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Original Investigation | Journal Club

Music to Reduce Pain and Distress in the Pediatric Emergency Department:  A Randomized Clinical Trial

Lisa Hartling, PhD1,2; Amanda S. Newton, PhD2; Yuanyuan Liang, PhD3; Hsing Jou, MD2; Krista Hewson, BMT, MTA4; Terry P. Klassen, MD, MSc5; Sarah Curtis, MD, MSc2
[+] Author Affiliations
1Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Canada
2Department of Pediatrics, University of Alberta, Edmonton, Canada
3Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
4Soundaffects Music Therapy, Edmonton, Alberta, Canada
5Manitoba Institute of Child Health, Department of Pediatrics, University of Manitoba
JAMA Pediatr. 2013;167(9):826-835. doi:10.1001/jamapediatrics.2013.200.
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Importance  Many medical procedures aimed at helping children cause them pain and distress, which can have long-lasting negative effects. Music is a form of distraction that may alleviate some of the pain and distress experienced by children while undergoing medical procedures.

Objective  To compare music with standard care to manage pain and distress.

Design, Setting, and Participants  Randomized clinical trial conducted in a pediatric emergency department with appropriate sequence generation and adequate allocation concealment from January 1, 2009, to March 31, 2010. Individuals assessing the primary outcome were blind to treatment allocation. A total of 42 children aged 3 to 11 years undergoing intravenous placement were included.

Interventions  Music (recordings selected by a music therapist via ambient speakers) vs standard care.

Main Outcomes and Measures  The primary outcome was behavioral distress assessed blinded using the Observational Scale of Behavioral Distress–Revised. The secondary outcomes included child-reported pain, heart rate, parent and health care provider satisfaction, ease of performing the procedure, and parental anxiety.

Results  With or without controlling for potential confounders, we found no significant difference in the change in behavioral distress from before the procedure to immediately after the procedure. When children who had no distress during the procedure were removed from the analysis, there was a significantly less increase in distress for the music group (standard care group = 2.2 vs music group = 1.1, P < .05). Pain scores among children in the standard care group increased by 2 points, while they remained the same in the music group (P = .04); the difference was considered clinically important. The pattern of parent satisfaction with the management of children’s pain was different between groups, although not statistically significant (P = .07). Health care providers reported that it was easier to perform the procedure for children in the music group (76% very easy) vs the standard care group (38% very easy) (P = .03). Health care providers were more satisfied with the intravenous placement in the music group (86% very satisfied) compared with the standard care group (48%) (P = .02).

Conclusions and Relevance  Music may have a positive impact on pain and distress for children undergoing intravenous placement. Benefits were also observed for the parents and health care providers.

Trial Registration  clinicaltrials.gov Identifier: NCT00761033

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Figures

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Figure 1.
Flow Diagram

Study procedures and timing of outcome assessments. CD indicates compact disc; FPS, Faces Pain Scale; HR, heart rate; IV, intravenous; OSBD-R, Observational Scale of Behavioral Distress–Revised; STAI, State-Trait Anxiety Inventory.

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Figure 2.
Participants

Enrollment and randomization of patients in the trial.

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