Can Music Effectively Reduce Anxiety in Outpatient Dermatologic Surgery?

Although anxiety may be a normal physiologic response to stress in patients undergoing elective outpatient surgery, it may adversely affect patient outcomes during and after a procedure. Whenever possible, it is important for clinicians to recognize and mitigate unproductive stress emotions, including anxiety, with a combination of pharmacologic and nonpharmacologic  interventions. Perioperative music intervention may be an important, yet underutilized, modality to reduce patient anxiety in the operating room.
 
Music Intervention Studies 
In the cardiovascular procedure space, programmed music intervention has been shown to reduce stress-evoked physiologic and  neurologic responses, including post-procedural pain, heart rate, and systolic blood pressure, in patients undergoing invasive coronary procedures.¹ And limited studies on music intervention in the fields of outpatient dermatology and Mohs micrographic surgery (MMS) may also yield clues to the anxiety-reducing effect of playing music in the perioperative setting. 

In a study of patients undergoing non-MMS dermatologic procedures under local anesthesia, Sorenson et al. demonstrated that physician-selected classical music played during surgery reduced patients’ pain and anxiety.² The prospective, unblinded, randomized controlled trial divided 91 outpatients into 2 groups. Fortyfive participants in the music group were given a headset playing Chopin’s piano nocturnes, while 46 patients in the control group did not listen to music during their procedure. The music group had lower mean pain and anxiety scores than the control group, demonstrating that music intervention may be a safe, inexpensive, and easily implementable intervention.

Vachiramon et al. conducted an open-labeled, randomized controlled trial of 100 patients undergoing MMS divided into a control group and a music group.³ The music group listened to patient-selected music during their outpatient MMS with local anesthesia, while the control group did not listen to music during their surgery. The study found a significantly lower mean anxiety level in the music group. The authors conclude that the introduction of patient-selected music is a “simple strategy to minimize anxiety during MMS.”

Alam et al. measured pain and anxiety among patients undergoing cutaneous surgical procedures using local anesthesia.⁴ The randomized controlled study divided 155 patients into 3 relatively equal groups, including a control group who had no music, those  who listened to a short, pre-recorded session of ”guided imagery,” and those who listened to clinic-selected “relaxing” music during their procedure. Guided imagery consisted of a 13:25 minute recording that “explained in detail how the surgery would proceed painlessly and without incident to a conclusion free of cancer, associated with rapid healing and with the least scar possible.” The relaxing music consisted of a half-hour recording, with a tempo of 60 to 70 beats per minute, of “soothing music and nature sounds, such as falling water and chirping birds.” The study identified no significant differences in patients’ pain, anxiety, blood pressure, and heart rate across all 3 groups. Although this study did not identify any statistically significant improvements in anxiety among patients in the music group, the authors did identify lower anxiety among surgeons who were present in the guided imagery and relaxing music group.

Discussion
Perioperative anxiety can be a functional coping mechanism or a dysfunctional adaptive strategy to manage fear. A healthy dialogue between patient and physician may be an important first step in establishing trust and reducing stress related to a procedure. Patients may have procedure-related anxiety for many reasons, including preconceived notions of pain and discomfort, subjective bias, lack of information, or generalized anxiety disorder. However, anxiety is not always a pathologic response. Baseline stress levels and comorbid psychological behaviors may also affect a patient’s coping mechanism during surgery.

Although some clinical studies have not identified statistically significant differences in anxiety among patients exposed to music during surgery, confounding variables in patient selection, small study populations, subjectivity of patient reporting, and receptive biases toward various types of music may have affected outcomes. Quantifying anxiety, or even the reduction in anxiety, among patients remains a difficult task. 

The very definition of “relaxing” music is also subjective, as a specific melody or type of music may elicit vastly different emotional responses among patients. In a hypothetical scenario, classical music may be deemed relaxing by the researcher but may be despised by the patient. In such a scenario, the emotions elicited by clinician-chosen music may bear atypical patient responses. Some researchers have opted to circumvent this problem by studying the anxiety-reducing response to patientselected music intervention. This too has limitations, however, as patients may feel stressed, overwhelmed, or overburdened to choose a specific genre of music for the entire operation in a limited amount of time.

Conclusion
It is feasible that music therapy may be utilized in conjunction with other modalities to increase patient comfort and decrease perioperative anxiety. For future studies, larger patient populations are needed to ensure enough power to detect statistically significant differences in patient-reported anxiety. Future projects may also wish to examine the role of different types of music for diminishing patient-reported anxiety during dermatologic procedures.

Levon Karamanoukian is co-founder of the Brentwood Piano Collective, a charitable foundation for pediatric illness. Dr Rtail is a certified plastic surgeon specialized in facial plastic surgery. Kushagra Tewari is a medical student at the UCLA School of Medicine in Los Angeles, CA.

Disclosure: The authors report no relevant financial relationships. 

References
1. Siddiqi AK, Shafiq A, Ahmed M, et al. Therapeutic use of music listening in patients undergoing invasive coronary procedures: a meta-analysis. World J Cardiol. 2025;17(1):97406. doi:10.4330/wjc.v17.i1.97406

2. Sorensen EP, Gu H, Tabacchi M, Council ML. Music reduces pain and anxiety associated with local anesthesia for dermatologic procedures: a randomized controlled trial. J Am Acad Dermatol. 2021;85(4):989-991. doi:10.1016/j.jaad.2020.09.034

3. Vachiramon V, Sobanko JF, Rattanaumpawan P, Miller CJ. Music reduces patient anxiety during Mohs surgery: an open-label randomized controlled trial. Dermatol Surg. 2013;39(2):298-305. doi:10.1111/dsu.12047

4. Alam M, Roongpisuthipong W, Kim NA, et al. Utility of recorded guided imagery and relaxing music in reducing patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures: a single-blinded randomized controlled trial. J Am Acad Dermatol. 2016;75(3):585-589. doi:10.1016/j.jaad.2016.02.1143