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We read the currently published article entitled “Effect of music on level of anxiety in patients undergoing colonoscopy without sedation” with interest. Dr Ko and colleagues conducted a “randomly assigned” study to evaluate the effect of music and/or music style in reducing anxiety in patients undergoing colonoscopy. This randomized study enrolled 138 patients who underwent colonoscopy. All patients had their anxiety levels assessed and scored using the StateeTrait Anxiety Inventory (STAI). The authors found that the patients who listened to music could reduce their anxiety level during the colonoscopy procedure without sedation, compared to those patients without music (depression scores, 79.9 vs. 85.3; p1⁄4 0.054). In addition, the authors found that different styles of music might play a critical role in determining whether exposure to such music can decrease the anxiety score. For example, the relaxing effects of music might be apparent by Kevin Kern's music [odds ratio (OR)1⁄4 0.34; 95% confidence interval (CI), 0.14e0.81]; by contrast, the effects might not be so obvious if David Tolley's music was used (OR1⁄4 0.70; 95% CI, 0.31e1.60). We congratulate the authors on the success of this publication. This article is definitely interesting and worthy of further discussion. First, as shown in our previous publication, anxiety and/or pain are a complicated response in humans. Many factors, including endocrine, the nervous system, psychosocial relationships, personality, and other elements can be interwoven into an often very subjective determination of the levels of anxiety and/or pain. Therefore, it is important to mention the biological mechanisms involved in the interconnection between physiological effects of anxiety and/or pain perception. Physiological response, including systolic pressure, diastolic pressure, heart rate, and respiratory rate, might be a better representative as an objective determination of the levels of anxiety and/or pain after procedure (colonoscopy). If the authors designed this study as a “randomized” study to evaluate the effect of music on the levels of anxiety for

Anxiety can be reduced by music during colonoscopy examination, but the effect may be varied by musical styles