Music for Pain and Anxiety in Children Undergoing Medical Procedures: A Systematic Review of Randomized Controlled Trials

OBJECTIVE: The aim of this study was to conduct a systematic review of the efficacy of music therapy (MT) on pain and anxiety in children undergoing clinical procedures. METHODS: We searched 16 electronic databases of published and unpublished studies, subject bibliographies, reference lists of relevant articles, and trials registries. Two reviewers independently screened 4559 citations and reviewed the full manuscript of 393 studies. Nineteen studies met the inclusion criteria: randomized controlled trial, children aged 1 month to 18 years were examined, music was used as an intervention, and the study measured pain or anxiety. Music therapy was considered active if a music therapist was involved and music was used as a medium for interactive communication. Passive music therapy was defined as listening to music without the involvement of a music therapist. RESULTS: The 19 included trials involved 1513 subjects. The methodological quality of the studies was generally poor. Overall, MT showed a significant reduction in pain and anxiety (standardized mean difference [SMD] -0.35; 95% confidence interval [CI], -0.55 to -0.14; 9 studies; N = 704; I(2) = 42%). When analyzed by outcome, MT significantly reduced anxiety (SMD -0.39; 95% CI, -0.76 to -0.03; 5 studies; n = 284; I(2) = 52.4%) and pain (SMD -0.39; 95% CI, -0.66 to -0.11; 5 studies; N = 465; I(2) = 49.7%). There was no evidence of publication bias. CONCLUSIONS: Music is effective in reducing anxiety and pain in children undergoing medical and dental procedures. Music can be considered an adjunctive therapy in clinical situations that produce pain or anxiety