Music as a non-pharmacological intervention for anxiety during extracorporeal shock wave lithotripsy: a systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials
In brief
Music lowers ESWL anxiety by roughly one point on visual scale
A meta-analysis of ten trials found that patients who listened to music during extracorporeal shock wave lithotripsy reported about one point lower anxiety on a 10-point visual analog scale and roughly four points lower on the State-Trait Anxiety Inventory. The effect was modest and derived from very low-certainty evidence, so clinicians should view music as a possible adjunct while awaiting higher-quality trials.
- Journal
- International urology and nephrology (Q2)
- Published
- 21 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Jose Arnaldo Shiomi da Cruz, Breno Cordeiro Porto, Joshua Faldini Pinheiro Koren de Lima, Eugênio Vicari Neto, Gustavo Freschi, Diego Pucharelli Resuto, et al.
- PMID
- 42481774
- DOI
- 10.1007/s11255-026-05266-2
Why clinicians should know about it
- Picked for Nephrology (top studies of the week, 26 July 2026).
Abstract
INTRODUCTION: Extracorporeal shock wave lithotripsy (ESWL) is a widely used non-invasive treatment for urinary stones. Nevertheless, procedural noise, discomfort, uncertainty, and repeated shock-wave delivery may cause clinically relevant anxiety. Music has been proposed as an accessible non-pharmacological strategy to improve the patient experience, but previous reviews have reported heterogeneous results and have frequently combined anxiety with pain or audiovisual interventions. We evaluated the association between music exposure and anxiety during ESWL. METHODS: MEDLINE/PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials, and Google Scholar were searched from inception to March 2026. Randomized controlled trials comparing music with standard care or no music in adults undergoing ESWL were eligible. Anxiety measured using a Visual Analog Scale (VAS) and the State-Trait Anxiety Inventory (STAI) was analyzed separately. Random-effects meta-analyses were performed using mean differences (MDs) with 95% confidence intervals (CIs). Risk of bias was evaluated using Cochrane RoB 2. Leave-one-out sensitivity analyses, Baujat plots, funnel plots, and trial sequential analysis (TSA) were also performed. RESULTS: Twelve randomized controlled trials were included in the systematic review. Ten contributed to the VAS analysis and eight to the STAI analysis. Music was associated with lower anxiety measured using VAS (MD -1.01; 95% CI -1.63 to -0.39; I2 = 80.1%) and STAI (MD -4.46; 95% CI -7.10 to -1.81; I2 = 91.2%). Leave-one-out analyses showed that the direction of the pooled estimates was not determined by any single study. However, substantial heterogeneity and possible small-study effects were present. The certainty of evidence was rated as very low for both outcomes. Under the pre-specified assumptions, TSA indicated that the cumulative evidence crossed the trial sequential monitoring boundary, although this finding does not address the risk of bias or inconsistency of the underlying studies. CONCLUSION: Music was associated with modest reductions in anxiety scores during ESWL and may be considered a feasible non-pharmacological adjunct. Nevertheless, substantial heterogeneity, methodological limitations, variation in music and analgesia protocols, and very low certainty of evidence limit confidence in the magnitude and clinical relevance of the pooled effects. Additional well-designed trials using standardized interventions and clinically meaningful anxiety outcomes remain warranted.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.