Biopsy in D minor by Johann Sebastian you know who


A group of medical students and fellows at Duke University have shown that if you distract patients’ attention while they are having a prostate biopsy it can (at least to some extent) reduce the likelihood of patient reports of pain and anxiety associated with the procedure.

Tsivian et al. enrolled 88 patients who were randomized to one of three groups:

  • Men in the first group were given a standard biopsy with no distractions (Group A).
  • Those in the second group wore a pair of noise-canceling headphones (Group B).
  • Men in the third group wore the noise-canceling headphones and were asked to listen to parts of J. S. Bach’s Brandenberg concertos (Group C).

Alas, there appears to have been no group wearing the headphones and asked to listen to the rock opera “Tommy” or to classical music more like “The Firebird” (let alone to an extended rap by Eminem) so we have little input here as regards the relative benefits of differing types of musical distraction.

Patients’ blood pressure levels were  taken before and after the trans-rectal biopsy. (It is known that diastolic blood pressure often rises as a eresponse to stress and anxiety.) Patients were also asked to complete validated questionnaires before and after biopsy as a means to assess patients’ perceived levels of pain and anxiety. All patients received lidocaine-based analgesia prior to the biopsy procedure.

The study results were as follows:

  • Post-biopsy pain scores increased from baseline among all study groups.
  • The lowest median post-biopsy pain score was observed in Group C.
  • Post-biopsy anxiety scores were similar to baseline anxiety scores in all three groups.
  • Post-biopsy systolic blood pressure levels were comparable to baseline levels in all three groups.
  • Among patients in Group A and Group B, diastolic blood pressure was elevated after the biopsy compared to before the procedure.
  • Among patients in Group C, there was no rise in diastolic blood pressure post-biopsy (suggestive of less physiological response to pain and anxiety ion this group of men).

The authors conclude that, “Music-induced attention shift during prostate biopsy may have a beneficial impact on procedural anxiety and pain perception, but no apparent effect was noted for use of headphones alone.” In other words, removing the noises associated with the biopsy alone (e.g., the “click” of the biopsy gun)  was not enough to relieve patient anxiety about this procedure.

The research team was clearly cognizant of the fact that music choice might be significant to the outcome of this study: “We couldn’t study all the permutations and variables, but it’s evident that this kind of approach works,” said Thomas Polascik, MD, director of Urologic Oncology at the Duke Cancer Institute and senior author of the study, in a media release from DukeHealth.org.

About 20 percent of the men who undergo biopsies for prostate cancer each year find this procedure to be very stressful and very painful. It is unclear exactly why this is a significant problem for some men and much less so for others. Clearly any low-cost and effective method to relieve patient stress and anxiety induced by this procedure would be a good thing. Your author thinks he would go for music from “Tommy” (specifically including “Pinball Wizard”).

10 Responses

  1. Seems like Won’t Get Fooled Again off of Who’s Next might have been more appropriate.

  2. And I say BULL to that!

  3. Any of the music from “Tommy”? Would that include “See me, feel me, touch me, heal me”? :-)

  4. I have had the procedure, no distractions, just a warning from the doctor before each click. The pain was no worse than a slight pull on a strand of hair. Some men have a high threshold to pain (me); some will yell ouch before the tube is even in their butt. So this tells me, anything that works to comfort those who have a low threshold to pain is well worth the effort. Not all men are created equal when it comes to pain.

  5. As a second addendum, I decided to have a RP back in 2003 when I was 65. The nurse kept asking me during the night if I needed more meds after the RP. I didn’t need any but they were concerned that I was trying to act brave. Men, I can tell you, I never had any pain, the worst issue was: carrying around that damn piss bag for 10 days, no discomfort, just an annoyance.

  6. My first 8-sample biopsy was done without any distraction; my second 12-sample one was done with me fully sedated. Music was never offered. The first one was a nightmare. The second one was a dream. It is nice to see that music could help, but having done it both ways, I’d never consider doing another one other than fully sedated, and let the doctor listen to whatever music s/he wants to (perhaps Verdi’s “The Anvil Chorus”?).

  7. And asking a patient to breathe deep and wiggle his toes and move his hands and … wait, you’re not wiggling your toes … why are you not breathing deep like a Shaolin monk … while removing a surgical drain has the same effect.

  8. Because — as I understand it — if a patient is actually sedated, …

    (1) This needs to be supervised by an anesthetist, which means that biopsies would need to be done at some form of surgical center, driving up the cost of what is a relatively simple procedure.

    (2) There would need to be a recovery room where patients could have time to recover after their procedure and

    (3) Patients would need to be advised that they should not attempt to drive immediately following their procedure (so someone would have to take them for their procedure and pick them up afterwards).

    There may be other reasons that I am not aware of too.

  9. For a whole variety of possible reasons:

    (1) Sedation may require supervision by a trained anesthetist, which would probably mean the procedure had to be carried out at some form of surgical facility with appropriate anesthesia staff available. (This would significantly drive up the cost of a biopsy.)

    (2) Sedated patients would need a recovery room in which to be able to recover after their procedure (again impacting cost).

    (3) Sedated patinets should not drive for a significant period after their sedation, which means that someone would have to take the patient for his biopsy and pick him up again afterwards (which adds to the inconvenience).

    There may be other reasons that others are aware of too.

  10. Just like a colonoscopy?

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