The Soothing Power of Music in the ER

Pediatric IV placement was easier and less distressing in ER rooms where music was playing

(RxWiki News) A visit to the emergency room can be stressful for kids and parents. If a kid is about to get stuck with a needle, music may make everyone in the emergency room a little more comfortable.

A recent clinical trial tested whether playing music in the emergency room while kids underwent a needle stick would reduce pain levels.

The results of this trial showed music provided a slight reduction in pain for some kids. As a bonus, music made things easier for healthcare providers and reduced anxiety in parents, too.

"Take headphones to the ER for stressful moments."

Lisa Hartling, PhD, of the Department of Pediatrics at the University of Alberta in Canada, led this clinical trial to test whether music could help manage pain in kids during emergency department needle sticks.

ERs can be full of strange people and surroundings, bright lights and loud noises, which can be unsettling to kids. Having blood drawn or an IV placed can be very stressful for a child, especially in a potentially chaotic place like an ER. Previous research has shown that the combination of pain and stress in the ER can have long-term effects on kids.

This clinical trial was done between 2009 and 2010 at Stollery Children's Hospital in Edmonton, Canada. All of the 42 kids in the trial were between 3 and 11 years of age and in need of an IV placement. An IV placement involves sticking a needle into a hand vein so that fluids and/or medication can be delivered directly into a person's blood stream.

None of the children in the trial were unconscious for their IV placement. Overall, 67 percent of the kids had experienced a needle poke at some point before this trial.

Half of the kids in the trial were given an IV in a room where music was playing and the other half were given an IV in a room where no music was playing. The music selections were chosen by a music therapist.

The researchers videotaped the IV placement and asked the kids questions about their pain. Each kid wore a heart rate monitor during the IV placement.

The kids were shown a sheet of paper with six different facial expressions displaying increasing levels of pain. The happy face was a zero on the pain scale, and the worst pain face was a 10, with the four other pain faces ranging in between. The kids were asked to point at which face matched the pain they were feeling.

Parents were asked to fill out an anxiety questionnaire based on their own feelings during the IV placement. A 3 out of 5 qualified as moderate and 5 out of 5 qualified as significant distress.

At first glance, the music group and the no-music group appeared to report the same levels of pain during the IV placement. However, after removing the kids who showed no distress at all from the equation, the kids in the no-music group averaged one pain face worse on the pain scale compared to kids in the music group. 

The parents in both groups had similar levels of anxiety while their kids were undergoing IV placement. No differences were found between the children's heart rates in either groups.

When the researchers interviewed the healthcare providers who placed the IVs, 76 percent said the procedure was "very easy" with the kids in the music group. Only 38 percent of the healthcare providers working on kids in the no-music group said the procedure was "very easy."

Also, 86 percent of healthcare providers working with the kids in the music group reported being "very satisfied" with how the procedure went, compared to only 48 percent of providers working with kids in the no-music group.

Overall the authors concluded that the music helped reduce distress in kids who experienced distress in the first place. As an unexpected outcome, the greatest differences between the groups were found in the healthcare providers' easy experiences with the procedure in the music group.

Chris Galloway, MD, emergency room physician and dailyRx Contributing Expert said, "The ER environment is reliably chaotic, noisy, and stressful. This can be particularly frightening to our youngest patients and their parents. Anxiety levels can skyrocket when some kind of invasive procedure is needed during the visit. It is an added bonus if an ER has a dedicated pediatric space that can isolate the kids and their families from the chaos and add calming overtones such as painted cartoon scenes on the walls, walled off rooms instead of curtains, and I do believe music helps the patient, parents, and even the ER staff. 

"We need to de-stress this environment as much as possible because scary and painful healthcare encounters early in life can leave an imprint on pediatric patients causing long-term anxiety in the future," Dr. Galloway said.

The authors recommended that future studies on music to manage pain in children in medical settings should use larger groups.

"Music may have a positive impact on pain and distress in children undergoing IV placement. Benefits observed for the parents and healthcare providers have important clinical implications," the study authors wrote.

This study was published in July in JAMA Pediatrics.

The Women and Children's Health Research Institute provided funding for this trial. Drs. Hartling and Newton reported support from the New Investigator Salary Award from the Canadian Institute of Health Research.

Review Date: 
July 19, 2013