Music does not reduce alfentanil requirement during patient-controlled analgesia (PCA) use in extracorporeal shock wave lithotripsy for renal stones

The effect of music on state anxiety in patients undergoing extracorporeal shockwave lithotripsy

AIM

Extracorporeal shockwave lithotripsy is a commonly used method to break down kidney stones in urology clinics. This study aims to investigate whether or not listening to music is effective against state anxiety in patients undergoing kidney stone treatment with this method.

METHODS

A total of 80 patients (50 males, 30 females) undergoing extracorporeal shockwave lithotripsy for the first time at our clinic were included in the study. The first group (24 patients) listened to instrumental classical music through headphones 20 minutes before the procedure, while the second group (28 patients) listened to instrumental classical music during the procedure. The third group (28 patients) was the control group and consisted of patients who did not listen to music before or during the procedure. Patients were administered a state-trait anxiety inventory test to measure state anxiety after the process, and their results were compared.

RESULTS

While there was a significant difference in state-trait anxiety inventory scores between patients who listened to music before/during the procedure and the control group, there was no significant difference between patients who listened to music before and those who listened to music during the procedure. Assessment of randomisation showed groups achieved homogeneity.

CONCLUSION

Among the groups homogeneously distributed according to age and gender, significantly lower anxiety scores of groups that listened to music compared with the control group have provided supporting data to be open-minded and exploratory about increasing patient tolerability and comfort during these potentially pain-inducing procedures.

Effect of media distraction (audio-visual and music) for pain and anxiety control in patients undergoing shock-wave lithotripsy: A systematic review and meta-analysis

Audio-visual (AV) or music distraction may be used to reduce pain during several healthcare procedures. The present manuscript is a systematic review and meta-analysis to assess the effectiveness of media distraction in reducing pain and anxiety in extracorporeal shock wave lithotripsy (ESWL) patients. The PubMed, Embase, Scopus, BioMed Central, Ovoid and CENTRAL (Cochrane Central Register of Controlled Trials) databases were screened for studies assessing the role of media distraction (music/AV media) in reducing pain and anxiety of ESWL patients. Data were summarized using the mean difference (MD) with 95% confidence intervals (CI). A total of 11 randomized controlled trials were included. Pooled analysis indicated a statistically significant difference in pain outcomes with media distraction [mean difference (MD): -1.18; 95% CI: -2.35, -0.01; I²=96.8%)]. Subgroup analysis indicated that both AV media (MD: -2.94; 95% CI: -4.70, -1.17; I²=79.2%) and music (MD: -0.86; 95% CI: -1.37, -0.35; I²=62.5%), led to significant reduction in pain outcomes. Pooled analysis indicated a statistically significant reduction of anxiety scores with the use of media distraction (MD: -3.91; 95% CI: -6.44, -1.38; I²=77.7%). To conclude, the present review suggests that media distraction in the form of AV media or music may be beneficial in reducing the pain and anxiety of patients undergoing ESWL. Evidence is, however, weak considering the small effect size, confidence intervals being close to zero, and instability of the results on sensitivity analysis. In clinical practice, media distraction may be used during ESWL as a nursing intervention, but a clinically important reduction of pain and anxiety may not be expected.

Impact of music on anxiety and pain control during extracorporeal shockwave lithotripsy: A protocol for systematic review and meta-analysis

BACKGROUND

The present evidence is insufficient for evaluating the impact of exclusive music therapy on anxiety and pain control in extracorporeal shock wave lithotripsy (ESWL).

METHODS

A systematic review and meta-analysis was conducted to explore the efficacy of music therapy in reducing pain and anxiety in patients undergoing ESWL. PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated March 2020) were searched for randomized controlled trials assessing music therapy in reducing pain and anxiety in patients undergoing ESWL. The search strategy and study selection process were managed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement.

RESULTS

Five randomized controlled trials were included in the meta-analysis. Overall, music intervention groups experienced significant reductions in pain (risk ratios = -1.20, 95% confidence intervals = -1.95 to -0.45, P = .002) and anxiety (risk ratios = -3.31, 95% confidence intervals = -4.97 to -1.84, P < .0001) compared with control groups during ESWL. Music therapy gave patient more satisfaction with the treatment and a willingness to repeat the therapy was reported. However, there was no significant difference in the stone clearance rate.

CONCLUSIONS

Listening to music can reduce patient's pain and anxiety significantly with increased therapy satisfaction and willingness to repeat.

Strategies to maximise patient comfort during extracorporeal shockwave lithotripsy - A randomised controlled trial

BACKGROUND/PURPOSE OF STUDY

We aim to assess if distraction techniques improve patient comfort tolerability of SWL.

METHODS

We carried out a prospective randomised controlled trial of SWL-naïve patients attending for treatment. Patients were randomised into three groups and offered oral analgesia as standard of care. Group 1 (n = 19) received stress balls to squeeze during treatment. Group 2 (n = 19) listened to music during treatment. Group 3 (n = 17) received standard of care only. All patients completed a validated health anxiety inventory score prior to treatment. All patients completed a validated pain questionnaire and visual analogue scale (VAS) after treatment. Primary outcomes were completion of SWL treatment and pain score results.

RESULTS

55 patients attending for SWL were randomised. There was no difference in stone size or position, presence of a stent, height or weight between the groups. VAS scores were lower in controls compared to Group 1 (1.93 vs 3.69, p = 0.08). On subgroup analysis of non-anxious patients, pain questionnaire scores were lower in controls compared to Group 1 (2.58 vs 4.77, p = 0.06). VAS scores were lower in patients who received optional analgesia alone than in patients who received stress balls alone (1.92 vs 4.07, p = 0.05). Across all subgroups, pain scores were lower in the control group compared to the distraction groups, but did not achieve significance.

CONCLUSIONS

In conclusion, distraction techniques should not replace standard of care for analgesia during SWL. This study was registered with clinicaltrials.gov (identifier NCT03379922).

Role of Complementary Medicine (Music, Acupuncture, Acupressure, TENS and Audio-Visual Distraction) in Shockwave Lithotripsy (SWL): A Systematic Review From EAU Sections of Urolithiasis (EULIS) and Uro-Technology (ESUT)

We performed a systematic review to look at the role of alternative or complementary medicine such as music, acupressure, acupuncture, transcutaneous electrical nerve stimulation (TENS) and audiovisual distractions to decrease analgesia requirement and alleviate anxiety during SWL. Twenty-three papers(2439 participants) were included: Music (n = 1056.6%), Acupuncture (n = 517.7%), Acupressure (n = 13.8%), TENS (n = 617.2%), and audiovisual distraction (n = 14.6%). Most of the studies showed that complementary therapy, lowered pain, and anxiety with higher patient satisfaction and willingness to undergo the procedure. With its feasibility and convenience, urological guidelines need to endorse it, and more should be done to promote its use in outpatient urological procedures.

Physiologic effects of voice stimuli in conscious and unconscious palliative patients-a pilot study

BACKGROUND

Sounds and acoustic stimuli can have an effect on human beings. In medical care, sounds are often used as parts of therapies, e. g., in different types of music therapies. Also, human speech greatly affects the mental status. Although calming sounds and music are widely established in the medical field, clear evidence for the effect of sounds in palliative care is scare, and data about effects of the human voice in general are still missing. Thus, the aim of this study was to evaluate the effects of different voice stimuli on palliative patients.

METHODS

Two different voice stimuli (one calm, the other turbulent) were presented in a randomized sequence, and physiological parameters (blood pressure, heart frequency, oxygen saturation, respiratory rate) were recorded.

RESULTS

Twenty patients (14 conscious and 6 unconscious) participated in this study. There was a decrease of heart frequency as well as an increase of oxygen saturation in the group of conscious patients, whereas no significant change of blood pressure or respiratory rate were detected in either group, conscious and unconscious patients.

CONCLUSIONS

Although our dataset is heterogeneous, it can be concluded that voice stimuli can influence conscious patients. However, in this setting, no effect on unconscious patients was demonstrated. More clinical research on this topic with larger groups and a broader spectrum of parameters is needed.

Does Listening to Music during Tonsillectomy Affect Sevoflurane Consumption?

OBJECTIVE

The aim of this study was to investigate the effect of listening to music on the consumption of an anesthetic agent as well as postoperative recovery and pain in children undergoing elective tonsillectomy.

MATERIALS AND METHODS

Fifty patients were randomized into those to whom music was played during surgery (group M) and a control group to whom music was not played (group C). The depth of anesthesia was provided by entropy levels of 50 ± 5 in both groups. Demographic characteristics and hemodynamic parameters were recorded perioperatively. The duration of surgery, sevoflurane consumption, eye opening time, and extubation time were also recorded. p < 0.05 was considered statistically significant.

RESULTS

Surgical pleth index values measured intraoperatively were statistically lower in group M than in group C. In the postanesthesia care unit children in the music group felt less pain than those in the control group according to the Wong-Baker Faces Pain Rating Scale (p = 0.035). The heart rates of the patients in the music group were statistically lower at 30 min intraoperatively and at the end of the procedure compared to the values of the control group (p = 0.015). The consumption of sevoflurane was lower in group M than in group C but the difference was not statistically significant. The need for additional fentanyl was significantly lower in group M than in group C.

CONCLUSION

In this study, the children exposed to music intraoperatively needed less analgesia during surgery, and reported less pain postoperatively, but there was no difference in sevoflurane requirements.

Comparison of Two Different Distraction Methods Affecting the Level of Pain and Anxiety during Extracorporeal Shock Wave Lithotripsy: A Randomized Controlled Trial

BACKGROUND

Extracorporeal shock wave lithotripsy can cause pain and anxiety for patients. Despite the use of many distraction methods to reduce pain and anxiety, there is no study on the use of stress balls during lithotripsy.

AIM

The aim of the study was to investigate the efficacy of use of stress balls and music therapy to reduce pain and anxiety during lithotripsy.

DESIGN

This was a single-center, parallel randomized controlled trial.

SETTINGS

The study involved the lithotripsy unit in a training and research hospital in Turkey.

PARTICIPANTS

The study included 120 patients who had kidney or ureter stones.

METHODS

The patients were randomly divided into three groups. The control group (group 1) received no interference, whereas experimental groups received stress ball (group 2) and music (group 3) interventions during lithotripsy, respectively. Data were collected using the Patient Information Form, visual analog scale, and State-Trait Anxiety Inventory.

RESULTS

There was no statistically significant difference among the three groups in regard to anxiety and pain mean scores (p > .05). No statistically significant difference was found between anxiety scores before and after lithotripsy in each group (p > .05), whereas there was a statistically significant difference between pain scores during and after lithotripsy (p < .05).

CONCLUSION

Based on the present study, no statistically significant difference was found between the use of stress balls and music in reducing pain and anxiety during lithotripsy. Further studies are needed to evaluate the effectiveness of stress balls used during lithotripsy.

Effect of Music on Outpatient Urological Procedures: A Systematic Review and Meta-Analysis from the European Association of Urology Section of Uro-Technology

PURPOSE

Music is a practical, inexpensive and harmless analgesic and anxiolytic. An increasing number of original studies have been performed to investigate its potential application in urology. Our aim was to identify the effect of music on outpatient based urological procedures.

MATERIALS AND METHODS

We systematically reviewed the effect of using music during all reported outpatient urology procedures, including transrectal ultrasound guided prostate biopsy, shock wave lithotripsy, urodynamic studies, percutaneous nephrostomy tube placement and cystoscopy. Data were included on all randomized trials from 1980 to 2017 and no language restrictions were applied.

RESULTS

Included in analysis were 16 randomized studies in which 972 of 1,950 patients (49.8%) were exposed to music during an outpatient procedure. The procedures included transrectal ultrasound guided prostate biopsy in 4 studies in a total of 286 patients, shock wave lithotripsy in 6 studies in a total of 1,023, cystoscopy in 3 studies in a total of 331, urodynamics in 2 studies in a total of 210 and percutaneous nephrostomy in 1 study in a total of 100. All studies incorporated a visual analog score to measure pain. Anxiety was measured by STAI (State-Trait Anxiety Inventory) in 13 studies and by a visual analog scale in 2. While 14 of the 16 studies showed a reduction in self-reported pain, a reduction in anxiety was seen in 14. When using music, overall procedural satisfaction was better in 9 studies and patient willingness to repeat the procedure was also higher in 7. Our meta-analysis revealed a significant reduction in visual analog scale and STAI findings across all studies (p <0.001).

CONCLUSIONS

Our systematic review demonstrated a beneficial effect of music on urological outpatient procedures. Music seemed to decrease anxiety and pain. It might serve as a useful adjunct to increase procedural satisfaction and patient willingness to undergo the procedure again.

Analgesia for patients undergoing shockwave lithotripsy for urinary stones - a systematic review and meta-analysis

Background

Shock wave lithotripsy (SWL) is the first line treatment modality for a significant proportion of patients with upper urinary tracts stones. Simple analgesics, opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are all suitable agents but the relative efficacy and tolerability of these agents is uncertain.

Objectives

To determine the efficacy of the different types of analgesics used for the control of pain during SWL for urinary stones.

Materials and Methods

We searched the Cochrane Renal Group’s Specialised Register, MEDLINE, EMBASE and also hand-searched reference lists of relevant articles (Figure-1). Randomised controlled trials (RCT’s) comparing the use of any opioid, simple analgesic or NSAID during SWL were included. These were compared with themselves, each-other or placebo. We included any route or form of administration (bolus, PCA). We excluded agents that were used for their sedative qualities. Data were extracted and assessed for quality independently by three reviewers. Meta-analyses have been performed where possible. When not possible, descriptive analyses of variables were performed. Dichotomous outcomes are reported as relative risk (RR) and measurements on continuous scales are reported as weighted mean differences (WMD) with 95% confidence intervals.

Results

Overall, we included 9 RCTs (539 participants from 6 countries). Trial agents included 7 types of NSAIDs, 1 simple analgesic and 4 types of opioids. There were no significant differences in clinical efficacy or tolerability between a simple analgesic (paracetamol) and an NSAID (lornoxicam). When comparing the same simple analgesic with an opioid (tramadol), both agents provided safe and effective analgesia for the purpose of SWL with no significant differences. There were no significant differences in pain scores between NSAIDs or opioids in three studies. Adequate analgesia could be achieved more often for opioids than for NSAIDs (RR 0.358; 95% CI 043 to 0.77, P=0.0002) but consumed doses of rescue analgesia were similar between NSAIDs and opioids in two studies (P=0.58, >0.05). In terms of tolerability, there is no difference in post-operative nausea and vomiting (PONV) between the groups (RR 0.72, 95% CI 0.24 to 2.17, P=0.55). One study compared outcomes between two types of NSAIDs (diclofenac versus dexketoprofen). There were no significant differences in any of our pre-defined outcomes measures.

Conclusion

Simple analgesics, NSAIDs and opioids can all reduce the pain associated with shock wave lithotripsy to a level where the procedure is tolerated. Whilst there are no compelling differences in safety or efficacy of simple analgesics and NSAIDs, analgesia is described as adequate more often for opioids than NSAIDs.

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.

Listening to music during shock wave lithotripsy decreases anxiety, pain, and dissatisfaction : A randomized controlled study

BACKGROUND

We analyzed the effects of music on pain, anxiety, and overall satisfaction in patients undergoing a shock wave lithotripsy (SWL) procedure.

METHODS

A total of 200 patients scheduled to undergo SWL were included in this study. Group 1 consisted of 95 patients who listened to music during the SWL session while group 2 included 105 patients who did not listen music during the procedure. State-Trait Anxiety Inventory (STAI) was used to assess state and trait anxiety (STAI-S/T). A visual analog scale (VAS) was used at the end of the session in order to assess pain, willingness to repeat the procedure, and overall patient satisfaction. Hemodynamic parameters including systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded before and after the session.

RESULTS

No statistically significant difference was found between the two groups in terms of stone characteristics, SWL parameters, pre-SWL STAI-T/S scores, and pre-SWL hemodynamic parameters. Post-SWL STAI-S scores were found to be lower in patients who listened to music (p = 0.006). At the end of the SWL, VAS scores of pain, satisfaction, and willingness to repeat procedure were significantly different in favor of the music group (p = 0.007, p = 0.001, p = 0.015, respectively). SBP, DBP, and HR were significantly higher in patients who did not listen to music (p = 0.002, p = 0.024, p = 0.001, respectively).

CONCLUSION

Music can be an ideal adjunctive treatment modality for patients undergoing SWL treatment. It has the potential to enhance patient compliance and treatment satisfaction by reducing the procedure-related anxiety and pain perception.

The effect of music therapy during shockwave lithotripsy on patient relaxation, anxiety, and pain perception

OBJECTIVES

To research the effect of listening to music during shock wave lithotripsy (SWL) on the patient's pain control, anxiety levels, and satisfaction.

PATIENTS AND METHODS

The study comprised 400 patients from three hospitals. Half of patients listened to music during their first SWL session but not during their second session. The other half had no music for the first session but the second session was accompanied by music. During all sessions, with and without music, pulse rates, blood pressure, State-Trait Anxiety Inventory-State Anxiety scores (STAI-SA), Visual Analog Scale (VAS scores for pain), willingness to repeat procedure (0 = never to 4 happily), and patient satisfaction rates (0 = poor to 4 = excellent) were assessed.

RESULTS

There was no statistical difference between the two groups in terms of blood pressure and pulse rates. In both groups, the STAI-SA and VAS pain scores were lower in the session when music was listened to (p < 0.001). The patients requested more SWL treatment be completed while listening to music and their satisfaction was greater.

CONCLUSION

Music lowered the anxiety and pain scores of patients during SWL and provided greater satisfaction with treatment. Completing this procedure while the patient listens to music increases patient compliance greatly and reduces analgesic requirements.

The effect of distraction on pain perception during an endovenous thermal ablation procedure

OBJECTIVES

To determine whether audio and visual distraction can affect the pain perception of a patient undergoing endovenous thermal ablation under tumescent anesthesia.

METHODS

Patients underwent an endovenous thermal ablation procedure and were randomized into two groups: non-distraction (AVD-) and with distraction (AVD+). Visual analogue scale pain score and hospital anxiety depression scale scores were used to measure outcome. The recruited patients were asked to submit an anticipated visual analogue scale pain score prior to treatment as well as the actual experienced post-operative visual analogue scale pain score.

RESULTS

There was no significant difference between the AVD- and AVD+ groups post-operative pain score 2.85 (SD 1.7) versus 2.60 (SD 2.3), p = 0.68. Pain score in women with distraction (AVD+) decreased from 3.81 to 2.42. The pain score in men with distraction (AVD+) increases from 1.88 to 2.82. In the AVD- group, a significant difference was found between men and women (p = 0.014). Disregarding gender, a significant difference was found between the anticipated pain score and the actual pain score in both the AVD- group (p = 0.009) and AVD+ group (p = 0.021). There was a correlation between depression and the pain score, which was not seen between pain and anxiety score.

CONCLUSION

The results suggested that audiovisual distraction has no influence on the visual analogue scale pain score during endovenous thermal ablation under tumescent anesthesia. Despite this, patients appreciate and evaluate audio and visual distraction as pleasant to extremely pleasant when applied.

[Pain evaluation during extracorporeal lithotropsy]

OBJECTIVE

The aim of this study was to demonstrate the feasibility of extracorporeal lithotripsy using lithotripter Sortz MODULITH SLK(®) without analgesics.

MATERIALS AND METHODS

An anonymous self-administered questionnaire was sent to 854 patients post-shock wave lithotripsy for urinary lithiasis. No patient had pain medication. The questionnaire included seven questions to assess the pain symptoms due to treatment. After 15 days, a reminder letter was sent.

RESULTS

The response rate was 69% (591/854). The extracorporeal lithotripsy without analgesic treatment was generally well tolerated. About 70% of patients felt just a few or no pain and average pain assessment was 3.6/10 on VAS. The pain was often considered to be multifactorial, related to the treatment itself, the duration of the session and the position on the table. Anxiety seemed to play an equally important role in pain relief with an average VAS 4.5 against 2.9 for non-anxious patients. If a new session of extracorporeal lithotripsy was necessary, 53% of patients would require no pain medication.

CONCLUSIONS

The extracorporeal lithotripsy could easily be done without systematic analgesics allowing for outpatient care. In contrast, anxiety seemed to be an important predictor of poor tolerance of sessions so the idea of a prophylactic anxiolytic treatment based on psychological profile of the patient should allow less aggressive and less costly management of urolithiasis.

WITHDRAWN: Music for pain relief

2011: this review is being updated by a new author team who are preparing a new protocol. This update is due to be published in 2011.

The replacement protocol was published in September 2011 (Bradshaw DH, Brown CJ, Cepeda MS, Pace NL. Music for pain relief (Protocol). Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD009284. DOI: 10.1002/14651858.CD009284).

2015: at July 2015, the PaPaS Review Group withdrew the 2011 protocol (Bradshaw 2011) as there were significant delays in preparing the full review, which did not meet the expectations of Cochrane and PaPaS editorial processes and timelines. For more information, please contact the PaPaS CRG office.

The editorial group responsible for this previously published document have withdrawn it from publication.

Music's use for anesthesia and analgesia

This review article provides an overview of published data regarding the involvement of music in anesthesia practice. Music is an important topic for research in different fields of anesthesiology. The use of music preoperatively is aimed at reducing anxiety, stress, and fear. However, the effect of music on perception of pain intraoperatively is controversial, according to studies of both adults and children undergoing various surgical procedures under general and/or regional anesthesia. In postoperative pain management, postanesthesia care, and neonatal intensive care, music can be a complementary method for reducing pain, anxiety, and stress. Music is a mild anxiolytic, but it is relatively ineffective when a pain stimulus is severe. However, music is inexpensive, easily administered, and free of adverse effects, and as such, can serve as complementary method for treating perioperative stress and for acute and chronic pain management, even though music's effectiveness depends on each individual patient's disposition and severity of pain stimulus.

Sensory environment on health-related outcomes of hospital patients

BACKGROUND

Hospital environments have recently received renewed interest, with considerable investments into building and renovating healthcare estates. Understanding the effectiveness of environmental interventions is important for resource utilisation and providing quality care.

OBJECTIVES

To assess the effect of hospital environments on adult patient health-related outcomes.

SEARCH METHODS

We searched: the Cochrane Central Register of Controlled Trials (last searched January 2006); MEDLINE (1902 to December 2006); EMBASE (January 1980 to February 2006); 14 other databases covering health, psychology, and the built environment; reference lists; and organisation websites. This review is currently being updated (MEDLINE last search October 2010), see Studies awaiting classification.

SELECTION CRITERIA

Randomised and non-randomised controlled trials, controlled before-and-after studies, and interrupted times series of environmental interventions in adult hospital patients reporting health-related outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors independently undertook data extraction and 'Risk of bias' assessment. We contacted authors to obtain missing information. For continuous variables, we calculated a mean difference (MD) or standardized mean difference (SMD), and 95% confidence intervals (CI) for each study. For dichotomous variables, we calculated a risk ratio (RR) with 95% confidence intervals (95% CI). When appropriate, we used a random-effects model of meta-analysis. Heterogeneity was explored qualitatively and quantitatively based on risk of bias, case mix, hospital visit characteristics, and country of study.

MAIN RESULTS

Overall, 102 studies have been included in this review. Interventions explored were: 'positive distracters', to include aromas (two studies), audiovisual distractions (five studies), decoration (one study), and music (85 studies); interventions to reduce environmental stressors through physical changes, to include air quality (three studies), bedroom type (one study), flooring (two studies), furniture and furnishings (one study), lighting (one study), and temperature (one study); and multifaceted interventions (two studies). We did not find any studies meeting the inclusion criteria to evaluate: art, access to nature for example, through hospital gardens, atriums, flowers, and plants, ceilings, interventions to reduce hospital noise, patient controls, technologies, way-finding aids, or the provision of windows. Overall, it appears that music may improve patient-reported outcomes such as anxiety; however, the benefit for physiological outcomes, and medication consumption has less support. There are few studies to support or refute the implementation of physical changes, and except for air quality, the included studies demonstrated that physical changes to the hospital environment at least did no harm.

AUTHORS' CONCLUSIONS

Music may improve patient-reported outcomes in certain circumstances, so support for this relatively inexpensive intervention may be justified. For some environmental interventions, well designed research studies have yet to take place.

Audiovisual distraction reduces pain perception during shockwave lithotripsy

BACKGROUND AND PURPOSE

Lithotripsy is an established method to fragment kidney stones that can be performed without general anesthesia in the outpatient setting. Discomfort and/or noise, however, may deter some patients. It has been demonstrated that audiovisual distraction (AV) can reduce sedoanalgesic requirements and improve patient satisfaction in nonurologic settings, but to our knowledge, this has not been investigated with lithotripsy. This randomized controlled trial was designed to test the hypothesis that AV distraction can reduce perceived pain during lithotripsy.

PATIENTS AND METHODS

All patients in the study received identical analgesia before a complete session of lithotripsy on a fixed-site Storz Modulith SLX F2 lithotripter. Patients were randomized to two groups: One group (n=61) received AV distraction via a wall-mounted 32″ (82 cm) television with wireless headphones; the other group (n=57) received no AV distraction. The mean intensity of treatment was comparable in both groups. Patients used a visual analogue scale (0-10) to record independent pain and distress scores and a nonverbal pain score was documented by the radiographer during the procedure (0-4).

RESULTS

In the group that received AV distraction, all measures of pain perception were statistically lower. The patient-reported pain score was reduced from a mean of 6.1 to 2.4 (P<0.0001), and the distress score was reduced from a mean of 4.4 to 1.0 (P=0.0001). The mean nonverbal score recorded by the radiographer was reduced from 1.5 to 0.5 (<0.0001).

CONCLUSIONS

AV distraction significantly lowered patients' reported pain and distress scores. This correlated with the nonverbal scores reported by the radiographer. We conclude that AV distraction is a simple method of improving acceptance of lithotripsy and optimizing treatment.

Meta-analysis of the efficacy of non-steroidal anti-inflammatory drugs vs. opioids for SWL using modern electromagnetic lithotripters

PURPOSE

Clinical studies produce conflicting results on pain relief for shock wave lithotripsy (SWL). We performed a systematic review and meta-analysis to compare non-steroidal anti-inflammatory drugs (NSAIDs) and opioids in pain relief for SWL powered by an electromagnetic generator.

MATERIAL AND METHODS

A search of MEDLINE and EMBASE was performed and all randomized controlled trials comparing NSAIDs and opioids in pain relief for SWL using modern electromagnetic lithotripters were included in the analysis. Data from 3 trials (244 patients) were pooled. The primary outcome measure was adequate analgesia, defined as "if no additional pain relief was used". The difference in the proportion of patients with adequate anesthesia was compared between the NSAIDs and opioids groups as an odds ratio and odds ratio were pooled across the 3 trials with a fixed effects model.

RESULTS

There was no statistically significant difference between using NSAIDs and opioids for pain relief during SWL using modern electromagnetic lithotripters (odds ratio 0.886, 95% CI 0.446-1,760, p = 0.730).

CONCLUSIONS

Our analysis shows that in relieving pain during SWL using modern electromagnetic lithotripters NSAIDs are as effective as opioids.

Effectiveness of nursing intervention for adult patients experiencing chronic pain: a systematic review

OBJECTIVES

To determine the best available evidence regarding the effectiveness of nursing interventions for adult patients experiencing chronic pain.

TYPES OF STUDIES

Randomized Controlled Trials (RCT) and Quasi-Randomized Controlled Trials.

TYPES OF PARTICIPANTS

Participants were adults, aged at least 18 years, suffering from chronic pain (lasting for longer than six months). Pain of oncological origin and patients admitted in a hospital, were excluded.

TYPES OF INTERVENTIONS

Non pharmacological nursing interventions for chronic pain.

TYPES OF OUTCOME MEASURES

The primary outcome measure was chronic pain, and secondary outcome measures were: disability, depression, dependence and health related quality of life.

SEARCH STRATEGY

All studies, published and unpublished, in English and Spanish, carried out between January 1997 and December 2007 were retrieved..

SELECTION OF STUDIES

The methodological quality of included articles was assessed by two independent reviewers using appropriate critical appraisal tools from the Joanna Briggs Institute.

DATA EXTRACTION AND ANALYSIS

Data were independently extracted by two reviewers, using the standardised data extraction tool from the Joanna Briggs Institute.A meta-analysis was not possible as the trials were heterogeneous in their interventions, characteristics of the populations, intervention duration measurement instruments and outcomes measures.

RESULTS

1,666 references were identified that fit the aim of the review. 92 articles were retrieved, of which 13 were chosen to be critically appraised for their methodological quality. In the end, eight controlled trials were included.The main results were:Other outcome measures showed an improvement in the quality of life (sensorial stimulation and guided imagery), in depression, disability and empowerment (music therapy) and physical functioning (program of psycho-education).The main limitations of this review were: excluding studies were the professional performing the interventions were not detailed or the intervention was not carried out by a nurse and that the search strategy was limited up to 2007.

IMPLICATIONS FOR PRACTICE

Listening to music, a cognitive-behavioural treatment programme, magnetic therapy, sensorial stimulation, a psychoeducation programme and guided imagery are nursing interventions that helps to reduce the chronic pain in adults and may be used as contributory to the pharmacological treatment. Short exercises for increasing endurance does not reduce pain.

IMPLICATIONS FOR RESEARCH

For future reviews we do not recommend the inclusion of different interventions for the reduction of chronic pain, due to the great number and variability of intervention, but the development of a SR on specific interventions.

An investigation of the effects of music on anxiety and pain perception in patients undergoing haemodialysis treatment

This study aimed to investigate the effects of preferred music listening on anxiety and pain perception in patients undergoing haemodialysis. A two group experimental design was used. Sixty people diagnosed with end stage renal failure undergoing haemodialysis treatment participated in this study. Preferred music listening was applied as an intervention. Anxiety and pain were measured pre-test and post-test. The control group scored significantly higher in state anxiety than the experimental group and experienced significantly higher pain intensity in post-test phase. Findings provide experimental evidence to support the effectiveness of preferred music listening in medical settings.

The anxiety- and pain-reducing effects of music interventions: a systematic review

Musical interventions have been used in health care settings to reduce patient pain, anxiety, and stress, although the exact mechanism of these therapies is not well understood. This article provides a systematic review of 42 randomized controlled trials of the effects of music interventions in perioperative settings. Music intervention had positive effects on reducing patients' anxiety and pain in approximately half of the reviewed studies. Further research into music therapy is warranted in light of the low cost of implementation and the potential ability of music to reduce perioperative patient distress.

Music for pain relief

BACKGROUND

The efficacy of music for the treatment of pain has not been established.

OBJECTIVES

To evaluate the effect of music on acute, chronic or cancer pain intensity, pain relief, and analgesic requirements.

SEARCH STRATEGY

We searched The Cochrane Library, MEDLINE, EMBASE, PsycINFO, LILACS and the references in retrieved manuscripts. There was no language restriction.

SELECTION CRITERIA

We included randomized controlled trials that evaluated the effect of music on any type of pain in children or adults. We excluded trials that reported results of concurrent non-pharmacological therapies.

DATA COLLECTION AND ANALYSIS

Data was extracted by two independent review authors. We calculated the mean difference in pain intensity levels, percentage of patients with at least 50% pain relief, and opioid requirements. We converted opioid consumption to morphine equivalents. To explore heterogeneity, studies that evaluated adults, children, acute, chronic, malignant, labor, procedural, or experimental pain were evaluated separately, as well as those studies in which patients chose the type of music.

MAIN RESULTS

Fifty-one studies involving 1867 subjects exposed to music and 1796 controls met inclusion criteria. In the 31 studies evaluating mean pain intensity there was a considerable variation in the effect of music, indicating statistical heterogeneity ( I(2) = 85.3%). After grouping the studies according to the pain model, this heterogeneity remained, with the exception of the studies that evaluated acute postoperative pain. In this last group, patients exposed to music had pain intensity that was 0.5 units lower on a zero to ten scale than unexposed subjects (95% CI: -0.9 to -0.2). Studies that permitted patients to select the music did not reveal a benefit from music; the decline in pain intensity was 0.2 units, 95% CI (-0.7 to 0.2). Four studies reported the proportion of subjects with at least 50% pain relief; subjects exposed to music had a 70% higher likelihood of having pain relief than unexposed subjects (95% CI: 1.21 to 2.37). NNT = 5 (95% CI: 4 to 13). Three studies evaluated opioid requirements two hours after surgery: subjects exposed to music required 1.0 mg (18.4%) less morphine (95% CI: -2.0 to -0.2) than unexposed subjects. Five studies assessed requirements 24 hours after surgery: the music group required 5.7 mg (15.4%) less morphine than the unexposed group (95% CI: -8.8 to -2.6). Five studies evaluated requirements during painful procedures: the difference in requirements showed a trend towards favoring the music group (-0.7 mg, 95% CI: -1.8 to 0.4).

AUTHORS' CONCLUSIONS

Listening to music reduces pain intensity levels and opioid requirements, but the magnitude of these benefits is small and, therefore, its clinical importance unclear.

Subjective Pain Scale and the Need for Analgesia during Shock Wave Lithotripsy

OBJECTIVE

To investigate patients' opinions on the degree of pain during shock wave lithotripsy, and the need for analgesics in patients with urinary stone.

METHODS

A prospective questionnaire study involving subjective pain assessment during and just after shock wave lithotripsy was performed in consecutive patients with uncomplicated renal or ureteral stones. The patients were given unbiased information on the analgesics prior to the procedure. Ten minutes after beginning shock wave lithotripsy, the degree of pain was rated by the patient using a 10-point visual analog scale. After the procedure, the patients were asked to complete a self-administered questionnaire. Based on the response for the questionnaire, the patients were divided as 'tolerable' or 'non-tolerable' group.

RESULTS

The results from 180 patients (males 113, females 67) with a mean age of 50.0 +/- 13.0 were analyzed. The average subjective pain score was 6.6 +/- 2.3 during the procedure, and 70 (38.9%) patients responded that they were able to tolerate the pain without analgesics. A total of 116 (64.4%) patients did not agree that analgesic should be recommended to other patients. Subjective pain score during the procedures was not affected by laterality, size of stone, level of education or socioeconomic status, but was affected by patient age (p = 0.042), sex (p = 0.012) and location of stone (p = 0.014). Right and kidney stones were significantly higher in the 'non-tolerable' group than in the 'tolerable' group (p = 0.003 and p = 0.011, respectively), and the 'non-tolerable' patient group had a significant higher pain score than the 'tolerable' group (p < 0.001).

CONCLUSIONS

Our result shows that subjective pain severity during shock wave lithotripsy is high but may be well tolerated in some patients. Our findings raise the question as to whether routine analgesics are required during newer generation shock wave lithotripsy procedures in all patients with a urinary stone.

Addition of ultralow dose naloxone to postoperative morphine PCA: unchanged analgesia and opioid requirement but decreased incidence of opioid side effects

Ultralow doses of naloxone (0.001-0.1 microg/kg) produce analgesia in animal models. However, no clinical study has evaluated the combination of ultralow dose naloxone and morphine using patient-controlled analgesia (PCA). This randomized, double blind controlled study sought to determine if the combination of ultralow dose naloxone and morphine in PCA solutions affects opioid requirements, analgesia, and side effects. Two-hundred and sixty-five patients (18-65 years old) undergoing operations were randomized to receive PCA morphine 1 mg/ml (n=129) or PCA morphine 1 mg/ml plus naloxone 0.6 microg/ml (n=136). We evaluated the numbers of supplemental rescue doses, the cumulative dose of each PCA solution, pain intensity, pain relief, and opioid side effects during the first 24 h after surgery. We found that opioid requirements did not differ significantly between groups. The morphine+naloxone group on average required 0.07 mg more morphine (95% CI -1.1 to 1.3) during the 24 h than the morphine group. Pain intensity levels were also similar in both groups. The morphine+naloxone group had 0.06 units lower (95% CI -0.5 to 0.4) pain intensity levels than the morphine group. The morphine+naloxone group had a lower incidence of nausea and pruritus than the morphine group (P=0.01 for both symptoms). However, the incidence of vomiting, time to tolerate fluids, sedation, and urinary retention were similar between groups (all P values >0.1). The combination of ultralow dose naloxone and morphine in PCA does not affect analgesia or opioid requirements, but it decreases the incidence of nausea and pruritus.

Music versus distraction for procedural pain and anxiety in patients with cancer

PURPOSE/OBJECTIVES

To test the hypotheses that the effects of a music intervention are greater than those of simple distraction and that either intervention is better at controlling procedural pain and anxiety than treatment as usual.

DESIGN

Randomized, controlled experiment.

SETTING

A midwestern comprehensive cancer center.

SAMPLE

60 people with cancer having noxious medical procedures such as tissue biopsy or port placement or removal; 58 provided usable data.

METHODS

Participants completed measures of pain and anxiety before and after their medical procedures and provided a rating of perceived control over pain and anxiety after the procedure.

MAIN RESEARCH VARIABLES

Procedural pain, state anxiety, and perceived control over pain and anxiety.

FINDINGS

Contrary to hypotheses, outcomes achieved with music did not differ from those achieved with simple distraction. Moreover, outcomes achieved under treatment as usual were not significantly different from those obtained with music or distraction interventions. Some patients found that the interventions were bothersome and reported that they wanted to attend to the activities of the surgeon and the medical procedure itself.

CONCLUSIONS

The effects of music, distraction, and treatment as usual are equivocal. In addition, patients have individual preferences for use of distraction during painful or anxiety-provoking procedures.

IMPLICATIONS FOR NURSING

Patients having noxious medical procedures should be asked about their desire to be distracted before and during the procedure and offered a strategy that is consistent with their preferences.

Music decreases anxiety and provides sedation in extracorporeal shock wave lithotripsy

OBJECTIVES

To evaluate the efficacy of music on sedation in extracorporeal shock wave lithotripsy (ESWL) treatment to compare its anxiolytic effects with those of midazolam.

METHODS

Ninety-eight urolithiasis patients were randomly divided into two groups. Hemodynamic parameters, including mean arterial pressure, heart rate, respiration rate, and oxygen saturation, were recorded in all patients. In 50 patients (group 1), 2 mg of midazolam was administered intravenously 5 minutes before ESWL. In group 2 (n = 48), music chosen by the patients was listened to with a headset and continued during the treatment. The visual analog scale (0 to 100 mm), Observer's Assessment of Alertness/Sedation Scale, State and Trait Anxiety Inventory-Trait Anxiety test, and State and Trait Anxiety Inventory-State Anxiety test were administered for the evaluation of pain, sedation level, and patient anxiety.

RESULTS

For the hemodynamic parameters, a statistically significant decrease in mean arterial pressure was noted at the end of the ESWL procedure in group 2 and in oxygen saturation from the 10th minute to the end of the treatment in group 1. Although the visual analog scale, Observer's Assessment of Alertness/Sedation Scale, and State and Trait Anxiety Inventory-State Anxiety test did not show statistically significant differences, the State and Trait Anxiety Inventory-Trait Anxiety score was found to be lower in the music group (group 2) than in the midazolam group (group 1).

CONCLUSIONS

With the anxiolytic effects of music, ESWL can be performed more effectively with the patient in a comfortable state. Listening to music by patients during the ESWL session is a feasible and convenient alternative to sedatives and anxiolytics.

The combination of low dose of naloxone and morphine in PCA does not decrease opioid requirements in the postoperative period

The continuous infusion of low doses of naloxone has been reported to decrease postoperative opioid requirements and opioid side effects. However, there is no study that evaluates the effectiveness of the combination of a low dose of naloxone and morphine using patient-controlled analgesia (PCA). This prospective, randomized double-blind controlled study sought to determine if the combination of a low dose of naloxone and morphine in a PCA solution decreases postoperative opioid requirements and pain intensity. One hundred sixty-six patients (18-65 years old) undergoing operations of less than 3 h duration with an American Society of Anesthesiologist physical status I or II were randomized to receive PCA morphine 1 mg/cc plus normal saline or PCA morphine 1 mg/cc plus naloxone 6 microg/cc. Initial PCA settings were 0.5 cc per demand with a lockout time of 10 min. The numbers of 2.5 cc supplemental rescue doses and the cumulative dose of each solution were recorded in the first 24 h after the surgical procedure. Pain intensity and opioid side effects were evaluated every 10 min in the post-anesthesia care unit and every 4 h afterwards. Patient satisfaction was assessed at the end of the 24 h of observation. The morphine+naloxone group had more treatment failures (P=0.0001), higher opioid requirements (P=0.0097), greater pain intensity (P=0.04), less pain relief (P=0.004), and less satisfaction (P=0.01) than the morphine group. The incidence of side effects was similar in both groups (P=0.3). Contrary to previous reports, adding low doses of naloxone to a morphine PCA solution increases opioid requirements and pain.

Improved recovery after music and therapeutic suggestions during general anaesthesia: a double-blind randomised controlled trial

PURPOSE

This study was designed to determine whether music or music in combination with therapeutic suggestions in the intra-operative period under general anaesthesia could improve the recovery of hysterectomy patients.

METHODS

In a double-blind randomised clinical investigation, 90 patients who underwent hysterectomy under general anaesthesia were intra-operatively exposed to music, music in combination with therapeutic suggestion or operation room sounds. The anaesthesia was standardised. Postoperative analgesia was provided by a patient-controlled analgesia (PCA). The pain scores were recorded by means of a visual analogue scale. Nausea, emesis, bowel function, fatigue, well-being and duration of hospital stay were studied as outcome variables.

RESULTS

On the day of surgery, patients exposed to music in combination with therapeutic suggestions required less rescue analgesic compared with the controls. Patients in the music group experienced more effective analgesia the first day after surgery and could be mobilised earlier after the operation. At discharge from the hospital patients in the music and music combined with therapeutic suggestion group were less fatigued compared to the controls. No differences were noted in nausea, emesis, bowel function, well-being or length of hospital stay between the groups.

CONCLUSION

This double-blind study has demonstrated that intra-operative music and music in combination with therapeutic suggestions may have some beneficial effects on postoperative recovery after hysterectomy. Further controlled studies are necessary to confirm our results.

The effect of standard care, ibuprofen, and music on pain relief and patient satisfaction in adults with musculoskeletal trauma

OBJECTIVE

The purposes of this study were to determine the most effective nursing intervention to decrease pain for patients with minor musculoskeletal trauma and moderate pain at triage and to examine patient satisfaction.

METHODS

Patients were assigned to 1 of 3 intervention groups: (1) standard care (ice, elevation, and immobilization); (2) standard care and ibuprofen; or (3) standard care and music distraction. Patients were monitored for pain ratings for 60 minutes. Patients who sustained minor musculoskeletal trauma within the past 24 hours and presented with pain ratings of 4 or greater were included. Two patient satisfaction questions were asked upon discharge from the emergency department.

RESULTS

Seventy-seven patients met the inclusion criteria. No differences in pain ratings between groups were demonstrated. A statistically significant reduction in pain for all patients occurred at 30 minutes (F = 16.18, P <.01) and was maintained at 60 minutes. However, 70% of patients continued to report pain ratings of 4 or greater (on a scale of 1 to 10) at 60 minutes. The reduction in pain was not found to be clinically significant.Eighty-four percent of patients stated that they were more satisfied with their overall care in the emergency department because of the immediate attention to pain relief they received at triage. No differences in satisfaction existed between treatment groups, although patients who reported higher pain ratings expressed statistically significant lower satisfaction with pain management scores (F = 9.375, P =.003).

CONCLUSION

None of the therapies-standard care (ice, elevation, immobilization), standard care with ibuprofen, or standard care with music distraction-provided clinically significant pain relief to patients who had minor musculoskeletal trauma (ie, sprains and fractures) and moderate pain at triage. Interestingly, satisfaction scores were sometimes positive, even when pain was not relieved.

Acute pain and pain control: state of the art

Recognition and treatment of pain in the emergency department has undergone an evolution in the past decade. Emergency clinicians, educators, and researchers have begun to address the undertreatment of pain as well as challenge the long-standing dogmas concerning pain treatment. Well-described barriers, both psychological and educational, contribute to our providing inadequate pain relief. This state-of-the-art update describes the current perception of our practice with regard to pain relief and how it can be modified. Pain and pain control is such a broad and complex topic that only new advances and important principles relevant to the practice of emergency medicine are presented. Headache, pediatric pain, and procedural sedation and analgesia are not covered in this article as they will be addressed in future state-of-the-art articles.