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Music: An Analgesic?

The Relationship between Music Therapy and

Post-Operative Pain Management

Anna Hus

September 24, 2007

 

http://indylaw.indiana.edu/alum/images/medicinemusicmed.jpg

 

Introduction

Pain is vital to our daily existence; it deters us from noxious stimuli and, consequently, disciplines us to avoid harmful situations.  However, pain that is acute or chronic can be both debilitating and detrimental to our psychological and physiological health.  According to the National Institute of Health 2007 fact sheet, “Pain affects more Americans than diabetes, heart disease, and cancer combined….[With] chronic pain [being] the most common cause of long-term disability” (http://www.nih.gov/about/researchresultsforthepublic/Pain.pdf).  Post-operative pain alone is capable of ranging from moderate to severe in intensity for 80% of the patients undergoing surgical procedures.  Its inadequate relief can result in a prolonged healing process and overall discomfort (Tse, Chan, & Benzie, 2005).  As a result, methods to alleviate pain have ranged from the traditional medical approach of providing medications to the relatively more recent non-pharmacological methods, such as music therapy.  Musical healing initiatives have gradually become more prevalent as an adjunct to traditional medical practices, spurring interest among researchers attempting to decipher whether music holds any physiological and psychological benefits (Krout, 2007).  Research on the internet returns over two million sites eagerly promoting the use of music to relieve pain.  Evaluating claims that hold leverage versus those which provide fictitious information can be both challenging and overwhelming. 

Thus, in an attempt to better understand the relationship, if one exists, between music therapy and post-operative pain, we will focus on evaluating the veracity of those claims with research studies done on the topic.  First, the paper will define music therapy and its purpose. Then, it will explain the mechanisms behind music therapy in relation to pain management.  The following section will focus on some of the claims made on the internet about music’s ability to provide relief for patients following surgery, and then present the research studies evaluating the existence of that relationship. The paper will conclude with a discussion about the implications of the research findings in comparison to web-based claims on the relationship between music and post-operative pain.

What is Music Therapy?

            The field of music therapy is a relatively novel non-pharmacological, professional medical practice acclaimed to promote the wellbeing of individuals of all ages who are both sick and healthy (American Music Therapy Association, http://www.musictherapy.org/).  Used both in clinical settings and in personal homecare, music therapy is deemed to benefit those suffering from acute and chronic pain (i.e., post-operative, cancer, labor), brain injuries, mental conditions (e.g., Alzheimer’s disease and other age-related conditions), substance abuse, as well as a range of developmental, learning, and physical disabilities (http://www.musictherapy.org/faqs.html). 

What is the Purpose of Music Therapy?

            According to the American Music Therapy Association (http://www.musictherapy.org/faqs.html), when executed through the help of a certified music therapist, music therapy can serves a myriad of functions. These include, but are not limited to:

¯  For Healthy Individuals:

 

³  Stress reduction and, thus, relaxation achieved through

³  Music making

      (e.g., drumming       

      or piano playing)

³  Passive listening

³  Support during physical exercise

³  Assist in labor and  

      delivery

¯        In Hospitals:

 

³  Used in conjunction with anesthesia and/or pain medications to reduce pain intensity

³  Mitigate depression and enhance patients’ mood

³  Encourage movement 

       in physical 

       rehabilitation sessions

³  Induce sleep and/or calm patients

³  Alleviate fear

³  Muscle and autonomic nervous system relaxation

 

¯  In Psychiatric Facilities:

 

³  Music encourages emotional exploration

³  Used to enhance patients’ mood and emotional states

³  Successful musical experiences/sessions are aimed at providing patients with a perception of control over their (daily) life experiences

³  Allows patients to practice problem solving and reconcile conflicts

 

The development of these skills is aimed at educating patients about the mechanisms by which they can establish and strengthen peer and family relationships.

¯  In Nursing Homes:

 

³  To improve or maintain geriatric patients’ physical, mental, social, and emotional wellbeing.

 http://www.kent.ac.uk/music/music_symbol.jpg

¯  In Schools:

 

³  Teach and enhance language/ communication skills and physical coordination in children with developmental disabilities (e.g., Autism) and those deemed to be special learners.

 

Understanding the Mechanisms behind Music Therapy and Pain Management

            In humans, the brain controls all biological and psychological processes, acting also as a conduit for the myriad stimuli that bombard the body daily.  Processed through the brain, music has the potential to positively affect our biological systems and, as such, improve our sense of wellbeing and facilitate the healing process when necessary (Harvey, 1987 in Krout, 2007).  For optimal results, Krout (2007) recommended that music therapy be performed with an accredited music therapist.  Music therapy can be applied as a more receptive and passive exercise, such as through music listening, as well a more engaging, expressive activity such as singing or drumming. Depending on the choice of music, music can affect the body in a variety of ways from having a more arousing effect to one that calms. For instance, by interacting with our physiological systems, it can serve as a distraction from pain stimuli, have a sedative effect, and provide relief from undesirable environmental impetuses, such as hospital noise (Krout, 2007; Kwekkeboom, 2003).

¯  A Glance into a Typical Music Therapy Session

            Joke Bradt is a music therapist working with the Montclair State's Music Therapy Program.  She described that, in accordance with the Entrainment Principle and the Gate Control Theory, a typical music therapy session aimed at helping the patient contend with their pain would begin with the patient verbally describing their pain. Then, because pain typically has a pattern or rhythm in which it occurs, the patient is handed an instrument (i.e., a drum) and asked to express his pain that way. The patient will typically play the drums for a few minutes before settling on a rhythm that sounds like or mimics their pain, thereby allowing both the music therapist and the patient to hear the pain.  The patient and the therapist would then create music that is more comforting and the entrainment process (see below) ensues.  After the patient lies down, the therapist begins by playing the "pain sound" first and then slowly progresses to playing the more comforting piece (http://www.montclair.edu/insight/INSIGHT04-01-02/qa.html).

¯  The Entrainment Principle

         In music therapy, one of the main objectives is to synchronize or "entrain" the patient's heart rate with the music's tempo. This is accomplished by first choosing music with a tempo that matches the heart rate and then gradually changing the beat of the music.  According to the Entrainment Principle, over time, two entities that are vibrating at different velocities will synchronize their vibrations with each other.  Therefore, as long as the change in music does not happen suddenly, the beat of the heart will follow the beat of the music. This enables the therapist to induce a sense of tranquility in a patient who is in distress, for example. Attempting to alter the patients' physiological state by matching their arousal to the pace of the music and then progressing to a slower, more relaxing tempo is also referred to by music therapists as the iso-principle (http://hubel.sfasu.edu/courseinfo/SL03/music_therapy2.htm; Krout, 2007).

            Once music entrainment is applied to pain and takes effect (the heart rate is synchronized with the music tempo), the patient's perception of their pain is also believed to change (http://www.montclair.edu/insight/INSIGHT04-01-02/qa.html; Krout, 2007). The Gate Control Theory suggests that pain signals, which are conveyed along small never fibers, are dampened by neural impulses generated by the music stimuli.  The type of cognitive reaction a patient has to the pain (e.g., thinks it will never end vs. tells himself it is temporary), his means of coping with it, his prior pain experience, as well as his emotional reaction (e.g., sense of panic vs. calm endurance) all affect the patient's perception of the pain.  By altering the body's physiological response to pain (as described by the Gate Control Theory) through music entrainment, music reciprocally influences the psychological mechanisms as well; this changes the way that the patient perceives his pain, thereby helping him cope with it more effectively (Krout, 2007).

¯  The Heart of the Matter: The Nitty-gritty Details to Understanding the Gate Theory of

       Pain in Relation to Music

            In an attempt to explain the relationship between music, pain, and the body, Loewy, on a site that warns “we are NOT doctors and have NO medical training”

(http://www.annieappleseedproject.org/mustherforpa.html), states that the brain processes music and pain along the same neural pathways. Therefore, if the patient activates those pathways with music prior to surgery or a medical procedure, these neural pathways would be preoccupied at the time of intervention and the patient will not perceive the pain to the same degree as if music were not used. Support for this claim has actually been found in numerous studies, which explain this phenomenon with the Gate Control Theory.

Conceptualizing the Gate Control Theory to Music Processing

(Tse, Chan, & Benzie, 2005, p. 23)

 

            The Gate Control Theory states that pain signals are transmitted from the place of injury, via nerve receptors in the spinal cord, to synapses that receive the pain information in the brain.  The synapses are believed to act as gates that open and close in response to the pain impulses.  When the "gates" are closed, the pain signal is prevented from reaching the brain. However, when they are open, the impulses are able to travel to the brain where they are consciously perceived by the person as pain.  Whether other sensory impulses in addition to the pain are being simultaneously sent to the synapses determines if the gates are kept open or closed. Music is believed to send enough competing sensory inputs through pathways descending from the brain to cause the brainstem to signal some of the gates shut, thereby reducing the amount of pain that the patient listening to the music perceives (Krout, 2007; Sendelback, Halm, Doran, Miller, & Gaillard, 2006; Tse, Chan, & Benzie, 2005; Good, Stanton-Hicks, Grass, Anderson, Lai, Roykulcharoen, & Adler, 2000; Good, Anderson, Stanton-Hicks, Grass, & Makii, 2002; Nilsson, Rawal, & Unosson, 2003).

            The perceived distracting and relaxing aspects of music therapy are believed to not only inhibit the brain from transmitting pain signals, but to also cause the body to release endorphins (our naturally "feel good" hormones) through a process known as autonomic modulation. Neurotransmitters in the brain are believed to be released in response to musical impulses, which in turn stimulate other biological systems, such as the endocrine glands that release hormones (i.e., endorphins).  By dampening the pain response and stimulating the release of our body's endogenous opioids, music enables the patient to more effectively contend with the adverse repercussions of surgery (Good et al., 2002; Krout, 2007).   

Fictitious Facts? The Relationship between Music Therapy and Post-Operative Pain Management as Defined on the World Wide Web

                A plethora of benefits associated with music therapy have been purported ranging from enhancing communication skills in Autistic, Alzheimer, and Parkinson patients, “ease[ing] the trauma of grieving,” and helping people “remain forever young” (all cited on http://www.musictherapy.org/quotes.html), to lowering cholesterol (http://healing.about.com/od/sound/a/kmucci_music_2.htm?=1v), enhancing the immune system (http://stress.com/od/tensiontamers/a/music_therapy.htm?p=1) and alleviating a multitude of pain types (http://soundfeelings.com/products/alternative_medicine/music_therapy/ease_chronic_pain.htm).

As Sen. Harry Reid D-Nev succinctly stated, “Music can heal people” (http://www.musictherapy.org/quotes.html).  Thousands of such claims about music’s ability to provide holistic healing can be found on the World Wide Web; merely typing in “music therapy benefits” in the Google search engine, or even more specifically, “music therapy and pain management,” returns over two million hits for each!  Thus, deciphering between the sites whose sole purpose is to profit (http://www.somethinghigher.com/merits.html) and those who are likely to provide factual information (e.g., http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Music_Therapy.asp?sitearea=ETO) can turn into an arduous task.  The following is an overview of some of the claims made about music’s ability to alleviate post-operative pain.

            After presenting music therapy as an effective adjunct to remedies for depression, chronic illness, pain and grieving, http://www.somethinghigher.com/merits.html attempts to sell their “Dance of the Soul” CD for only $16.95 plus shipping and handling.  Although they do not provide any support for their claims with the exception of their very vague, “Scientific studies have evaluated the merits of music therapy,” the site claims that Jay Friedman’s music featured on the CD is not only pleasant and “noninvasive,” but has benefited numerous people.   These include, “people suffering from depression, pain, the terminally ill, psychologists, psychiatrists, massage therapists, music therapists, dentists, alternative healthcare, wellness centers, homeopathy, naturopathy, hypnotherapists, [and] astronomers” (http://www.somethinghigher.com/merits.html).  The means by which their music CD “allows you to raise your consciousness and view the world from a higher point of view” is unknown (http://www.somethinghigher.com/merits.html).

            Similarly, a strongly recommended “supportive and comforting self-help tool for pain relief” comes from soundfeelings.com’s “Sound Healing: Ease Chronic Pain, Book/CD.” While the book is meant to outline the most effective way to reduce pain, the CD is intended to help the listener reach a “meditative, pain-free state” (http://www.soundfeelings.com/products/alternative_medicine/music_therapy/ease_chronic_pain.htm).   Provided is one anecdotal testimonial from a customer for whom the product appeared to work miracles,

“I had major surgery due to an old injury that would not heal or allow me to fall asleep. I couldn’t even begin my physical therapy because the pain was unbearable. After listening to your CD the very first time, I was able to sit and stand up straight AND take deep breaths all without pain. Minutes later, I was dancing and days later I began my physical therapy. Thank you Howard and Judy for making it possible to ‘ease my chronic pain’ quickly and without drugs,”

-Sun Rose, North Hollywood, CA.”

 

The website further claims, “The sound waves themselves have a force that can help relax the blocked energy that may be associated with your pain” (http://www.soundfeelings.com/products/alternative_medicine/music_therapy/ease_chronic_pain.htm).   How will the “Sound Healing” CD and book help you achieve the same level of satisfaction and pain relief as it did for Sun Rose? The website provides the following remedy:

"The guided imagery component is designed to help you develop the power of your mind over your body by focusing on your thoughts. The words will help you paint a picture of your pain in your mind, then visualize it as images, light, color, and energy moving throughout and then out of your body. You will feel totally relaxed. The exercise will help you release tension and stress, and experience reduced pain or even a pain-free state. As you experience the imagery repeatedly over time, you may gradually deepen your ability to use visualizations to achieve more voluntary control over your pain."

(http://www.soundfeelings.com/products/alternative_medicine/music_therapy/ease_chronic_pain.htm)

 

            Other websites, although not primarily in the business to make a profit but rather to serve as an educational or informational resource, also acclaim music for its ability to alleviate pain and provide comfort.  The following quotes were taken from a range of internet sources that failed to verify their assertions with research and typically only presented patient or healthcare professionals’ testimonials, which would be very difficult, if impossible, to confirm.  It is important to note that those which did attempt to provide evidence did so with vague statements, such as “one study found” and neglected to provide a citation to the study.

¯           

 

"Before I had surgery, they told me I could never walk again. But when I sat and listened to music, I forgot all about the pain."

Ida Goldman (90 yr old testifying at Senate hearings) who walked w/assistance during the hearing. (REUTERS, Aug. 1, 1991; on http://www.musictherapy.org/quotes.html)

 

¯           

 

 “Got pain? Got the blues? Try the music cure”

http://www.prevention.com/cda/article/music-as-medicine/ff9350d1fa803110VgnVCM10000013281eac____/health/natural.remedies

 

¯           

 

"People undergoing surgery require less anesthesia, awaken from anesthesia more quickly and with less side effects, and heal more rapidly when healing music is played before, during and after the surgical procedure..."

http://healing.about.com/od/sound/a/kmucci_music_2.htm?p=1

 

¯           

 

"Our new and still controversial non-drug method for helping to relieve pain is music."

http://www.healingmusic.org/Library/Newsroom/MusicTherapyForChronicPain.asp

 

¯           

 

"Music is the medicine of the mind they say. And Lillian Lucas of Germantown needs a large dose. Lillian just had her second leg amputated and the mysterious phantom pain of her lost limbs is agonizing. But the music therapy makes it better. 'It soothed my soul. It really did,’ Lillian said."

http://www.nbc10.com/print/8214930/detail.html

 

¯           

 

“Take advantage of music’s healing power, you don’t need to take a prescription to your local music store.”

http://www.prevention.com/cda/article/music-as-medicine/ff9350d1fa803110VgnVCM10000013281eac____/health/natural.remedies

 

¯           

 

"One study evaluated relaxation, music, and the combination of relaxation and music pain following gynecologic surgery.  All patients used patient-controlled analgesia, or PCA.  Patients who received relaxation, music, or music and relaxation plus PCA had from 9-29% less pain than the control group that used PCA alone. "

http://www.revolutionhealth.com/healthy-living/natural-health/healing/music-therapy/pain

 

¯           

 

"Another dying patient was in extreme distress, suffering from so much pain and agitation that she would constantly alternate between her bed and the floor.  However, once Loeb began playing music, she calmed down. Deborah Wertheimer, the medical director of Seasons Hospice in Baltimore, added, "This lady remained peaceful for some period of time. It was just a pleasure to see, because we clearly had not been able with traditional medicines to achieve that kind of comfort for her."

http://www.npr.org/templates/story/story.php?storyId=5519661

 

¯           

 

"Virgina Norman before her death said that 'The music boosted the effectiveness of pain medications.' She said, 'The music helps the pain medicine work even better when I have it. If I haven't had it in a while, it takes away a lot of the pain that is there. I go down usually about three levels, sometimes only two, but mostly three levels of pain, which is quite a bit.'"

http://www.npr.org/templates/story/story.php?storyId=5519661

 

¯           

 

"Using music therapist Janalea Hoffman's music of 50-60 beats per minute, the synthesized instrumental sounds relax patients, lower their heart rates and blood pressure and have even reduced pain. Madonna used prescriptive music with a 73 yr old woman who was in the final stages of lung disease and emphysema. She was in extreme pain and discomfort and medication no longer gave her relief. Within minutes of listening to the music, the woman fell asleep for the first time in days, O'Hara said. The music stayed on for the remainder of the woman's life. And during that time, the woman no longer needed increased dosages of medication. She remained comfortable with no visible signs of physical pain, respiratory distress, or anxiety, O'Hara said. 'She said the tapes was the first thing that had helped..."

http://www.healingmusic.org/Library/Newsroom/MucicTherapyOffersSoothingHelp.asp

 

¯           

 

“You can design your own musical ‘prescription’”

http://www.prevention.com/cda/article/music-as-medicine/ff9350d1fa803110VgnVCM10000013281eac____/health/natural.remedies

 

               

            Although numerous compelling claims advertising music as an analgesic-like stimulus are unsupported with scientific evidence, they are nonetheless intriguing, especially for individuals who are contending with pain and searching for a source of relief.  Consequently, to validate the relationship between music therapy and post-operative pain management, as well as to determine whether music therapy can aid traditional medical practices in alleviating patients’ pain, we will now turn our attention to research studies addressing those exact concerns.

Music: An Analgesic? The Evidence behind the Relationship

            Numerous studies have been done evaluating the relationship between music and pain management.  For the purpose of this paper, we will examine six studies attempting to determine whether music can alleviate post-operative pain for patients who underwent cardiac (Sendelback, Halm, Doran, Miller, & Gaillard, 2006), nasal (Tse, Chan, & Benzie, 2005), inguinal (abdominal) hernia repair or varicose vein surgery (Nilsson, Rawal, & Unosson, 2003), an abdominal operation (Good, Stanton-Hicks, Grass, Anderson, Lai, Roykulcharoen, & Adler, 2000), and gynecological surgery (Good, Anderson, Stanton-Hicks, Grass, & Makii, 2002; Ikonomidou, Rhenstrom, & Naesh, 2004).

¯  Effects of music therapy on physiological and psychological outcomes for patients undergoing cardiac surgery (Sendelback et al., 2006)

 

³  Purpose:

            To determine whether providing music therapy for the first three days immediately following patients' heart surgery would be effective in decreasing the patients' levels of pain, anxiety, heart rate, blood pressure, and the amount of pain medications required.

           

³  Method:                                       

  1. 86 patients undergoing open heart surgery who were interested in participating in the study were randomly selected from a patient list.
  2. Through a flip of a coin, patients were either placed into the experimental or control group. Thirty-six patients in the control group were asked to comfortably rest in bed for 20 minutes without being advised how to relax. Fifty patients in the experimental group listed to music for 20 minutes and were given suggestions on how to relax (e.g., to clear their heads, relax their muscles, and listen to the music).
  3. From the first day until the third day after their surgery, the music-listening group listened to music via headphones for 20 minutes twice a day, in the morning between 8AM and 10AM and in the evening between 4 PM and 9PM.
  4. The patients in both groups had their pain and anxiety levels, heart rate and blood pressure measured before and after each 20-minute intervention.

           

³  Results:                

            Compared to the patients who were recommended bed rest, those who listened to music were shown to experience significantly less pain and anxiety. However, no significant differences were found in the blood pressure and heart rate of patients in either group.  The amount of pain medications received by either group was also relatively similar. The lack of differences between the patients' heart rates and blood pressure in both groups could be attributed to the post-operative heart medications given to patients to regulate their heart rate and blood pressure (Sendelback et al., 2006).

 

 

¯  The effect of music therapy on postoperative pain, heart rate, systolic blood pressure and analgesic use following nasal surgery (Tse, Chan, & Benzie, 2005)

 

³  Purpose:

            To examine whether patients' pain intensity, heart rate, blood pressure, and use of analgesic (pain medications) following nasal surgery would be affected by music therapy.

           

³  Method:

  1. For convenience, 57 patients scheduled for nasal surgery were assigned to either the experimental (music-listening) group or the control (no music) group depending on the day for which their operation was scheduled.  Twenty-seven patients scheduled for Monday surgery were in the experimental group and the remaining 30 patients scheduled for Thursday surgery were placed in the control group.  Those in the control group only received standard postoperative care (i.e., pain medications).
  2. Immediately following the operation, all of the patients' blood pressure, heart rate, and pain intensity were measured using standard methods of pain assessment. These included the verbal rating scale (VRS), which asked patients to rank their pain from least to most intense, the numerical rating scales (NRS) which classified pain intensity on a scale from 1 to 10 ("no pain" to "worst possible pain"), and the visual analogue scales (VAS) showing pain ranging from "no pain" to "worst pain ever" on a 10-cm horizontal or vertical line.
  3. The day of the operation, the patients in the experimental group were given music to listen to via a cassette recorder headphone set 30 minutes immediately after their surgery and then again four hours later.
  4. On the first postoperative day, the patients were offered music therapy at 8 AM and finally at 12 PM. Each music session lasted half an hour.  Pain intensity, blood pressure, and heart rate were measured prior to and following each music session for those in the experimental group as well as those in the control group.

 

³  Results and Conclusions:

            Within the first 24 hours following surgery that music therapy was administered, the experimental group experienced significantly less pain, was more relaxed as evident by their lower blood pressure and heart rate, and required less analgesics than the control group.  For example, the amount of pain medications required four hours after surgery and at 8 AM on post-operative day one differed significantly between the experimental and control groups.  On average, on the day of the surgery, patients in the no-music therapy control group required 4.21.9 acetaminophen (pain) tablets while those in the experimental group only needed 2.81.8 tablets.  On the first post-operative day, while those who received music therapy in addition to pain medications required only 2.12.4 tablets, those in the control group required 5.42.0 tablets (Tse, Chan, & Benzie, 2005). By selecting music with a low pitch and slower tempo, Tse, Chan, and Benzie (2005) believe that the patients in the experimental group enabled their bodies to enter a more relaxed physiological state, which in turn might have helped them contend with the painful remnants of surgery. Alternatively, music with a faster tempo and high pitch is thought to induce a more cognitively alert mental state and increase arousal.  Although the study had a relatively small sample size and was short in duration, Tse, Chan, and Benzie (2005) concluded that music therapy is an effective non-pharmacologic intervention with the potential to decrease or eliminate the need for pain medications and to shorten recovery time.

 

 

¯  A comparison of intra-operative or postoperative exposure to music – a controlled trial of the effects on postoperative pain (Nilsson, Rawal, & Unosson, 2003)

 

³  Purpose:

            The purpose of this study was two-fold: first, to analyze any pain-reducing effects of music therapy intra-operatively and post-operatively.  Secondly, it was to determine the most effective time for a music therapy intervention, either during the operation or immediately following surgery.

 

³  Method:

  1. 151 patients scheduled for inguinal (abdominal) hernia repair or varicose vein surgery under anesthesia were randomly assigned by a computer to one of the three groups: the IM (Intra-operative Music) group, the PM (Post-operative Music) group, or the control group.  Patients in the control group listened to a blank CD both during the surgery and recovery period. Patients in the IM group listened to music intra-operatively and then to a blank CD following surgery. Finally, those in the PM group were played a blank CD during their operation, but were exposed to music post-operatively.  For 43 minutes, patients exposed to music listened to a soft instrumental CD via headphones on a compact disc player featuring tracks of a slow tempo. To avoid bias in data collection, the blank CD was programmed to change tracks and display the track number in the CD player as a normal music CD, thus making it impossible for the observer to distinguish between the patients who were listening to music and those who were not.
  2. For patients who heard music during the operation, the CD played continuously from the time that the anesthesia was administered until the patients' wound dressings were changed.                 
  3. For patients in the post-operative music-listening group, the CD was played for an hour starting from the time that they arrived in the recovery room.
  4. Every 30 minutes for two hours following surgery, patients were asked to rate their pain on a standard NRS pain intensity scale ranging from 0 = "no pain" to 10 = "maximal possible pain." In addition, the patients' anxiety, fatigue, nausea, and pain were measured one hour following surgery, upon release from the hospital, in the home at night the day of the operation, and postoperative days one and two in the morning and evening. The patients were asked to record their pain intensity on a scale from 0 to 10 in a patient diary that they turned in on the third postoperative day. Information regarding the amount of postoperative pain (morphine) medications administered were acquired from the patients' records.  

 

³  Theory about the mechanism of music therapy in relation to pain management:

            Music therapy is believed to serve as a distraction and to mitigate pain perception by providing stimuli that compete with pain signals being sent to the brain (as described by the Gate Control Theory of Pain). According to some music therapists, the consistent tone and form of instrumental music that corresponds to a pulse rate of 60-80 beats per minute is deemed to be the most relaxing.  In an attempt to achieve this analgesic effect, patients in this study listened to new age classical music (Nilsson, Rawal, & Unosson, 2003).

                                   

³  Results and Conclusions:

            In comparison to patients in the control group, patients who were exposed to music therapy intra-operatively or post-operatively reported significantly decreased pain one hour and two hours following their operations.  Therefore, music therapy was beneficial in alleviating pain regardless of the time at which it was administered. Significant differences were also found in the degree of pain medications administered to patients in the control group and music therapy groups. Compared to patients in the control group who required 2.5 mg of morphine post-operatively, those in the post-operative music group only needed 1.2 mg one hour into their recovery period. However, there were no significant differences between all three groups in long-term pain intensity scores and medication measured at the time of discharge, at home on the day of the operation, and on post-operative days one and two in patients comprising all three groups. At these times, all patients regardless of the group into which they were assigned experienced fairly low amounts of pain (ranging from 1.1 to 2.8 on a 10 point scale) and did not differ in the amount of ibuprofen that they required once at home.  Nilsson, Rawal, and Unosson (2003) were, thus, able to conclude that music therapy has the potential to provide temporary pain-relief for post-operative patients.

 

¯  Relaxation and music to reduce postsurgical pain (Good et al., 2000)

 

³  Purpose:

            To investigate the effects of music and relaxation on pain intensity in patients on the first and second day following their surgery, and to determine whether the effects would vary by day and activity (ambulation or rest).

           

³  Method:

  1. 468 patients scheduled to receive major abdominal surgery, who were expected to receive analgesia (PCA) as well as to walk following their operation, were randomly assigned by a computer program into one of the four conditions: relaxation, music, a combination of relaxation and music, or control.
  2. Before their surgery, patients who were selected to receive relaxation techniques were taught jaw relaxation exercises that involved breathing slowly, not thinking, slowly descending their lower jaw, allowing their tongues to rest and their lips to soften.
  3. First, patients in the music group listened to a selection of five 30-second long clips that were meant to be relaxing in nature, including slow modern jazz, piano, orchestra, synthesizer, and harp. Then, patients were encouraged to select a genre that would be most distracting or soothing post-operatively.
  4. Patients who were in the combination group were allowed to choose among the five music types and were taught the jaw relaxation exercise.                 
  5. Finally, patients in the control group received standard preoperative preparations and were engaged in a casual 10-minute conversation.  Post-operatively, they rested quietly for 15 minutes and walked with the data collector.
  6. Pain after surgery was measured using the VAS sensation of pain scale that asked patients to verbally report their pain sensation from "none" to "most sensation." Measurements were taken prior to and following 15 minutes of bed rest, as well as during four points of the ambulation process, which occurred three times a day for two days post-operatively.  The process included a 5-minute preparatory period, getting out of bed and ambulating a comfortable distance, returning to bed, and resting for 10-minutes. Patients in the music conditions listened to their selected music throughout the ambulation procedure. Pain intensity was recorded prior to the ambulation process, during each stage of it, and after their 10-minute recovery period.

                       

³  Results and Conclusion:

            Regardless of day or activity, Good et al. (2000) found that patients in the three treatment groups experienced significantly less pain than those in the pain medication only-control group and did not differ significantly from each other.  Across both days and activities, patients who received music alone, only relaxation techniques, or their combination experienced 15%-26% less pain than those in the control group. In addition, compared to before they began ambulating, patients in the treatment groups experienced a 10%-15% decrease in pain intensity following the 10-minute recovery period.  Good et al. (2000) concluded that music therapy appeared to be used as both a source of distraction and relaxation, and potentially, a source of encouragement for walking by making the typically painful experience more pleasant. As their results indicate, music, relaxation, and their combination helped alleviate the patients' pain on both post-operative days, as well as during ambulation and rest.

 

¯  Relaxation and music reduce pain after gynecologic surgery (Good et al., 2002)

 

³  Purpose:

            To investigate whether similar positive effects of music and relaxation found among gynecologic post-surgical patients (Good et al., 2000) would be replicated with female patients undergoing gynecologic surgery.

           

³  Method:

            311 GYN patients who were scheduled for intensive - GYN surgery, expected to receive PCA (pain medications) and to ambulate post-operatively were selected from pre-surgical appointment schedules and randomly assigned into a control group, relaxation, music, or their combination condition.  80 of the patients were placed into the control group, 74 into the combination, 81 to the relaxation, and 76 to the music condition. The study followed the same procedure and employed the same measures that were used with patients who underwent abdominal surgery (Good et al., 2000). 

 

³  Results and Conclusions:

            The study successfully replicated Good et al.'s (2000) findings with post-operative abdominal patients.  Compared to women who only received PCA pain medications, the women who were provided a combination of music and relaxation techniques, music, or relaxation alone in conjunction with PCA following their surgery reported a significant (9% to 29%) decrease in pain.  Pain intensity also did not significantly differ among the three experimental groups. As in the previous study (Good et al., 2000), Good et al.'s (2002) results also yielded similar conclusions showing non-pharmacologic interventions, such as music and relaxation, to be effective mechanisms by which to help diminish pain in post-operative patients.  Good et al. (2002) believe that, in combination with pain medications, these interventions might be potent enough to expedite recovery time and reduce the adverse side effect of analgesics (e.g., dizziness, falls, and difficulties walking).                                                                                                                                                                                                

                       

¯  Effects of music on vital signs and postoperative pain (Ikonomidou, Rhenstrom, & Naesh, 2004)

 

³  Purpose:

            Ikonomidou, Rhenstrom, and Naesh (2004) were interested in first studying whether preoperative and postoperative exposure to music would influence the severity of pain and nausea, as well as the patients’ overall sense of wellbeing following surgery. Second, they also sought to investigate whether music would have an impact on the patients’ blood pressure, heart rate, respiratory rate, and dose of analgesics administered immediately after the operation.         

           

³  Method:

  1. 60 patients scheduled for gynecologic laparoscopy were randomly assigned into either the experimental “M” or the control “C” group.  Patients in the control and experimental groups were provided with a CD to listen to pre- and post-operatively.  For 30 minutes prior to and following surgery, those in the M-condition listened to a CD containing serene flute music while those in the C-condition listened to a blank CD.
  2. The visual analogue scale (VAS) ranging from 0 “no pain” to 100 “worst thinkable pain” was used to measure pain intensity. The VAS scale was also used to determine the degree of nausea and sense of wellbeing.  Patients were asked to mark the scales before and after each 30-minute music session, which occurred prior to the onset of surgery and during the immediate recovery period.  The patients’ vital signs were also measured during these times. Pain medications were administered along with anesthesia to all patients. Fifteen minutes following surgery, patients in both the experimental and control conditions were provided with headphones and their respective blank or music CD.  Patients were discharged on the same day of their operation at which point they completed a final VAS.

 

³  Results and Conclusions:

            When compared to patients in the control group, those who listened to music preoperatively had a decreased respiratory rate, which might suggest music’s soothing qualities. This effect, however, was not found once the surgery was complete. Also, data indicating that a resting period pre-operatively was beneficial to patients regardless of whether music was played makes it difficult to determine the degree to which music is an effective adjunct to traditional medical practices.  Post-operatively, pain intensity (recorded as low) also did not significantly differ among patients in either group. Since pain medications were administered to all the patients following their surgery, it is challenging to determine whether low pain levels could only be attributed to music.  However, it is important to note that the control group patients received a significantly greater amount of pain medications than the experimental music-listening groups.

 

Conclusions, Limitations, and Implications

            Music therapy appears to be an effective therapeutic tool to conventional medical practices as it has been shown in some post-operative patients to alleviate pain, reduce the amount of analgesics needed, and to possibly expedite their recovery time.  The auspicious results found by the studies do not, however, come without a number of limitations.  First, it is important to note that in all the studies examined, music therapy was used as a complementary measure.  For ethical reasons, it would be impossible for researchers to prevent the administration of analgesics to patients in order to study music’s potentially pain-alleviating effects in their purest form. Thus, it is still unclear whether music therapy has the potential to offer relief as equally potent as traditional analgesic.

            Second, the studies were typically short in duration, ranging from one to three days in length, and some did not have very large sample sizes.  Future studies ought to consider using larger samples in order to draw stronger conclusions.  Also, music appeared to be most beneficial to post-operative patients immediately following surgery. Thus, further studies that are longer in duration need to be done in order to examine whether the positive results found in relation to short-term pain relief would be applicable to patients who recover from surgery for longer periods of time.

            Third, it is important to note that certified music therapists were neither used in the studies nor did music therapy ever involve anything but listening to music.  The American Music Therapy Association and Krout (2007), who reviewed a number of music therapy and pain management studies, did recommend that music therapy be performed with an accredited music therapist to achieve optimal results (http://www.musictherapy.org/faqs.html).  Therefore, if music therapists were used and patients were more actively engaged in the music therapy process (e.g., by playing an instrument), it is possible that a more significant effect of music on pain management could have been observed. 

            In regards to the web-based claims, a positive relationship between music and pain relief for post-surgical patients was supported by research evidence.  However, it is absolutely crucial to maintain that the websites attempting to sell products (e.g., (http://www.soundfeelings.com/products/alternative_medicine/music_therapy/ease_chronic_pain.htm) embellished their claims and provided no scientific evidence for explaining the process by which music would provide relief.  In addition, whether music therapy can perform miracles and make a person in excruciating pain dance within a few minutes (http://www.soundfeelings.com/products/alternative_medicine/music_therapy/ease_chronic_pain.htm) is unlikely and has not been found in scientific literature.  Furthermore, it is always important to err on the side of caution when reading sources that provide the results from studies for which no proper citation can be found.  Although the study done with patients who underwent gynecologic surgery as described by http://www.revolutionhealth.com/healthy-living/natural-health/healing/music-therapy/pain was actually done by Good et al. in 2002, the website failed to provide any reference to it.  In most cases, it is highly unlikely that an internet source reporting “scientific” evidence without providing specific information about the study would be vindicated as in the case above. 

            Despite some of the limitations discussed, when juxtaposed with traditional medical practices, music therapy does appear to help mitigate post-surgical pain.  Since it is inexpensive and does not seem to have any adverse side effects, using music therapy in combination with modern medical interventions can, at a bare minimum, be of great beneficence and enhance the patients’ wellbeing. 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Good, M., Stanton-Hicks, M., Grass, J.A., Anderson, G.C., Lai, H.L., Roykulcharoen, V., &

Adler, P.A. (2000). Relaxation and music to reduce postsurgical pain. Journal of Advanced Nursing, 33(2), 208-215.

Good, M., Anderson, G.C., Stanton-Hicks, M., Grass, J.A., & Makii, M. (2002). Relaxation and

music reduce pain after gynecologic surgery. Pain Management Nursing, 3(2), 61-70.

Ikonomidou, E., Rhenstrom, A., & Naesh, O. (2004). Effects of music on vital signs and

            postoperative pain. Aorn Journal, 80(2), 269-278.

Krout, R.E. (2007). Music listening to facilitate relaxation and promote wellness: Integrated

aspects of our neurophysiological responses to music. The Arts in Psychotherapy, 34, 134-141.

Nilsson, U., Rawal, N., & Unosson, M. (2003 ). A comparison of intra-operative or postoperative

exposure to music - a controlled trial of the effects on postoperative pain. Anaesthesia, 58(7), 699-703.

Sendelback, S. E., Halm, M.A., Doran, K.A., Miller, E.H., & Gaillard, P. (2006). Effects of

music therapy on physiological and psychological outcomes for patients undergoing

cardiac surgery. Journal of Cardiovascular Nursing, 21(3), 194-200.

Tse, M. M., Chan, M.F., & Benzie, I.F. (2005). The effect of music therapy on postoperative

pain, heart rate, systolic blood pressure and analgesic use following nasal surgery.

Journal of Pain and Palliative Care Pharmacotherapy, 19(3), 21-29.

 

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