The effect of music and distraction on pain and anxiety during colonoscopy: a systematic review and meta-analysis.

Background: Music has been shown to reduce pain and anxiety in patients undergoing colonoscopy. Distraction, a newer technique with less available evidence, has shown similar effective outcomes.

Objectives: This systematic review and meta-analysis evaluate the current evidence available on music and task distraction and its potential to reduce pain in colonoscopy.

Design: The study was performed within PRISMA guidelines and registered with PROSPERO. Inclusion criteria comprised peer-reviewed randomised controlled trial publications in English. Exclusion criteria comprised duplicate studies, non-peer-reviewed and non-English studies.

Methods: A literature search was conducted with Medline, Embase, Cochrane and Google. Two independent clinicians reviewed the studies to avoid inclusion bias. Visual analogue score mean pain and Spielberger State-Trait Anxiety Inventory (STAI) mean anxiety were collected. Inverse variance DerSimonian-led meta-analytical approach was conducted using a random effects model and statistical software STATA.

Results: Music intervention reported a significant (p < 0.05) weighted mean reduction of 1.50 for pain scores (95% CI 0.69-2.31) and a significant weighted mean reduction of 3.56 for anxiety scores (95% CI 0.86-6.27).Distraction intervention reported a significant weighted mean reduction of 1.59 for pain scores (95% CI 0.79-2.39) and a significant weighted mean reduction of 7.49 for anxiety scores (95% CI 3.64-11.35). There was high heterogeneity recorded for both pain and anxiety studies (I² >90%).

Conclusion: Music and distraction intervention has the ability to be introduced at minimal cost. Furthermore, no changes to endoscopy infrastructure are required. This allows a clinical real-world option that is immediately implementable for patients. This meta-analysis has demonstrated that there is a potential role for music and task distraction to reduce pain and anxiety for patients undergoing a colonoscopy. It supports a low cost and safe option for patients who may not be eligible for sedation. Whilst the body of evidence is growing, it is plausible to claim these interventions can be implemented and established into daily clinical practice.