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Supplementing Relaxation and Music for Pain After Surgery

Good, Marion; Albert, Jeffrey M.; Anderson, Gene Cranston; Wotman, Stephen; Cong, Xiaomei; Lane, Deforia; Ahn, Sukhee

doi: 10.1097/NNR.0b013e3181dbb2b3

Background: Most postoperative patients have unrelieved pain despite the use of patient-controlled analgesia. Nurses need additional effective modalities. Relaxation and music (RM), in addition to analgesics, have been shown to reduce pain more than do analgesics alone.

Objectives: The objectives of the study were to test an intervention of patient teaching for pain management (PT) and compare it with RM for immediate and general effects on postoperative pain.

Methods: Patients having abdominal surgery and receiving patient-controlled analgesia aged 18-75 years (n = 517) were randomized to four groups: PT, RM, a combination (PTRM), and a control. A 2 × 2 factorial design was used to assess PT-Effects and RM-Effects. Immediate effects on pain were measured on visual analogue sensation and distress scales before and after five 20-min tests in the first 2 days. Because participants also listened independently, general nonimmediate effects were examined at eight other times.

Results: Using multivariate analysis of covariance with contrasts and pretest control, immediate RM-Effects on pain were found at Day 1 a.m. (p < .001), Day 1 p.m. (p = .04), and Day 2 a.m. (p = .04). No PT-Effects or nonimmediate RM-Effects were found.

Discussion: Patient teaching did not result in less pain and did not support the theoretical proposition that PT reduces pain. However, the immediate RM-Effects supported the proposition that nonpharmacological adjuvants to analgesics can ease pain without adding side effects.

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Marion Good, PhD, RN, FAAN, is Arline H. and Curtis F. Garvin Professor of Nursing Excellence, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.

Jeffrey M. Albert, PhD, is Associate Professor, Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.

Gene Cranston Anderson, PhD, RN, FAAN, is Professor Emerita, University of Florida, Gainesville, and Edward J. and Louise Mellen Professor Emerita, Case Western Reserve University, Cleveland, Ohio.

Stephen Wotman, DDS, is Professor, School of Dentistry, Case Western Reserve University, Cleveland, Ohio.

Xiaomei Cong, PhD, RN, is Assistant Professor, School of Nursing, University of Connecticut, Storrs.

Deforia Lane, PhD, MT-BC, is Director of Music Therapy, Ireland Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio.

Sukhee Ahn, PhD, RN, is Associate Professor, School of Nursing, Chungnam National University, Daejeon, South Korea.

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Accepted for publication January 12, 2010.

This study was supported by the National Institute of Nursing Research, National Institutes of Health Grant R01 NR3933 (2001-2005) to M. Good, PhD, FAAN, principal investigator, and by the General Clinical Research Center, Case Western Reserve University, currently the William T. Dahms, M.D. Clinical Research Unit, University Hospitals, Case Medical Center, Cleveland, Ohio.

The authors thank Karen Young, Connie Bruening, Laura Bobrowski, Mary Lawless, Lori Gyor, Carol Rovit, Shih-Tzu Huang, Yaewon Seo, Riyad Al-Dgheim, Jennifer Schmidt, Unchalee Vealadee, Angela Chia Chi Chang, Susannah Handley, and Patricia Wilt.

Corresponding author: Marion Good, PhD, RN, FAAN, Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4904 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.