Alam, M., Roongpisuthipong, W., Kim, N.A., Goyal, A., Swary, J.H., Brindise, R.T., . . . Yoo, S. (2016). Utility of recorded guided imagery and relaxing music in reducing patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures: A single-blinded randomized controlled trial. Journal of the American Academy of Dermatology. Advance online publication. 

To determine if brief guided imagery or music can reduce patient pain and anxiety during cutaneous procedures

Consecutive adults undergoing surgery for basal or squamous cell carcinoma of the face were randomized to three groups: (a) guided imagery, (b) music, or (c) control. The guided imagery patients were sent a recording of the guided imagery by mail and instructed to listen to this at least once daily starting at least four days before surgery. Those in the music group listened to music via earphones during the surgery. Patients in the other two groups also wore earphones during the surgery, but without any sound. Pain and anxiety scores were obtained before and after the procedure on the day of surgery.

• N = 155   
• MEDIAN AGE = 62.4–64.2 across study groups 
• MALES: 58%, FEMALES: 42%
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: All had basal or squamous cell skin cancer and were undergoing facial surgery
• OTHER KEY SAMPLE CHARACTERISTICS: No significant differences across groups in the duration of surgery

• SITE: Single site   
• SETTING TYPE: Not specified    
• LOCATION: Northwestern University Hospital

• PHASE OF CARE: Active antitumor treatment

• Single-blind randomized, controlled trial

• Visual analog scale (VAS) for pain
• State-Trait Anxiety Inventory (STAI) short form
• Heart rate
• Blood pressure

There were no significant differences in average change in pain or anxiety scores between groups.

The visual imagery and music interventions as used here had no apparent effect on perioperative pain or anxiety.

• Unintended interventions or applicable interventions were not described that would influence results.
• Measurement validity/reliability questionable
• The logic of expecting to see a decline in pain from pre-op to post-op is questionable.
• No patient education on the use of the visual imagery recording was given.
• Patient adherence to use of the visual imagery was not explored.

This study did not show an effect of music or visual imagery on perioperative pain or anxiety. The lack of effects may be associated with the ways in which the interventions were provided or in the study design—it would be expected that pain should increase postoperatively and anxiety would decline after the surgery was completed. In addition, analysis was done regarding pre- and post-symptom change rather than actual postoperative symptom levels.