Mirror Versus Music for Fistula Cannulation Pain in Hemodialysis: A Randomized Trial

To compare the efficacy of mirror intervention and music intervention in managing arteriovenous fistula cannulation pain in patients undergoing hemodialysis.

A prospective, single-center, three-arm, parallel-group, randomized controlled trial according to CONSORT guidelines.

The present study was conducted in a specialized hemodialysis unit between 01 and 06 December 2025. The participants were randomly assigned to either the mirror intervention group (n = 25), the music intervention group (n = 25), or the control group (n = 25). Over the course of one week, participants underwent three cannulation sessions: one baseline session and two intervention sessions. During the intervention sessions, prior to cannulation, the mirror group was instructed to observe the reflection of their non-access arm for a period of 10 minutes, while the music group listened to analgesic instrumental music for a duration of 10 minutes. The control group received standard care. The intensity of pain was measured immediately after each cannulation using a 100 mm Visual Analog Scale. The study was registered with ClinicalTrials.gov (NCT07320859).

The mean age of participants was 56.97 ± 15.22 years. Baseline pain scores and demographic characteristics were comparable between groups. The mirror intervention group demonstrated statistically significant lower VAS pain scores at both the first (T1) and second (T2) post-intervention assessments compared to both the music intervention and control groups (p < .001 for both). When controlling for baseline scores, the effect size of mirror intervention was large (η² = 0.554 for T1; η² = 0.509 for T2). No significant difference in pain scores was found between the music intervention and control groups (p > .05).

Mirror intervention is significantly more effective than both music intervention and standard care in reducing arteriyovenöz fistül cannulation pain in hemodialysis patients. As a nurse-administered, cost-effective, safe, and evidence-based intervention, mirror intervention should be considered for integration into routine nursing care protocols.

The present study provides a protocol for nurses to manage arteriovenous fistula cannulation pain that is both ready-to-use and evidence-based. The integration of mirror intervention into routine care provides nurses with a safe, non-pharmacological skill that directly enhances their role in ensuring patient comfort during the procedure. For patients, the benefits of this approach include a reduction in perceived pain and anxiety related to needle procedures. Furthermore, it has the potential to enhance overall treatment satisfaction and compliance by making hemodialysis sessions less uncomfortable.