The Efficacy of Music as an Adjunct Analgesic in Reducing Pain and Anxiety During Ultrasound-guided Manual Vacuum Aspiration (USG-MVA): A Randomized Controlled Trial

Title: The efficacy of music as an adjunct analgesic in reducing pain and anxiety during ultrasound-guided manual vacuum aspiration (USG-MVA): A randomized controlled trial.

Approximately one in four women will experience an early pregnancy loss in her lifetime. Manual vacuum aspiration (MVA) is one of the treatment options for managing early pregnancy loss. USG-MVA is safer, more cost-effective, and is associated with shorter hospital stay and cost than traditional surgical method. However, majority of patients experience significant pain during the procedure.

At present, there is no consensus on the optimal pain control regimen for USG-MVA. The pain generated from USG-MVA may be due to the dilatation of the cervix or insertion of the catheter or due to uterine contraction. Various analgesic methods have been used to reduce the pain including the use of paracervical block (PCB), non-steroidal anti-inflammatory drugs (NSAIDs), lidocaine gel and conscious sedation but the procedure is still not absolutely painless. Pain management remains an important factor in its success and patient acceptance.

In our previous study, the investigator evaluated the effectiveness of adding Buscopan®, an anti-spasmodic agent, as pain control regimen for women undergone the USG-MVA. Result found that the intervention group were more satisfied to the procedure than the placebo group. They had 15% and 21% lower pain score immediately after the operation as well as two hours post operatively. The investigator postulated the women receiving Buscopan® is being relieved from experiencing uterine spasms. However, the investigator found that the women had higher anxiety levels as reflected by the high anxiety scores in their Hospital Anxiety Depression Scale. Pain perception maybe affected by one's psychological state at the time of the procedure. And undergo a surgical procedure plus the diagnosis of miscarriage further increases their anxiety and stress levels. Therefore to reduce the patient's anxiety during the USG-MVA may further improve the patient's pain control and overall acceptance of the procedure.

Music is known to have a calming effect; previous studies have postulated that music can act as a distracter which turns the patient's attention away from negative stimuli. Another theory is that music activates brain as rewarding region which is responsible for pleasant experiences and happiness and induces dopamine release in striatal system. A systematic review of 42 randomized controlled trials of music interventions in the preoperative setting found music significantly reduced anxiety and pain. Previous studies also showed music as an auxiliary analgesic during first trimester surgical abortion but only with small sample size and mixed results. There has not been any RCTs to investigate the beneficial effect of music therapy in pain control or reducing anxiety levels during USG-MVA.