Nguyen, T.N., Nilsson, S., Hellstrom, A.L., & Bengtson, A. (2010). Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: A randomized clinical trial. Journal of Pediatric Oncology Nursing, 27, 146–155.

To evaluate the effect of music in children with cancer who undergo lumbar puncture (LP)

Children were randomized to use either earphones with music (intervention group ) or earphones without music (control group) using iPods. The researcher and physician were blinded to participant group assignment. Immediately prior to the LP procedure, heart rate, blood pressure, oxygen saturation, and respiratory rate were obtained, and pain and anxiety scores were recorded. Directly after the procedure was finished, anxiety was remeasured. Self-reported pain was obtained before, during, and after LP. Physiologic parameters were recorded throughout the procedure. No local anesthetics or other analgesics were administered, which was usual care. Ten children in each group were chosen to be interviewed as well immediately after the LP procedure.

• The study reported on a sample of 40 pediatric patients.
• Patient age ranged from 7 to 12 years.
• The sample was 37.5% female and 32.5% male.
• All children had leukemia and were to have a lumbar puncture procedure.

• Single site
• Outpatient setting
• Hanoi, Vietnam

• Patients were undergoing the active treatment phase of care.
• The study has clinical applicability for pediatrics.

A double-blind, randomized controlled trial design was used.

• Pain Numeric Rating Scale (NRS): Pain intensity self-reported from 0 (no pain) to 10 (worst pain)
• Spielberger State-Trait Anxiety Inventory (STAI)–short form
• Physiologic measures of heart rate, blood pressure, etc.
• Brief semi-structured interview

Pain scores during LP were significantly lower for the music group (p < 0.001), 2.35 compared to 5.65 in controls. Pain scores after the procedure were also lower for the music group (p < 0.003). Anxiety scores after 10 minutes of music before LP were lower for children in the music group (p < 0.001). Anxiety after LP was also lower in the music group (p < 0.001) compared to controls; however, pre- and post-differences in anxiety in both intervention and control groups were minimal. Heart rate and respiratory rate were significantly different between the two groups, with lowered heart (p = 0.012) and respiratory rate (p = 0.009) during the procedure. In interviews, most of the children in the music group indicated that listening to their favorite music helped them feel calm and took their minds off the procedure.

Use of music as a distraction may be helpful to reduce pain and anxiety in children undergoing lumbar puncture.

• The study had a small sample, with less than 100 participants.
• The STAI was developed for and generally used in adults, and has not been validated in children.
• The children themselves could not be blinded to the intervention, and because the children in the control group were entered into the study with the knowledge that they might be given the intervention, but were then assigned to control, they may have felt they were missing something. This could have influenced findings.
• Potential risks with reuse of earphones for providing the music may be present.
• Post-anxiety between groups was reported, but no pre-post change in anxiety was reported. The music group also had lower anxiety at baseline, so it is not clear whether any post difference was due to the intervention.

This study does not provide convincing support for effectiveness of listening to music to reduce anxiety, but it appeared to reduce pain during the procedure. Music provision is a potentially low-risk and low-cost intervention that may be helpful to reduce pain and anxiety in children who are undergoing uncomfortable procedures. Further study of the use of music in combination with other forms of distractions and methods to combat pain are indicated. It is not clear if providing music via use of iPod and earphones is the best approach, as children in this study did indicate that the earphones were somewhat uncomfortable, and use of earphones for multiple patients could be a potential source for transmission of infection.