interventional radiology department for venous access device placement between 22 October 2014 and 7 October 2015. Patients were educated about sedation options and given the choice of undergoing the procedure with no sedation (local anesthetic only), or minimal or moderate sedation. Satisfaction was assessed through three survey questions. No sedation was selected by 53/198 (27%), minimal sedation by 71/198 (36%) and moderate sedation by 74/198 (37%). All subjects would recommend the option to another patient and valued the opportunity to select a sedation option. Post-procedure recovery time differences were statistically significant (p<0.0001) with median recovery times of 0 minutes for no sedation, 38 minutes for minimal sedation and 64 minutes for moderate sedation. In conclusion, patient sedation preference for venous access device placement is variable, signifying there is a role for shared decision-making as it empowers the patient to select the option most aligned with his or her goals. The procedure is well-tolerated, associated with high satisfaction, and the impact on departmental flow is notable because patients choosing no or minimal sedation results in a decreased post-procedure recovery time burden.

Clinical Efficacy, Safety, and Feasibility of Using Video Glasses during Interventional Radiologic Procedures: A Randomized Trial

PURPOSE

To evaluate the clinical efficacy, safety, and feasibility of implementing video glasses in a variety of interventional radiologic (IR) procedures.

MATERIALS AND METHODS

Between August 2012 and August 2013, 83 patients undergoing outpatient IR procedures were randomized to a control group (n = 44) or an experimental group outfitted with video glasses (n = 39). State-Trait Anxiety Inventory (STAI) scores, sedation and analgesia doses, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), pain scores, and procedure times were obtained. Complications and adverse events related to the use of video glasses were recorded. Postprocedural staff surveys and patient satisfaction surveys were completed.

RESULTS

Women had greater preprocedural anxiety than men (P = .0056), and patients undergoing vascular interventions had greater preprocedural anxiety than those undergoing nonvascular interventions (P = .0396). When assessed after the procedure, patients who wore video glasses had significantly reduced levels of anxiety (-7.7 vs -4.4, respectively; P = .0335) and average MAP (-6.3 vs 2.1, respectively; P = .0486) compared with control patients. There was no significant difference in amount of sedation and analgesia, HR, RR, pain score, or procedure time between groups. No significant adverse events related to the use of video glasses were observed. Postprocedural surveys showed that video glasses were not distracting and did not interfere or pose a safety issue during procedures. Patients enjoyed using the video glasses and would use them again for a future procedure.

CONCLUSIONS

Video glasses can be safely implemented during IR procedures to reduce anxiety and improve a patient's overall experience.

Options and Considerations for Procedural Sedation in Pediatric Imaging

As pediatric imaging capabilities have increased in scope, so have the complexities of providing procedural sedation in this environment. While efforts by many organizations have dramatically increased the safety of pediatric procedural sedation in general, radiology sedation creates several special challenges for the sedation provider. These challenges require implementation of additional safeguards to promote safety during sedation while maintaining effective and efficient care. Multiple agent options are available, and decisions regarding which agent(s) to use should be determined by both patient needs (i.e., developmental capacities, underlying health status, and previous experiences) and procedural needs (i.e., duration, need for immobility, and invasiveness). Increasingly, combinations of agents to either achieve the conditions required or mitigate/counterbalance adverse effects of single agents are being utilized with success. To continue to provide effective imaging sedation, it is incumbent on sedation providers to maintain familiarity with continuing evolutions within radiology environments, as well as comfort and competence with multiple sedation agents/regimens. This review discusses the challenges associated with radiology sedation and outlines various available agent options and combinations, with the intent of facilitating appropriate matching of agent(s) with patient and procedural needs.

Effects of Intravenous Patient-Controlled Sufentanil Analgesia and Music Therapy on Pain and Hemodynamics After Surgery for Lung Cancer: A Randomized Parallel Study

OBJECTIVE

Postoperative pain is caused by surgical injury and trauma; is stressful to patients; and includes a series of physiologic, psychological, and behavioral reactions. Effective postoperative analgesia helps improve postoperative pain, perioperative safety, and hospital discharge rates. This study aimed to observe the influence of postoperative intravenous sufentanil patient-controlled analgesia combined with music therapy versus sufentanil alone on hemodynamics and analgesia in patients with lung cancer.

METHODS

This was a randomized parallel study performed in 60 patients in American Society of Anesthesiologists class I or II undergoing lung cancer resection at the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University. Patients were randomly assigned to a music therapy (MT) group and a control (C) group. The MT group underwent preoperative and postoperative music intervention while the C group did not. Both groups received intravenous patient-controlled sufentanil analgesia. The primary outcome was the visual analogue scale (VAS) score at 24 hours after surgery. The secondary outcomes included hemodynamic changes (systolic blood pressure, diastolic blood pressure, heart rate), changes on the Self-Rating Anxiety Scale (SAS), total consumption of sufentanil, number of uses, sedation, and adverse effects. The postoperative sufentanil dose and analgesia frequency were recorded.

RESULTS

Compared with the C group, the MT group had significantly lower VAS score, systolic and diastolic blood pressure, heart rate, and SAS score within 24 hours after surgery (p < 0.01). In addition, postoperative analgesia frequency and sufentanil dose were reduced in the MT group (p < 0.01).

CONCLUSIONS

Combined music therapy and sufentanil improves intravenous patient-controlled analgesia effects compared with sufentanil alone after lung cancer surgery. Lower doses of sufentanil could be administered to more effectively improve patients' cardiovascular parameters.

The effect of relaxing music on heart rate and heart rate variability during ECG GATED-myocardial perfusion scintigraphy

BACKGROUND

The positive changes in human behavior caused by relaxing music demonstrate the psychological effect of music on human body. A meta-analytical study has shown that relaxing music affects blood pressure and heart rate in coronary heart patients and cancer patients. The aim of our study is to research whether there is a significant effect on heart rate and heart rate variability due to listening to relaxing music during ECG GATED MPS imaging under gamma camera.

METHOD

The music group (n = 50 patients) could choose from 15 different musical types including folk music (no lyric). The other 50 patients were placed in a "no music group" and did not get headphones or any music.

RESULTS

There was a statistically significant reduction in the heart rate of patients in the music group compared to those in the control group.

CONCLUSIONS

Relaxing music provides great benefits to both patient and clinician. There is close relationship between relaxing music and health procedure, can use every area of the health noninvasiv, safe, cheap and is a method don't have side effect.

Listening to music during electromyography does not influence the examinee's anxiety and pain levels

INTRODUCTION

Listening to music is a low-cost intervention that has demonstrated ability to reduce pain and anxiety levels in various medical procedures.

METHODS

Subjects undergoing electrophysiological examinations were randomized into a music-listening group and a control group. Visual analog scales were used to measure anxiety and pain levels during the procedure.

RESULTS

Thirty subjects were randomized to each group. No statistically significant difference was found in anxiety or pain levels during the procedure between groups. However, most subjects in the music-listening group reported anxiety and pain reduction and would prefer to hear music in a future examination.

CONCLUSIONS

Although listening to music during electrophysiological examinations did not reduce anxiety or pain significantly, most subjects felt a positive effect and would prefer to hear music; therefore, we suggest that music may be offered optionally in the electromyography laboratory setting.

Music reduces panic: an initial study of listening to preferred music improves male patient discomfort and anxiety during flexible cystoscopy

PURPOSE

To assess the impact of listening to preferred music on relieving male patients' pain and anxiety during flexible cystoscopy.

PATIENTS AND METHODS

A total of 124 male patients were admitted to our hospital for flexile cystoscopy by a single urologist between January 2013 and September 2013 and randomized to two equal groups. Group 2 included 62 patients who could select and listen to their preferred music during flexible cystoscopy. Group 1 included 62 patients who were unable to listen to the music. All patients were administered the same amount of lidocaine (10 mL) for 3 minutes for local anesthesia before flexible cystoscopy. A visual analog scale (VAS) ranging from 0 to 10 was used to assess patients' pain feeling after the cystoscopy procedure. Anxiety levels were calculated according to the State Instrument of State-Trait Anxiety Inventory (STAI-S), and the pulse rate were recorded 5 minutes before and immediately after the procedure. The duration of the procedure of each group were also analyzed.

RESULTS

Statistically significant differences were detected between group 1 and group 2 in the mean pain score on VAS (2.53 ± 1.34 vs 1.63 ± 1.09, P=0.002, Mann-Whitney U test), mean postprocedural State Anxiety Inventory pain score (39.4 ± 6.5 vs 34.5 ± 5.8), and postprocedural pulse rate (79.8 ± 5.5 vs 76.0 ± 7.3) (P<0.001 for both, t test). Patients who listened to their preferred music experienced less discomfort and lower anxiety at cystoscopy. Patient age, duration of the procedure, preprocedural STAI-S, and preprocedural pulse rate of each group were comparable.

CONCLUSION

Listening to preferred music during flexible cystoscopy is an easy way to improves male patients' comfort and reduce their anxiety. It could be recommended for male patients.

Effects of music on complications during hemodialysis for chronic renal failure patients

The study was planned as a case-control study to examine the effects of music on some of the complications experienced by chronic renal failure (CRF) patients during hemodialysis. A total of 60 patients (30 intervention and 30 control) diagnosed with end-stage renal failure undergoing hemodialysis treatment participated in this study. The study was conducted in Manisa Merkez Efendi State Hospital Hemodialysis Unit and Manisa Özel Anemon Hemodialysis between April 2012 and July 2012. The intervention group listened 30 minutes in each session (12 total sessions) Turkish art music at the beginning of the third hour of their hemodialysis sessions. Patient Information Form and visual analog scale to assess pain, nausea, vomiting, and cramps during hemodialysis session were used. For the analysis of data, the number, percentage, chi-square test, and significance test of independent group differences between two averages were conducted. According to the findings of the study, the average of the intervention and control group ages, respectively, was 50.86 ± 11.3 and 55.13 ± 9.68. The primary duration of hemodialysis treatment for both intervention and control groups was "1 year and above" (70.0%). The intervention group's pain and nausea scores were lower than the control group for all 12 sessions. The difference between the intervention and the control group's pain scores was significant (P < 0.05). However, in pain scores from the first session to 12th session, continuous decreasing trend was not observed. According to the results, music can be used as an independent nursing practice for reduction of complications for CRF patients receiving hemodialysis treatment.

Effectiveness of a single education and counseling intervention in reducing anxiety in women undergoing hysterosalpingography: a randomized controlled trial

Hysterosalpingography (HSG) is generally considered a stressful and painful procedure; we aimed to evaluate whether a single education and counseling intervention could reduce women's distress and pain after undergoing HSG for infertility. Patients were randomized into control group (n = 108) and intervention group (n = 109). All patients filled the following questionnaires before and after HSG: Zung self-rating anxiety scale (Z-SAS), Zung self-rating depression scale (Z-SDS), and an ad hoc questionnaire designed to evaluate HSG procedure knowledge. Pain was scored using a visual analog scale. The intervention consisted in a 45-minute individualised session 48 h before HSG. We observed a reduction of anxiety and depression scores in the intervention arm compared to the control group. After controlling for potential confounding variables, intervention was an independent predictor of the difference of Z-SAS score before and after HSG. This is the first randomised controlled trial to assess the potential effectiveness of a single education and counseling intervention to lower anxiety in a diagnostic setting.

A study of the effect of relaxing music on heart rate recovery after exercise among healthy students

BACKGROUND

Music has been employed in various clinical settings to reduce anxiety. However, meta-analysis has shown music to have little influence on haemodynamic parameters. This study aimed at investigating the effect of relaxing music on heart rate recovery after exercise.

METHOD

Twenty-three student volunteers underwent treadmill exercise and were assessed for heart rate recovery and saliva analysis; comparing exposure to sedative music with exposure to silence during the recovery period immediately following exercise.

RESULTS

No differences were found between music and non-music exposure regarding: heart rate recovery, resting pulse rate, and salivary cortisol. Music was no different to silence in affecting these physiological measures, which are all associated with anxiety.

CONCLUSIONS

Relaxing music unaccompanied by meditation techniques or other such interventions may not have a major role in reducing anxiety in certain experimental settings.