Music as an adjunct to analgesics for improved anxiety and pain during prostate biopsy

Prostate cancer remains a pressing global health concern among men (1). Transrectal ultrasound-guided prostate biopsy (TRUSPB) continues to be a standard diagnostic procedure for confirming prostate malignancies histologically (2). However, this procedure is associated with significant complications, including pain, hematuria, acute urinary retention, urinary tract infections, and life-threatening sepsis (2,3). Growing awareness of the higher rates of infectious complications with the transrectal approach has prompted increased adoption of the transperineal technique. Nevertheless, while this technique offers notable benefits, concerns persist about its potential for increased procedural pain (3).

In their article entitled “Practical use of self-adjusted nitrous oxide during transrectal prostate biopsy: A double-blind randomized controlled trial”, published in the Journal of Urology, Escobar and colleagues evaluated the use of low-dose (<45%) nitrous oxide for managing pain during TRUSPB (4). A total of 133 patients were allocated to receive either self-adjusted nitrous oxide (n=66) or oxygen (n = 67), alongside routine periprostatic bupivacaine injection. While patient-reported anxiety levels after the biopsy showed no significant difference between the groups, those receiving nitrous oxide reported a significant reduction in procedural pain. Additional outcomes, including biopsy efficacy, operative time, and complication rates, were comparable between the groups. These findings corroborate earlier research indicating that a 50:50 nitrous oxide-oxygen mixture effectively reduces TRUSPB pain and improves patient satisfaction, albeit with potential dose-dependent side effects (5). Notably, higher concentrations of nitrous oxide provide stronger analgesic and anxiolytic effects but carry an increased risk of adverse events both during and after the procedure.

Music has been shown to alleviate pain, anxiety, and stress by redirecting patients’ attention away from negative stimuli and fostering focus on more positive and comforting experiences (6). These effects are supported by well-documented physiological mechanisms linking anxiety and pain perception (7). Specifically, music can reduce the need for sedatives and analgesics by modulating activity in the cingulo-frontal cortex, which plays a critical role in pain regulation and anxiety reduction. A recent meta-analysis has highlighted the potential of music interventions to improve outcomes in patients with cancer by reducing anxiety, pain, and fatigue while enhancing overall quality of life (8). Furthermore, multiple studies have demonstrated the utility of music as a complementary therapeutic tool during urological procedures, such as prostate biopsies, urodynamic evaluations, and both rigid and flexible cystoscopy (9).

Patients undergoing TRUSPB may be adversely impacted by the noises produced in the environment during this procedure. Noise-canceling headphones can mitigate this issue by reducing background noise and enhancing the clarity of music, allowing patients to better perceive its calming effects (10). A recent randomized clinical trial has suggested that noise-canceling headphones may have beneficial effects on anxiety, pain, satisfaction, and willingness to repeat the procedure in men undergoing TRUSPB (11). Similarly, in a prospective randomized trial, using noise-canceling headphones to deliver music to male patients with bladder cancer was found to reduce anxiety during cystoscopy (12).

Despite these promising findings, existing studies have limitations. Many fail to assess anxiety and pain at specific stages of the procedure, relying primarily on subjective reports or limited objective markers, such as vital signs and oxygen saturation. Future research should focus on developing comprehensive tools to evaluate both subjective and objective parameters of pain and anxiety in real time. Such advancements would enable a more precise assessment of the efficacy and impact of pain management strategies during and after the procedure.

Acknowledgments

None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Translational Andrology and Urology. The article has undergone external peer review.

Peer Review File: Available at https://tau.amegroups.com/article/view/10.21037/tau-2024-760/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-2024-760/coif). The authors have no conflicts of interest to declare.

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