Effect of Music in Reducing Pain during Hemodialysis Access Cannulation

Abstract

Background and objectivesPain during cannulation for vascular access is a considerable problem for patients with kidney disease who are undergoing hemodialysis. We examined whether listening to music can reduce cannulation pain in these patients.Design, setting, participants, & measurementsWe conducted a multicenter, single-blind, crossover, randomized trial of 121 patients who reported pain during cannulation for hemodialysis. We compared participants listening to “Sonata for Two Pianos in D Major, K.448” or white noise as control while undergoing the cannulation procedure. The cannulation operator was blinded to the intervention, and the hypothesized superiority of music over white noise was concealed during explanations to the participants. The primary end point was the visual analog scale score for cannulation pain independently evaluated by participants.ResultsThe primary analysis was on the basis of the modified intention-to-treat principle. The median baseline visual analog scale pain score was 24.7 mm (interquartile range, 16.5–42.3). Median change of the visual analog scale pain score from the “no sound” to the music period was −2.7 mm (interquartile range, −9.2 to 3.6), whereas it was −0.3 mm (interquartile range, −5.8 to 4.5) from “no sound” to white noise. The visual analog scale pain score decreased when listening to music compared with white noise. (Adjusted difference of visual analog scale pain score: −12%; 95% confidence interval, −21 to −2; P=0.02.) There were no significant differences in the secondary outcomes of anxiety, BP, or stress assessed by salivary amylase (adjusted difference of visual analog scale anxiety score −8%, 95% confidence interval, −18 to 4; P=0.17). No intervention-related adverse events were reported.ConclusionsListening to music reduced cannulation pain in patients on hemodialysis, although there was no significant effect on anxiety, BP, or stress markers.

Factors Affecting Pain in Hemodialysis and Non-pharmacological Management

“…About 20% of patients on hemodialysis have serious pain during cannulation, despite the use of analgesics topically [ 23 ]. About 48% of dialysis people are afraid of the pain associated with the insertion of needles into the fistula.…”

“…Moreover, these individuals usually have pain in the access arm between dialysis regimens [ 26 ]. Pain is one of the main causes of patients’ withdrawal from hemodialysis because they need about 150 hemodialysis regimens per year [ 23 ].…”

“…It has been found that music therapy can significantly decrease pain and anxiety during dialysis therapy [ 32 ] and is efficient for people with painful muscle cramps and musculoskeletal pain [ 24 ]. Additionally, Inayama et al [ 23 ] in their study with 121 hemodialysis patients found that listening to music significantly reduced pain levels during cannulation. In a similar study, with 114 hemodialysis patients, it was found that self-selected soothing music relieved patients from pain caused by fistula puncture [ 24 ].…”

Music intervention in patients undergoing hematopoietic stem cell transplantation: A systematic review and meta‐analysis

“…Music has been shown to be a noninvasive, inexpensive, and useful complementary intervention for reducing pain, anxiety, and distress, and improving relaxation in lung cancer patients undergoing chemotherapy (Tang et al, 2021). Other studies have also demonstrated the use of music therapy to improve nausea and pain in patients with breast cancer undergoing chemotherapy, and in hemodialysis patients (Chirico et al, 2020; Inayama et al, 2022). Music therapy is an emerging discipline based on the theory and methods of psychotherapy; it applies a unique method, through various specially designed music behaviors, to help patients eliminate psychological obstacles, and to restore or improve physical and mental health (Brungardt et al, 2021).…”

Mitigating Pain in People Undergoing Hemodialysis

“…The recent study by Inayama et al published in this issue of CJASN is an example of such a study (5). This is a rigorous, multicenter, single-blind, crossover randomized trial evaluating the efficacy of music as an adjunct to analgesics in reducing pain in 121 people on hemodialysis who reported pain at least once per week during access cannulation.…”