title: Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy: a complementary approach to routine analgesia.
abstract: OBJECTIVE
  To determine whether distraction therapy with nature sights and sounds during flexible bronchoscopy (FB) reduces pain and anxiety.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Teaching hospital in Baltimore, MD.
  
  
  METHODS
  Consecutive adult patients (n = 80) undergoing FB with conscious sedation.
  
  
  METHODS
  Nature scene murals were placed at the bedside, and patients were provided a tape of nature sounds to listen to before, during, and after the procedure. Patients assigned to the control group were not offered either the nature scene or the sounds.
  
  
  RESULTS
  The primary outcomes were patient ratings of pain control (a 5-point scale ranging from poor to excellent) and anxiety. In a multivariate ordinal logistic regression model, the odds of better pain control were greater in the intervention patients than in the control patients (odds ratio [OR], 4.76; 95% confidence interval [CI], 1.35 to 16.7), after adjustment for age, gender, race, education, health status, and dose of narcotic medication. Older patients and patients with better health status reported significantly less pain. There was no difference in patient-reported anxiety between the two groups (OR, 0.87; 95% CI, 0.39 to 1.96).
  
  
  CONCLUSIONS
  Distraction therapy with nature sights and sounds significantly reduces pain in patients undergoing FB. Although the precise mechanism of this beneficial effect requires further investigation, clinicians should consider this nonintrusive strategy in addition to standard analgesic medications in patients undergoing painful, invasive procedures.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. gdiette@jhmi.edu
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Diette
authors.forename: Noah
authors.initials: N
authors.lastname: Lechtzin
authors.forename: Edward
authors.initials: E
authors.lastname: Haponik
authors.forename: Aline
authors.initials: A
authors.lastname: Devrotes
authors.forename: Haya R
authors.initials: HR
authors.lastname: Rubin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000517:prevention & control*; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D026441:Mind-Body Therapies; D015999:Multivariate Analysis; D010146:Pain / Q000517:prevention & control*; D017060:Patient Satisfaction