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Department: CONTROLLING PAIN

Sounds soothing

Music therapy for postoperative pain

Whitaker, Mauree H. BSN, RN

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doi: 10.1097/01.NURSE.0000390680.80395.cd
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In Brief

MORE THAN 80% of patients undergoing surgical procedures experience moderate-to-severe pain postoperatively.1 Despite national guidelines for pain management, many patients may have uncontrolled pain that can delay wound healing and lead to anxiety and depression. Relaxation and music have been recommended in acute pain management guidelines as interventions to be used with opioids for moderate postoperative pain.2 More randomized controlled trials are needed to confirm these recommendations, but compelling evidence exists that music therapy is a simple, cost-effective, and benign intervention to reduce the intensity and duration of postoperative pain.3–9

Unrelieved pain takes a toll

By activating the sympathetic nervous system, unrelieved pain can have negative cardiovascular, gastrointestinal, and renal effects. This can predispose patients to serious complications, such as cardiac ischemia and ileus.2 Pain also reduces patient mobility, increasing the risk of venous thromboembolism and pneumonia. Complications increase patient length of stay and prompt readmissions, increasing the cost of care.

What the research shows

In one of the first studies on the effects of music therapy, patients scheduled for gynecologic surgery received music therapy for 30 minutes preoperatively and 2 hours after skin closure, then for 15 minutes every 2 hours for the first 48 hours postoperatively. Compared to patients in the control group, patients provided with music therapy (using music of their preference) needed less analgesia and had smaller increases in BP and pulse rate.3

A meta-analysis found that postoperative patients who received music therapy had a 50% reduction in pain intensity and needed less analgesia than patients who didn't receive music therapy.4 Other studies have found that music therapy may be an acceptable, safe, and inexpensive alternative or adjunct therapy to pharmacologic pain relief for postoperative patients and for those undergoing painful procedures.1,5–7 Patients exposed to music reported 57% to 72% less pain intensity, distress, and anxiety than the control patients.8

In a study of patients undergoing open coronary artery bypass grafting or aortic valve replacement surgery, patients who listened to soothing music had higher oxytocin and PaO2 levels and higher subjective relaxation scores during bed rest, compared to the control group (whose oxytocin levels actually decreased). The music therapy patients also experienced reductions over time in respiratory rate and mean arterial pressure.9

These results demonstrate that music therapy can increase relaxation through psychological effects, as well as increasing oxytocin release.9 Oxytocin, which is synthesized in the hypothalamus, is released in response to stress and creates a sense of calmness, diminishes the sensation of pain, and promotes wound healing.10 Low levels of oxytocin have been associated with pain and anxiousness.11

Practice recommendations

More research is needed to determine the optimum timing of music therapy (preoperatively, intraoperatively, postoperatively, or a combination) and the duration and frequency of effective music therapy. Most studies used 30-minute sessions of music therapy, but further research could help determine whether this is the optimal therapy length. More research is also needed on the effect of repeated sessions and the influence of different music genres on the stress response.6

The delivery mode and type of music are also issues. One study used MP3 players with headphones and gave patients a selection of soft, slow music without lyrics.5 Another option is to deliver music therapy via a music pillow connected to an MP3 player, so that patients can fully relax in bed and listen without headphones.6 Patients' musical preference should be considered in music selection, as different types of music can evoke different responses in people. Patients can bring in their own music and music player, or choose from a selection provided to them. Many facilities also have access to music channels and radio stations on patient-room TVs. Tell patients about these options—many aren't aware that they're available.

Infection control is another concern because of the risk posed by shared equipment. Music pillows can be covered with a clean pillowcase that can easily be changed.6 Disposable headphones or earbuds can be used, or the units could be sanitized with germicidal wipes or sprays between patient uses.

Music therapy should be offered as an integral part of multimodal pain management for patients experiencing pain, including surgical patients. Music is a low-risk supportive intervention that most patients find appealing, and that increases relaxation and decreases pain. The therapy has the potential to become an adjunct standard of care for reducing postoperative pain.

REFERENCES

1. Tse MM, Chan MF, Benzue IF. The effect of music therapy on postoperative pain, heart rate, systolic blood pressure and analgesic use following nasal surgery. J Pain Palliat Care Pharmacother. 2005;19(3):21–29.
2. Nilsson U, Rawal N, Unestahl L, Zetterberg C, Unosson M. Improved recovery after music and therapeutic suggestions during general anesthesia: a double-blind randomized controlled trial. Acta Anesthesiol Scand. 2001;45(7):812–817.
3. Locsin RG. The effect of music on the pain of selected post-operative patients. J Adv Nurs. 1981;6(1):19–25.
4. Cepeda MS, Carr DB, Lau J, Alvarez H. Music for pain relief. Cochrane Database Syst Rev. 2006(2):CD004843.
5. Chan MF, Wong OC, Chan HL, et al. Effects of music on patients undergoing a C-clamp procedure after percutaneous coronary interventions. J Adv Nurs. 2006;53(6):669–679.
6. Nilsson U. The effect of music intervention in stress response to cardiac surgery in a randomized clinical trial. Heart Lung. 2009;38(3):201–207.
7. Ebneshahidi A, Mohseni M. The effect of patient-selected music on early postoperative pain, anxiety, and hemodynamic profile in cesarean section surgery. J Altern Complement Med. 2008;14(7):827–831.
8. Voss JA, Good M, Yates B, Baun MM, Thompson A, Hertzog M. Sedative music reduces anxiety and pain during chair rest after open-heart surgery. Pain. 2004;112(1–2):197–203.
9. Nilsson U. Soothing music can increase oxytocin levels during bed rest after open-heart surgery: a randomised control trial. J Clin Nurs. 2009;18(15):2153–2161.
10. DeVries C, Glasper E, Detillion C, Craft T, Predergast B. Study: a little help from friends makes wounds heal faster. ScienceDaily . http://www.sciencedaily.com/releases/2004/09/040804083847.htm.
11. Petersson M, Uvnas-Moberg K. Effects of an acute stressor on blood pressure and heart rate in rats pretreated with intracerebroventricular oxytocin injections. Psychoneuroendocrinology. 2007;32(8–10):959–965.

RESOURCES

Bradt J, Dileo C. Music for stress and anxiety reduction in coronary heart disease patients. Cochrane Database Syst Rev. 2009;(2):CD006577.
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      © 2010 Lippincott Williams & Wilkins, Inc.