The Effectiveness of Music in Reducing Patient
Anxiety and Pain During Phlebotomy: A Pilot Study
Pin Ying Koo
Introduction
Numerous studies have shown that about 10%
of patients report an excessive fear of needles,
causing significant anxiety and avoidance 1,2,3.
Considering that this is a sizable percentage, a
form of ‘on-the-spot’ intervention4 is desirable
to tackle this issue.
Music has been shown to have physiological
effects on the limbic system and therefore
influence emotion5 and facilitate relaxation by
reducing sympathetic nervous system activity6.
According to the gate control theory, listening
to music competes with pain stimuli travelling
via peripheral nerve impulses to be processed
in the brain and therefore, may aid in reducing
pain perception7.
Recruitment of Participants
Inclusion criteria:
 Ages 18 and over
 Having an English reading level of at least
grade 6
 Capable to give consent
 Been requested by a doctor to have a blood
sample taken
Patients
Approached:
Research Question
Does music effectively reduce patient anxiety
and pain during phlebotomy?
Methods and Materials
Music was predetermined to be playing or not
during the days of the research period. Two
groups of patients were allocated using
opportunistic block randomisation, according to
the day in which they arrived at the
department.
The experimental group was exposed to music
during the phlebotomy procedure and the
control group had no form of intervention. The
results obtained from the following
questionnaires were then compared in both the
groups:
Incomplete
Questionnaires:
15
 The mean state anxiety before the
procedure for the control group (31.91 ±
9.879, p value = 0.1822) is noticeably
greater compared to the experimental
group (29.97 ± 9.686, p value = 0.1822)
 It is therefore inconclusive as to whether
music is a causative factor in reducing the
overall state anxiety of patients
Patients that
Filled out
Questionnaires:
 There was no statistically significant
difference between the control and
experiment group for differences in pain (p
value = 0.352)
207
Final
Participants:
192
Results
 There is a decrease in mean state anxiety
for both the control and experimental
group after the venepuncture procedure
was carried out of (2.73 ± 6.803, p value =
0.014) and (0.47 ± 5.737, p value = 0.014)
respectively
342
Patients that
Declined:
135
Discussion
 Patients generally favour having music, with
62.5% of participants stating that they
would prefer music to be present in the
background of the phlebotomy room
 75% of patients with a possible needle
phobia advocated their support for playing
music
Conclusions
 There is insufficient data to support the
hypothesis that music reduces state anxiety
and pain levels during the phlebotomy
procedure
 From patient feedback, music was regarded
as being a good means by which to achieve
better patient- centred care
Future Indications
.
Music selection:
The music was sourced from a composer and
based on the criteria for 'relaxing' music in the
current literature8 under the advice of a music
therapist.
 A larger sample size will be required in
order to determine whether music truly
exerts an effect or not
 A different method of randomisation to be
utilised such as allocating patients who
arrive on the same day randomly into either
the control or experimental group
References
1. Mollema, E., Snoek, F., Adèr, H., Heine, R. and van der Ploeg, H. (2001). Insulin-treated diabetes patients
with fear of self-injecting or fear of self-testing. Journal of Psychosomatic Research, 51(5), pp.665-672.
2. Y. Nir, A. Paz, E. Sabo, I. Potasman. (2003). Fear of injections in young adults: prevalence and
associations. American Journal of Tropical Medicine and Hygiene, 68(3), pp. 341–344
3. Deacon, B. and Abramowitz, J. (2006). Fear of needles and vasovagal reactions among phlebotomy
patients. Journal of Anxiety Disorders, 20(7), pp.946-960.
4. Payne R. Relaxation techniques. Edinburgh: Churchill Livingstone; 2000.
5. Boso M, Politi F, Borale F, Emanuele E. Neurophysiology and neurobiology of the Musical Experience.
Functional Neurology 2006; 21(4): 187-191.
6. L. Bernardi, C. Porta, P. Sleight Cardiovascular, cerebrovascular, and respiratory changes induced by
different types of music in musicians and non-musicians: The importance of silence. Heart, 92 (4) (2006),
pp. 445–452
7. The Challenge of Pain. By R. Melzack and P. Wall. (Pp. 450; illustrated; £5.95.) Penguin Books:
Harmondsworth. 1982.Psychological Approaches to the Management of Pain. Psychological Medicine.
1984;14(02):476.
8. Elliott D, Polman R, McGregor R. Relaxing Music for Anxiety Control. Journal of Music Therapy.
2011;48(3):264-288.