Friday, March 12, 2010

Music-Listening Soothes the Savage Beast of Pain

Guest Author
By guest author Winnie Dawson, MA, RN, BSN
Everyone agrees that music is one of life's great pleasures, but music-listening should not be over-looked as a valuable therapeutic tool. During the past few years, an increasing number of studies have evaluated the effectiveness of music as a healing therapy, including offering significant benefits for pain relief.

In late 2009, investigators in Sweden released the results of a systematic review of published literature on the effect of music on postoperative pain [Engwall et al. 2009]. Of 1,631 articles examined, 18 studies from 6 countries were included in the review. Participants had varied options for music choice in 11 studies, while researchers of the remaining 7 studies selected the music for participants. Study design, pain assessment tools, and patient population varied from study to study; all studies except one—which played live harp music—used recorded music.

Fifteen studies reported a significant positive effect of music on postoperative pain reduction, either alone or in combination with other complementary pain-relief strategies. Even the patients from the studies that showed no significant effect on pain felt that the music intervention had helped them in some manner. Of the studies that evaluated analgesic consumption, 5 reported that music-listening patients used fewer analgesics than control groups, while 5 other studies did not show a significant difference in the use of pain relievers. The researchers concluded that music can be beneficial as an adjunctive therapy for postoperative pain relief. Evidence from other studies supports the value of music-listening for relaxation and anxiety reduction, both of which can enhance pain relief. For example, two evaluations of cardiac patients in 2009 reported modest positive results in both areas:
  • First, a Cochrane Systematic Review analyzed 23 studies with a total of 1,461 patients diagnosed with coronary heart disease [Brandt et al, 2009]. Most studies included in the review compared music interventions (primarily using pre-recorded music without the services of a music therapist) plus standard care with standard care alone. Results were not strong but showed decreases in anxiety levels, heart rate, respiratory rate, and blood pressure in patients with coronary heart disease.

  • Second, researchers in Sweden randomly assigned 40 post-operative patients to bed rest plus music-listening or bed rest alone the day after their open-heart surgery [Nilsson, 2009]. Assessment of relaxation was based on a comparison of pre- and post-intervention serum oxytocin levels (a neurotransmitter that affects normal homeostatic cardiac and vascular regulation), heart rate, and mean arterial blood pressure, as well as arterial oxygen tension and saturation. After 30 minutes of relaxing music, patients in the music group demonstrated a significant increase in oxytocin serum levels, arterial oxygen tension (necessary for hemoglobin oxygen saturation), and higher subjective levels of relaxation when compared with the group assigned to bed rest alone. The researchers concluded that music-listening can positively affect the physiology of relaxation during bed rest following open-heart surgery.

While the mechanisms are not completely known, music can provide multidimensional affects and has been shown to enhance distraction, provide psychological support, increase relaxation, and relieve anxiety. Just the act of selecting music can give a patient a sense of control, while connecting with the rhythm of the music can change a person’s breathing pattern or heart rate which can trigger a relaxation response. And, by acting as a competing stimulus to pain, the music can distract the patient's attention away from the pain. According to Good et al. [1999], "when relaxation and music distract the mind, the result is selective attention mediated by the thalamus that alerts the prefrontal cortex to the sound rather than to the painful input, causing pain inhibition”. While studies have shown that soothing music particularly can reduce mental and muscular tension, positive benefits have been reported for music of all types. Future multicenter studies that focus on music type and the timing and duration of the music intervention would advance our understanding of its magnitude of usefulness as a pain reliever.

Based on current evidence, it appears music can provide an enjoyable, non-invasive, safe, and inexpensive adjunctive therapy for patients who are appropriate for interdisciplinary pain management. It appears to be underused by practitioners and patients alike as a complementary therapy. If you are interested in following new studies on music and pain relief as they are published, researchers at MedSearch — see, http://medsearchservices.com/music — post article summaries as they are released.

REFERENCES:
> Bradt J, Dileo C. Music for stress and anxiety reduction in coronary heart disease patients. Cochrane Database of Systematic Reviews. 2009(Apr15); Issue 2.
> Engwall M, Duppils GS. Music as a nursing intervention for postoperative pain: a systematic review. J Perianesth Nurs. 2009(Dec);24(6):370-383.
> Good M, Stanton-Hicks M, Grass JA, et al. Relief of postoperative pain with jaw relaxation, music and their combination. Pain. 1999(May);81(1-2):163-172.
> Nilsson U. Randomized clinical trial examining the effect of soothing music in response to relaxation during bed rest after open-heart surgery. J Clin Nurs. 2009(Aug);18(15);2153-2161.