Music Therapy for Pain and Anxiety control in Patients Undergoing Bone Marrow Biopsy and Aspiration: A Systematic review and Meta-analysis

Introduction: Bone marrow biopsy and aspiration (BMBA) are invasive and painful procedures used to diagnose and monitor hematologic and non-hematologic disorders. Music therapy is known as a non- pharmacological approach to pain and anxiety management. However, there is an inconsistent findings regarding the effectiveness of music intervention on pain and anxiety control. We conducted a systematic review to synthesize and analyze the available evidence. Methods: In this systematic review, Google Scholar, PubMed, Web of Science, Cochrane, Scopus, and SID (Scientific Information Database) databases were searched until December 2023. Randomized controlled trials (RCTs) and quasi-experimental studies in English were eligible. Following screening, 4 studies (3 RCTs and 1 quasi-experimental study) were included. For meta-analysis, pain outcomes were analyzed using 3 RCTs, and anxiety outcomes were analyzed using all 4 studies (3 RCTs and 1 quasi-experimental study). Risk of bias was assessed using Cochrane tools (ROB-2 for RCTs, ROBINS-I for non-randomized studies). Meta-analysis was performed using RevMan 5.3, with standardized mean differences (SMDs) and 95% confidence intervals calculated for pain and anxiety outcomes. Result: Four studies (257 patients) were included in the review. Meta-analysis of the data showed listening to music during the bone marrow aspiration and biopsy may reduce pain (SMD -1.05, 95% CI -1.63 to -0.48; 3 trails), and anxiety (SMD -0.31, 95% CI -0.56 to -0.07). However, the certainty of evidence for both outcomes was assessed as very low according to the GRADE approach, due to serious risk of bias, inconsistency, and imprecision. Conclusion: Pain and anxiety are common during BMBA. While music therapy has been studied, the evidence is of very low certainty, so no strong clinical recommendations can be made. More high-quality, large-scale studies with standardized methods are needed to determine if music therapy is effective.