title: A randomized trial of nature scenery and sounds versus urban scenery and sounds to reduce pain in adults undergoing bone marrow aspirate and biopsy.
abstract: OBJECTIVE
  Bone marrow aspiration and biopsy (BMAB) is painful when performed with only local anesthetic. Our objective was to determine whether viewing nature scenes and listening to nature sounds can reduce pain during BMAB.
  
  
  METHODS
  This was a randomized, controlled clinical trial. Adult patients undergoing outpatient BMAB with only local anesthetic were assigned to use either a nature scene with accompanying nature sounds, city scene with city sounds, or standard care. The primary outcome was a visual analog scale (0-10) of pain. Prespecified secondary analyses included categorizing pain as mild and moderate to severe and using multiple logistic regression to adjust for potential confounding variables.
  
  
  RESULTS
  One hundred and twenty (120) subjects were enrolled: 44 in the Nature arm, 39 in the City arm, and 37 in the Standard Care arm. The mean pain scores, which were the primary outcome, were not significantly different between the three arms. A higher proportion in the Standard Care arm had moderate-to-severe pain (pain rating ≥4) than in the Nature arm (78.4% versus 60.5%), though this was not statistically significant (p = 0.097). This difference was statistically significant after adjusting for differences in the operators who performed the procedures (odds ratio = 3.71, p = 0.02).
  
  
  CONCLUSIONS
  We confirmed earlier findings showing that BMAB is poorly tolerated. While mean pain scores were not significantly different between the study arms, secondary analyses suggest that viewing a nature scene while listening to nature sounds is a safe, inexpensive method that may reduce pain during BMAB. This approach should be considered to alleviate pain during invasive procedures.
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. nlechtz@jhmi.edu
authors.forename: Noah
authors.initials: N
authors.lastname: Lechtzin
authors.forename: Anne M
authors.initials: AM
authors.lastname: Busse
authors.forename: Michael T
authors.initials: MT
authors.lastname: Smith
authors.forename: Stuart
authors.initials: S
authors.lastname: Grossman
authors.forename: Suzanne
authors.initials: S
authors.lastname: Nesbit
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Diette
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D001707:Biopsy, Needle / Q000009:adverse effects*; D001853:Bone Marrow / Q000473:pathology*; D002947:Cities; D004777:Environment; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019368:Nature; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D012064:Relaxation Therapy; D012720:Severity of Illness Index; D013016:Sound
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