Comparison of the Effects of Auditory and Visual Distraction on the Pain and Anxiety of Patients Receiving Extracorporeal Shockwave Lithotripsy

Today, the rate of kidney diseases and urinary tract stones is on the rise. A common treatment method for urinary tract stones is the use of extracorporeal lithotripsy using shock waves, which may cause pain in the patients when the waves penetrate the skin. Pain could affect hemodynamic parameters and cause restlessness and movement in the patients, thereby disrupting the lithotripsy process. To reduce the pain in these patients, pharmacological methods such as the injection of various narcotic and non-steroidal analgesics are used. In addition to these medications, non-pharmacological methods such as mental distraction could effectively decrease patientschr('39') pain during painful procedures. Previous studies have indicated that mental distraction methods could variable affect pain relief and reduce anxiety in patients during different painful techniques. The present study aimed to compare the effects of visual and auditory distraction the pain and anxiety of these patients.

This three-group quasi-experimental study (auditory intervention, visual intervention, and control) was conducted with a pretest-posttest design at Shahrekord University of Medical Sciences, Iran in 2019. The sample population included the eligible candidates of extracorporeal lithotripsy referring to the lithotripsy unit of Ayatollah Kashani Hospital in Shahrekord in 2019 for outpatient treatment. The patients were selected via non-random sampling from the crusher candidates to achieve the sample size based on the inclusion criteria. The inclusion criteria were the initial diagnosis of kidney stones, age range of 20-50 years, auditory and visual health, and no history of using anti-anxiety medications and painkillers. The exclusion criteria were pain intolerance during the procedure, higher blood pressure than 140/90 mmHg, receiving drug therapy, drug addiction, history of mental and respiratory diseases, and previous experience of stone crushing. Data were collected before and after the intervention using the demographic information questionnaire, McGill short-form pain questionnaire, and Spielberger state-trait anxiety inventory. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency, frequency percentage, mean, and standard deviation) and inferential statistics (paired t-test, t-test, Pearsonchr('39')s correlation-coefficient, and analysis of variance).

The Smirnov-Kolmogorov test showed that the study variables were normal (P>0.05). In total, 48% of the patients were male, and 42% were female. In terms of age, the research units were aged 23-51 years. The analysis of variance (ANOVA) and Chi-square indicated that demographic variables were not significantly different in the three study groups (P>0.05). The mean pain in the studied units was not considered significant in the study groups before the intervention (P=0.13), while this mean value was significant between the groups after the intervention (P<0.001). The lowest pain level during the intervention was observed in the visual intervention group, and Tukeychr('39')s post-hoc test for the difference between the groups also showed that the mean anxiety in the visual intervention group was significantly lower compared to the auditory group (P<0.001). In addition, paired t-test demonstrated that the mean pain was significant in the intervention groups before and after the intervention, and the intervention was effective in the intervention groups (visual and auditory). However, no significant difference was observed in the mean pain before and after the intervention in the control group (P>0.05). No significant correlations were observed between the mean pain and anxiety with the demographic variables (P>0.05), mean anxiety (P=0.84), and pain of the patients (P=0.13) before the intervention in different group, while a significant difference was denoted in the mean anxiety (P<0.001) and pain (P<0.001) after the intervention between the groups. The mean anxiety in the auditory group (P<0.001) and the mean pain in the visual group decreased more significantly (P<0.001) compared to the other groups. Furthermore, the mean pain in the visual group (P<0.001) and auditory group (P=0.02) and anxiety in the auditory group (P<0.001) and visual group (P<0.001) were significantly lower after the intervention compared to before the intervention.

The present study aimed to compare the effects of auditory and visual distraction on the anxiety and pain of the patients undergoing extracorporeal lithotripsy. According to the results, both the auditory and visual distraction techniques were effective in reducing the anxiety of the patients undergoing lithotripsy, while the auditory method had a more significant effect on the reduction of anxiety. Moreover, the visual method could decrease pain more significantly than the auditory method. Given the positive impact of music and movies on the anxiety and pain of the patients undergoing lithotripsy, as well as their lower demand for painkillers, these methods could be applied in the lithotripsy wards of hospitals and medical centers. In addition, using soft music and educational videos in this field while informing the patients about the incidence of kidney stones and treatment and its symptoms could reduce pain and anxiety; this decreases painkiller use and the side-effects of these medications. Such distractions (especially in the first lithotripsy session of the patients) could positively affect their anxiety and pain. The results of this study could be planned by the directors of medical institutions to reduce the pain and anxiety of the patients undergoing kidney stone crushing. Furthermore, nurses in stone-breaking wards should be familiar with various methods of visual and auditory distraction and their positive effect, so that they could be used on patientschr('39') demand as non-pharmacological methods to relieve anxiety and pain and increase patient satisfaction in those undergoing kidney stone crushing or other invasive procedures. It is also suggested that in the further investigations in this regard, the effects of this intervention be evaluated on the patients in the waiting room and on the personnel and researchers also determine the barriers to the use of non-pharmacological methods (e.g., mental distraction) in healthcare centers.