title: Audiovisual distraction reduces pain perception during shockwave lithotripsy.
abstract: OBJECTIVE
  Lithotripsy is an established method to fragment kidney stones that can be performed without general anesthesia in the outpatient setting. Discomfort and/or noise, however, may deter some patients. It has been demonstrated that audiovisual distraction (AV) can reduce sedoanalgesic requirements and improve patient satisfaction in nonurologic settings, but to our knowledge, this has not been investigated with lithotripsy. This randomized controlled trial was designed to test the hypothesis that AV distraction can reduce perceived pain during lithotripsy.
  
  
  METHODS
  All patients in the study received identical analgesia before a complete session of lithotripsy on a fixed-site Storz Modulith SLX F2 lithotripter. Patients were randomized to two groups: One group (n=61) received AV distraction via a wall-mounted 32″ (82 cm) television with wireless headphones; the other group (n=57) received no AV distraction. The mean intensity of treatment was comparable in both groups. Patients used a visual analogue scale (0-10) to record independent pain and distress scores and a nonverbal pain score was documented by the radiographer during the procedure (0-4).
  
  
  RESULTS
  In the group that received AV distraction, all measures of pain perception were statistically lower. The patient-reported pain score was reduced from a mean of 6.1 to 2.4 (P<0.0001), and the distress score was reduced from a mean of 4.4 to 1.0 (P=0.0001). The mean nonverbal score recorded by the radiographer was reduced from 1.5 to 0.5 (<0.0001).
  
  
  CONCLUSIONS
  AV distraction significantly lowered patients' reported pain and distress scores. This correlated with the nonverbal scores reported by the radiographer. We conclude that AV distraction is a simple method of improving acceptance of lithotripsy and optimizing treatment.
authors.affiliation: The Oxford Stone Group, The Churchill Hospital, Oxford, United Kingdom.
authors.forename: Emma
authors.initials: E
authors.lastname: Marsdin
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Noble
authors.forename: John M
authors.initials: JM
authors.lastname: Reynard
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Turney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001296:Audiovisual Aids; D003710:Demography; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D058748:Pain Perception; D055815:Young Adult