The effect of music on pain and subjective experience in image-guided musculoskeletal corticosteroid injections: a randomized controlled trial.

PURPOSE: To investigate the role of music on subjects undergoing routine image-guided musculoskeletal corticosteroid injections and its effect on post-procedure pain and subjective overall experience. MATERIALS AND METHODS: This prospective study was IRB-approved and HIPAA-compliant. A total of 126 subjects referred for outpatient image-guided musculoskeletal corticosteroid injections were enrolled in the study and randomized into a music offered group ((+)MO) and a no music offered group ((-)MO). (+)MO subjects were given the opportunity to listen to music during their corticosteroid injection. All subjects were then given an anonymous survey on which they recorded their pre-procedural and post-procedural pain on a scale from 0 to 9 and rated their overall experience and how likely they were to recommend our department for musculoskeletal procedures on scales from 1 to 5. RESULTS: (+)MO subjects had significantly lower post-procedural pain (p = 0.013) and significantly greater decrease in pain (p = 0.031) compared to (-)MO subjects. Among the (+)MO subjects, there was no statistically significant difference in post-procedure pain (p = 0.34) or change in pain (p = 0.62) if music was accepted or declined. However, subjects who listened to music did have lower post-procedural pain compared to those who did not listen to music (p = 0.012), although the differences in the decrease of pain between the two groups did not quite reach statistical significance (p = 0.062). CONCLUSIONS: Playing music during image-guided musculoskeletal corticosteroid injections may reduce patients' post-procedure pain. Offering patients some measure of control over their procedure may be a factor that contributes to decreased post-procedure pain as well.

Catheter-Directed Intraarterial Thrombolysis as Part of a Multidisciplinary Management Protocol of Frostbite Injury.

PURPOSE: To evaluate intraarterial catheter-directed thrombolysis for prediction and prevention of delayed surgical amputation as part of multidisciplinary management of frostbite injury. MATERIALS AND METHODS: A retrospective review was performed of 13 patients (11 men, 2 women; median age, 33.4 y; range, 8-62 y) at risk of tissue loss secondary to frostbite injury and treated with catheter-directed tissue plasminogen activator (t-PA) thrombolysis. Amputation data were assessed on follow-up (mean, 23 mo; range, 9-83 mo). Angiographic findings were classified into complete, partial, and no angiographic response and assessed for association with follow-up amputation rates. Correlation between amputation outcome and duration of cold exposure (mean, 23 h; range, 5-96 h), time between exposure and rewarming therapy (mean, 25.5 h; range, 7-95 h), and time between exposure and t-PA thrombolysis (mean, 32 h; range, 12-96 h) was assessed. Complications were recorded. RESULTS: Of 127 digits at risk on baseline angiography that were treated with catheter-directed thrombolysis, complete recovery was seen in 106 (83.4%). Total mean t-PA dose per extremity was 27.5 mg (range, 12-48 mg) over a mean period of 34 hours (range, 12-72 h). Patients with complete angiographic response (8 patients; 79.5% of digits) did not require amputations; 4 of 5 patients (80%) with partial angiographic response (20.5% of digits) underwent amputation (P = .007). There was no significant correlation between amputation rates and duration of cold exposure (P = .9), time to rewarming therapy (P = .88), and time to thrombolysis (P = .56). Femoral access site bleeding in 2 patients was managed conservatively. One patient underwent surgical exploration for brachial artery hematoma. CONCLUSIONS: Intraarterial catheter-directed thrombolysis should be included in initial management of frostbite injury, as it may prevent delayed amputations. The degree of angiographic response to thrombolysis can potentially predict amputation outcomes.