Effect of Music in Reducing Pain during Hemodialysis Access Cannulation A Crossover Randomized Controlled Trial

Abstract

Background and objectives Pain 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 cannulationpaininthesepatients. Design, setting, participants, & measurements We 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. Results The 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 22.7 mm (interquartile range, 29.2 to 3.6), whereas it was 20.3 mm (interquartile range, 25.8 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: 212%; 95% confidence interval, 221 to 22; P50.02.) 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 28%, 95% confidence interval, 218 to 4; P50.17). No intervention-related adverse events were reported. Conclusions Listening to music reduced cannulation pain in patients on hemodialysis, although there was no significant effect on anxiety, BP, or stress markers.