運用音樂治療於穿刺細胞檢查患者緩解疼痛之成效－系統性文獻回顧與統合分析

背景：穿刺細胞檢查可在門診利用便利快速的長針執行檢查，有助於早期診斷跟治療工具。傷口只有細針孔這麼小，但患者面臨檢查前、手術中、到檢查結果出來時，都會有高度焦慮、疼痛等情緒反應。疼痛是主觀且複雜的現象，可能受到生理、心理、社會、文化等影響。除了藥物治療外，例如音樂治療之非藥物治療在近年的研究也發現可有效緩解患者疼痛的成效。但近年來未有系統性文獻回顧與統合分析研究來檢視運用音樂治療於穿刺細胞檢查患者緩解疼痛之成效。目的：本研究目的旨在透過實證步驟執行系統性文獻回顧與統合分析探討運用音樂治療於穿刺細胞檢查患者緩解疼痛成效。方法：本研究使用PubMed、Medline Ovid、Cochrane、CINAHL、Embase、WOS、「華藝線上圖書館CEPS / Airiti Library中文電子資料庫」、以及「臺灣碩博士論文知識加值系統」等電子資料庫加以搜尋相關文獻。中文關鍵字為穿刺細胞檢查、組織切片、音樂治療、音樂介入、疼痛；英文關鍵字為Aspiration biopsy, Fine needle aspiration, Music therapy, pain以及其MeSH term。搜尋上述資料庫自1991年1月1日至2024年12月31日前已發表之隨機對照試驗文獻。本系統性文獻回顧使用JBI證據等級、JBI隨機對照試驗文獻評讀檢核表、Cochrane Risk of Bias Tool 2.0（RoB 2.0）作為評估工具；本研究由三位評讀者進行文獻評讀。依照RoB 2.0評定偏差風險後，提取數據導入RevMan 5.4版本進行統計檢定。結果：本研究針對音樂治療在穿刺細胞檢查患者中緩解疼痛的成效進行了系統性文獻回顧與統合分析，並整合了來自不同國家和地區的研究結果。研究發現音樂治療在多種穿刺細胞檢查中均能有效減輕患者的疼痛感受，無論是骨髓穿刺、甲狀腺穿刺，還是乳房、腎臟等部位的穿刺細胞檢查。音樂治療的介入方式主要分為耳機播放和揚聲器播放兩種，播放的音樂以古典音樂和輕柔音樂為主。大多數研究選擇將音樂播放時間設定在10至30分鐘之間。根據文獻資料，實驗組的患者在疼痛評分量表上顯示出顯著的疼痛減輕效果。特別是在使用耳機播放音樂時，患者的疼痛和焦慮感受有顯著下降。統合分析結果顯示，納入5篇風險評估為低或中度疑慮之研究後，音樂治療對穿刺細胞檢查患者疼痛緩解具顯著效果（綜合效果量 = 0.98，95% CI [0.82, 1.13]，p < .00001），且異質性極低（Q = 3.36, p = .50；I² = 0%）。進一步進行敏感性分析，納入3篇偏差風險更低之研究後，結果依然穩定且一致（綜合效果量 = 1.04，95% CI [0.87, 1.21]，p < .00001；I² = 0%），顯示音樂治療成效具穩定性與可信度。然而，也有少數研究未能顯示音樂治療對疼痛的顯著緩解作用，可能與樣本量、介入方式及音樂選擇等因素有關。儘管如此，整體來看，音樂治療作為非藥物干預手段對穿刺細胞檢查患者的疼痛緩解仍顯示出良好的效果。結論：本研究的系統性文獻回顧與統合分析證實了音樂治療在緩解穿刺細胞檢查患者疼痛方面的有效性，並提供了對臨床實踐的啟示。主要結果部分，統合分析結果顯示，納入5篇偏倚風險較低或中度之隨機對照試驗後，音樂治療對緩解疼痛具有顯著效果（綜合效應量 = 0.98，95% CI [0.82, 1.13]，p < .00001），且異質性為0%（Q = 3.36, p = .50），顯示研究間高度一致。進一步敏感性分析納入3篇偏差風險更低之文獻後，效果依然穩定（綜合效應量 = 1.04，95% CI [0.87, 1.21]，p < .00001），再度驗證音樂治療在臨床應用上的可靠性與一致性。次要結果部分，部分研究檢測生理指標（如心跳、血壓、呼吸率、自律神經活性與ACTH濃度），顯示音樂治療可促進副交感神經活性、穩定生理參數，並降低壓力相關賀爾蒙釋放，顯示其可能透過調節自律神經系統達成鎮痛與壓力緩解之效果。音樂治療作為一種簡單且成本低廉的非藥物干預手段，可以在不依賴藥物的情況下，幫助患者減輕手術過程中的疼痛與焦慮，提升患者的舒適度。未來的研究應該進一步探討音樂類型、播放方式、介入時間等因素對治療效果的影響，並根據研究結果制定更加標準化的音樂治療臨床應用指南。總體而言，音樂治療具有良好的應用前景，值得在臨床上廣泛推廣和應用，以提高患者的生活品質。PROSPERO註冊號碼：CRD420251056591

Background: Needle aspiration cytology has been a convenient and quick diagnostic tool that can be performed in outpatient settings using a long needle, facilitating early diagnosis and treatment. Despite the wound being as small as a needle puncture, patients have often experienced significant anxiety and emotional distress, including pain, from the time before the procedure until the results are available. Pain has been a subjective and complex phenomenon that may have been influenced by physiological, psychological, social, and cultural factors. In addition to pharmacological treatments, non-pharmacological interventions such as music therapy have been shown in recent studies to have effectively alleviated pain. However, no systematic reviews and meta-analyses have been conducted in recent years to evaluate the effectiveness of music therapy in relieving pain in patients undergoing needle aspiration cytology.Purpose: This study aimed to systematically review and meta-analyze existing evidence on the effectiveness of music therapy in relieving pain in patients undergoing needle aspiration cytology.Methods: The study targeted electronic databases such as PubMed, Medline Ovid, Cochrane, CINAHL, Embase, WOS, "Airiti Library (CEPS / Chinese Electronic Periodical Services)," and the "Taiwan Thesis and Dissertation Knowledge Value-Added System" for article searching. The search included English keywords such as aspiration biopsy, fine needle aspiration, music therapy, pain, and their respective MeSH terms. The search focused on the randomized controlled trials (RCTs) articles published between January 1, 1991, and December 31, 2024. This systematic review employed the JBI Levels of Evidence, the JBI Critical Appraisal Checklist for Randomized Controlled Trials, and the Cochrane Risk of Bias Tool 2.0 (RoB 2.0) appraisal tools. Three reviewers conducted the literature appraisal for this study. After assessing the risk of bias using RoB 2.0, data were extracted and analyzed using RevMan version 5.4 for statistical testing.Results:This study systematically reviewed music therapy's effectiveness in relieving pain in patients undergoing needle aspiration cytology. The review integrated findings from studies conducted in various countries and regions. The results indicated that music therapy effectively alleviated pain in patients undergoing different types of needle aspiration cytology, including bone marrow, thyroid, breast, and kidney biopsies. The interventions mainly involved listening to music through headphones or speakers, with classical and soft music being the most commonly used genres. Most studies set the duration of the music listening to be between 10 and 30 minutes. According to the literature, patients in the experimental groups had significantly reduced pain scores. Particularly, when music was played through headphones, patients experienced a noticeable decrease in pain and anxiety.The meta-analysis revealed a significant effect of music therapy on pain relief, based on five studies assessed as having low to moderate risk of bias (pooled effect size = 0.98, 95% CI [0.82, 1.13], p < .00001), with very low heterogeneity (Q = 3.36, p = .50; I² = 0%), indicating high consistency across studies. Further sensitivity analysis, which included three studies with low risk of bias, demonstrated stable and consistent results (pooled effect size = 1.04, 95% CI [0.87, 1.21], p < .00001; I² = 0%), supporting the robustness and credibility of music therapy’s effects.However, a few studies failed to show significant pain relief, possibly due to small sample sizes, intervention protocol variations, or music selection differences. Despite these exceptions, the overall findings suggest that music therapy, as a non-pharmacological intervention, significantly reduces pain in patients undergoing needle aspiration cytology.Conclusion:The systematic review and meta-analysis conducted in this study confirmed the effectiveness of music therapy in alleviating pain among patients undergoing needle aspiration cytology and provided valuable insights for clinical practice. The meta-analysis of five randomized controlled trials with low to moderate risk of bias showed a significant pain-relieving effect of music therapy (pooled effect size = 0.98, 95% CI [0.82, 1.13], p < .00001), with no heterogeneity across studies (Q = 3.36, p = .50; I² = 0%), indicating strong consistency. A sensitivity analysis including three studies with low risk of bias further demonstrated stable and consistent results (pooled effect size = 1.04, 95% CI [0.87, 1.21], p < .00001; I² = 0%), reinforcing the reliability and robustness of music therapy's effects in clinical settings.Regarding secondary outcomes, several studies assessed physiological indicators such as heart rate, blood pressure, respiratory rate, autonomic nervous system activity, and adrenocorticotropic hormone (ACTH) levels. These findings suggest that music therapy can enhance parasympathetic activity, stabilize physiological parameters, and reduce stress-related hormone release, potentially exerting its analgesic and stress-relieving effects through modulation of the autonomic nervous system.Music therapy, as a simple, low-cost, and non-pharmacological intervention, can effectively reduce pain and anxiety during procedures without reliance on medications, thereby improving patient comfort. Future research should further explore the influence of music type, delivery method, and intervention duration on therapeutic outcomes and establish standardized clinical guidelines accordingly. Music therapy holds significant promise for clinical application and should be widely promoted to enhance patient quality of life.PROSPERO Registration NO.: CRD420251056591