Does music reduce discomfort during ESWL? A prospective randomized trial.

Introduction & Objectives: ESWL is the treatment of choice for a large amount of kidney stones. With modern lithotripters ESWL is usually performed without anaesthesia, but some patients complain of discomfort or pain during treatment. Careful pain control during treatment is also important to limit pain-induced movements and excessive respiratory excursions. The objective of our study was to evaluate if music could reduce patient discomfort during ESWL. Material & Methods: We proposed music listening during ESWL to all patients treated from February 2011 to October 2012. Patients were randomized in two groups: Group A listened to music during the first half of the treatment (1800 shock- waves – SW), Group B during the second half (1700–2200 SW according to patient tolerance). A maximum of 24 kV was delivered according to patient tolerance. Patients were asked to fill in a questionnaire and a pain VAS (Visual Analogue Scale) concerning the first and second half of the treatment. Results: 84 patients (43 in Group A, 41 in Group B) were enrolled, completed and returned the questionnaire. All patients appreciated the chance to listen to music during ESWL and would choose music listening again in case of further treatments. 93% of patients considered music useful to relieve pain or discomfort. A temporary treatment suspension was requested by 20.2% of patients (Group A 16.2%; Group B 24.4%) during music listening and by 21.4% (Group A 18.6%; Group B 24.4%) during the phase without music (p = 0.69). 28.5% of patients (Group A 32.5%; Group B 24.3%) needed analgesics independently from listening to music (p = 1). Considering the whole population, VAS score had a statistically significant increase during the second half of the treatment (p = 0.004): First half 3.68 vs 4.81 second half. The same statistically significant difference was observed for patients of Group A (p = 0.004, first half 4.36 vs second half 5.86) but, interestingly, not for Group B (p = 0.34, first half 4.61 vs second half 5.12). Comparing the music listening phase and the non-listening phase of the treatment, no statistically significant difference in VAS score was observed. Conclusions: Appreciation for music listening during ESWL was very high. The great majority of patients think that music helps to relieve pain. Although the differences are not statistically significant, medium VAS score and treatment suspensions decreased during music listening. Music listening during the second part of the treatment was able to reduce the increase of VAS score observed in patients not listening to music. These data support a possible role for music to reduce discomfort and pain during ESWL.