Adjunct Therapy for Needlesticks and Anxiety 1

Adjunct Therapy for Painful Pediatric Needlesticks and Anxiety

Jennifer Repin
Seattle Pacific University

Adjunct Therapy for Painful Pediatric Needlesticks and Anxiety

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"Repetitive venipunctures are a stressful and painful experience for children" (Miguez-

Navarro & Guerrero-Marquez, 2016). Many studies are evaluating the use of adjunct therapies

like music to help reduce pain and anxiety in children. "Music therapy as procedural support has

been shown to alleviate pediatric pain, anxiety, distress, and fear during pediatric medical

procedures" (Yinger, 2016). With the pain and lasting trauma of needlesticks, music therapy

should be considered as an adjunct for any procedure where is might reduce the anxiety in

children. The purpose of this synthesis is to evaluate the effectiveness of music as an adjunct

therapy for anxiety and painful needlesticks for children.

This synthesis reviews five different randomized controlled studies that all have a slightly

different independent variable but the same dependent variable. Kristjánsdóttir et al. (2011) and

Noguchi (2006) offered similar insights that music via headphones offer adjunct therapy to

painful needle sticks, whereas Yinger (2016), Navarro et al. (2016), and Sahiner et al. (2015)

offered different noise type adjunct therapies to achieving distractions from painful needle sticks.

The dependent variable in all five studies were children experiencing pain and anxiety during

needle sticks. All five of these studies were striving to prove that music therapy was an

appropriately situated type of adjunct therapy for painful needlesticks in children.

Each of the studies used a previously validated pain scale to measure before and after

results of a child's pain level. The tools used in all the studies were deemed to be reliable based

on the validity of each pain scale. Sahiner et al. (2015), Navarro et al. (2016), and Noguchi et al.

(2006) used the Wong-Baker FACES pain scale to measure the level of pain experienced before,

during, and after the procedure. The use of pain scales gathers subjective data and is subject to

certain limitations, such as children not giving accurate reports of pain (Kristjánsdóttir, 2016).

There are other limitations that each study mentioned. All five studies had limitations that could
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threaten the internal validity of their subsequent studies. Kristjánsdóttir et al. (2011) and Sahiner

et al. (2016) had limitations concerning how children reported their pain. The study completed

by Yinger (2016) mentioned that there is room for bias because the study was not blinded. All

five of the studies were valid because they measured what was intended to be measured, which

was the distress and self-report of pain in children.

The primary demographics of all five studies included only children; each study had its

perimeters on the ages of the children, which ranged from three to fifteen years old.

Kristjánsdóttir et al. (2011), Noguchi (2006), and Yinger (2016) only focused on a single limited

age group whereas Navarro et al. (2016) and Sahiner et al. (2016) had multiple age groups in

their studies. Other demographics included gender, anxiety levels, number of injections, and

overall health.

All five of the randomized control studies had sample sizes that varied depending on an

independent variable, with three of the five studies meeting their power analysis; Kristjánsdóttir

et al., (2011), Yinger (2016) and Sahiner et al. (2016). Noguchi (2006) and Navarro et al. (2016)

did not report any power analysis. The results of the studies showed that the participants were

less anxious and reported less pain during the procedures. Yinger (2016) stated that the results

of music therapy intervention showed a significantly lower rate of distressed behavior in

children.

Despite limitations, each study proved that music therapy is some form, provided a

decrease in reported pain and anxiety during needlesticks. Music therapy, as an adjunct to a

painful procedure, is a lower cost, non-pharmaceutical treatment that provides a certain level of

relief. In conclusion, I recommend that music therapy be allowed at the request of parents and

patients during painful procedures like needle sticks. There does need to be further research to
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identify how music affects the individual based on their age. Also, for agencies and hospitals to

implement music therapy as an adjunct to painful procedures, there needs to be more research

done on types of musical distractions that are beneficial.

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References
Kristjánsdóttir, Ó., & Kristjánsdóttir, G. (2011). Randomized clinical trial of musical distraction
with and without headphones for adolescents’ immunization pain. Scandinavian Journal of
Caring Sciences, 25(1), 19–26. doi: 10.1111/j.1471-6712.2010.00784.x
Miguez-Navarro C, Guerrero-Marquez G. (2016). Video-distraction system to reduce anxiety
and pain in children subjected to venipuncture in pediatric emergencies. Pediatric Emergency
Care and Medicine: Open Access. 1:1.
Noguchi, L. K. (2006). The effect of music versus nonmusic on behavioral signs of distress and
self-report of pain in pediatric injection patients. Journal of Music Therapy, 43(1), 16–38.
doi: 10.1093/jmt/43.1.16
Sahiner, N. C., & Bal, M. D. (2016). The effects of three different distraction methods on pain
and anxiety in children. Journal of Child Health Care, 20(3), 277–285. doi:
10.1177/1367493515587062
Yinger, O. S. (2016). Music therapy as procedural support for young children undergoing
immunizations: A randomized controlled study. Journal of Music Therapy, 53(4), 336–363.
doi: 10.1093/jmt/thw010