Being immersed in a peaceful atmosphere complete with chirping birds, croaking frogs and trickling water can ease the considerable pain of bone marrow extraction in one of five people who must endure it, according to researchers at Johns Hopkins.
On the other hand, researchers found no significant pain relief for patients when they were exposed to busy cityscapes and the distracting sounds of honking cars in traffic, or in the absence of any distractions at all.
Furthermore, the calming distractions of the natural world were only helpful when the doctor performing the complex bone marrow procedure was highly skilled in minimizing pain.
Bone marrow aspirations must be repeated often to diagnose and monitor leukemia and anemia, and as part of bone marrow transplant therapy. The pain of the procedure is considerable, as a six-inch long needle, one-eighth of an inch wide, is inserted into the base of the spine for as long as 10 minutes. The researchers say about 40 percent of cancer patients rate bone marrow aspiration pain as moderate to severe.
The study’s lead investigator, critical care expert and pulmonologist Noah Lechtzin, M.D., M.H.S., says scenes from the natural world painted on bed curtains, along with recorded sounds of nature, are fairly simple distractions that offer a safe, inexpensive way to diminish the serious pain experienced by patients during the often life-saving procedure.
“Our study results also show that a physician’s skill in pain management is key to making these distraction techniques work effectively,” says Lechtzin, an assistant professor at the Johns Hopkins University School of Medicine.
Lechtzin’s previous research with senior study investigator Gregory Diette, M.D., M.H.S., pulmonologist and critical care expert, also showed that these same soothing distractions could produce as much as a fivefold drop in pain during a bronchoscopy, a common throat-irritating procedure.
The results of that study prompted Lechtzin and Diette to see if the technique worked during other painful procedures. Bone marrow aspirations use only a mild, local anesthetic, so patients would be awake and alert to give feedback regarding pain.
The new study included 120 patients, all about to undergo bone marrow aspirations at The Johns Hopkins Hospital. Each participant was randomly assigned one of the following situations: to have the procedure done without distraction therapy (as it is commonly performed in most hospitals) with plain-colored curtains and no background sounds; to have the procedure performed surrounded by curtains with painted murals of forests and mountains; or instead, experience the procedure with distracting scenes of downtown buildings and cars.
Sounds were matched to the scenery and played in the background, with patients having control over the volume.
Just before and after the procedure, patients rated their severity of pain. Results confirmed that, overall, bone marrow aspiration is a painful process, with an average score of 4.8 on the pain scale of 1 to 10, with one quarter of study participants reporting severe pain.
When researchers teased apart the findings among each of the 10 clinicians performing the procedure, they found that among the two physicians whose patients reported the lowest overall pain scores, that the ‘nature scene’ participants had an average pain score of 3.9, while those who were not distracted at all had an average score of 5.7.
“The bottom line here is that finding alternatives, such as these fairly inexpensive nature scenes, to reduce or better control a patient’s pain during common medical procedures is both needed and important, especially if we are trying to keep health care costs down and improve patients’ satisfaction with their care,” says Diette, an associate professor at Johns Hopkins.
Diette points out that each painted screen and audiotape cost less than $300, adding that alternatives, such as hypnosis or increased use of expensive analgesics and sedatives, carries the added risk for complications, greater need for patient monitoring and more recovery time, all of which add to the cost of care. He adds that there are also indirect costs that come with sedation, such as the time involved by family and friends in transporting patients who cannot drive after they wake up.
Diette says the team’s next focus on training clinicians in pain control will be to increase the use of nature scenery and sounds in clinics at Hopkins, and plan a multicenter trial to replicate and enhance the method.
The report is published in the September edition of the Journal of Complementary and Alternative Medicine.
Source: Johns Hopkins