A new prospective study suggests simple auditory interventions may help reduce procedure-related pain during upper-face botulinum toxin treatment.
Listening to music or white noise during cosmetic botulinum toxin injections may significantly reduce procedure-related pain, according to a new study published in Pain Research and Management.
The prospective controlled study, led by dermatologist Zuleyha Ozgen from Acibadem Hospital in Istanbul, examined whether sound-based interventions could make upper-face botulinum toxin treatment more comfortable for patients.
The study included 76 female participants aged 18-45 undergoing cosmetic botulinum toxin treatment for wrinkles on the forehead, around the eyes and glabella. Participants were allocated to one of three groups: favourite music, white noise or control. The music and white noise groups listened to their assigned sound from 10 minutes before the procedure and throughout treatment, while the control group was exposed only to background sound.
All patients received topical cold application with an ice pack before and after treatment, and all injections were performed by the same plastic surgeon using the same toxin, same 32-gauge needle and under identical treatment-room conditions.
The study found that pain scores were lower in both sound-intervention groups compared with the control group. Mean pain scores on a 0-10 visual analogue scale were 6.80 in the control group, 5.7 in the music group and 5.52 in the white noise group.
‘Both the white noise group and the music group had significantly lower pain scores compared to the control group,’ the paper reported. ‘Listening to white noise or music during cosmetic botulinum toxin injections can effectively reduce procedure-related pain.’
A simple adjunct for injection comfort
‘Patients often experience anxiety related to the use of needles during medical procedures, which may cause them to postpone treatment,’ Dr Ozgen notes. ‘Therefore, minimising pain and discomfort during injections is an important consideration for healthcare providers.’
In aesthetic medicine, common approaches to reducing discomfort during botulinum toxin injections include smaller needle tips, topical anaesthetic creams, cold application, vibration anaesthesia and skin pinching. In this study, sound was assessed as a low-cost, non-invasive adjunct used alongside ice-pack cryoanalgesia.
The white noise used in the study was a hair-dryer sound played from the same YouTube channel for each participant. Both music and white noise were played openly in the treatment room at 60dB, 150cm from the patient’s chair.
First-time patients reported more pain
The study also found that patients receiving botulinum toxin for the first time reported higher pain scores than those with prior experience.
The mean pain score for first-time patients was 6.57, compared with 5.74 among participants who had previously undergone botulinum toxin treatment.
‘The current study found that participants receiving their first Btx injection reported significantly higher levels of pain than those with prior experience,’ said Dr Ozgen. ‘In light of previous reports, this may be due to uncertainty in predicting pain and a potentially high fear of pain.’
Importantly, the first-time effect appeared most evident in the control group. The author noted that because the higher pain scores associated with first-time treatment were not seen in the music and white noise groups, ‘it can be indicated that white noise and music applications may modify this first-experience effect’.
Stress reduction and patient preference
Participants in the sound groups were also asked to rate the impact of the intervention on stress. The mean stress-reduction score was 6.35 for music and 7.19 for white noise, with no statistically significant difference between the two.
Most participants also indicated they would prefer sound to be used again in future procedures. In the music group, 85 percent of participants preferred sound application for their next procedure, compared with 96.8 percent in the white noise group.
One participant in the white noise group reported that the sound disturbed her and said she would prefer not to have it in future procedures. The remainder of participants who did not actively prefer sound said its presence was not important.
The paper stated: ‘Most participants reported that the application of sound during the procedure had a positive effect on their stress levels. Additionally, the majority expressed a preference for sound to be used in future procedures.’
While the clinical significance of the pain reduction requires further study, the findings suggest sound may be a practical, inexpensive addition to routine comfort measures during minimally invasive cosmetic procedures.
