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The Effects of Music Entrainment on Postoperative Pain Perception in Pediatric Patients
Abstract
Using a within-subjects counterbalanced design with random allocation to treatment sequences, this study examined the effects of music entrainment on postoperative pain perception and emotional state in 32 pediatric patients. Patients participated in two music entrainment conditions and one control condition over 2 consecutive days. During the music entrainment condition, live music was created by the music therapist to match the child’s pain. Once resonance was achieved between the pain and the music, the music progressed into music predetermined by the child as healing. During the control condition, standard care was provided. Measurements of the dependent variables were taken just prior to and immediately following each condition. The results support the effectiveness of music entrainment as a postoperative pain management technique for children and adolescents.
... Müzik müdahaleleri; ağrı, endişe ve sıkıntıyı azaltmak ve gevşemeyi artırmak için invaziv olmayan, ucuz ve kullanışlı bir tamamlayıcı müdahale olarak algılanmaktadır. Müzik dinleme, hastaların dikkatlerini stresli olaylardan uzaklaştırıp hoş ve rahatlatıcı bir şeye odaklamalarına yardımcı olmaktadır (Bradt, 2010;Choi, Park, Bellan, Lee ve Chung, 2018;Lee, 2016). ...
... Müzik müdahaleleri uygulanırken, sonuçları etkileyebilecek faktörlerin (müdahalenin yapıldığı yer; bir hasta odası ve post-operatif ayılma odası, ortamın mahremiyet seviyesi ve ortam sesinin miktarı) göz önüne alınması gerekliliğine de dikkat edilmesi önerilmektedir (Robb, Carpenter ve Burns, 2011). Dikkatle seçilmiş müzikle hastanın stresi azaltılıp, konfor ve rahatı artırılabilir (Bradt, 2010;Choi ve diğerleri, 2018;Lee, 2016). ...
... Literatür incelendiğinde çocuk ve yetişkin örneklemde yapılan birçok çalışmada çalışma bulgularımıza benzer olarak, ameliyat sonrası dönemde müzik dinletmenin hastaların ağrısında olumlu etkisinin olduğu gösterilmiştir (Abd-Elshafy ve diğerleri, 2015; Calcaterra ve diğerleri, 2014; Melo ve Cardoso, 2017; Miladinia ve diğerleri, 2016; Sayar ve Ergin, 2019). Bradt (2010) yaptığı çalışmada çocukların ağrı skorunu VAS ağrı ölçeğine göre belirlemiş ve müzik terapinin ağrı skorunu azaltıcı etkisini bulmuştur. Bir diğer benzer çalışmada 8-18 yaş arası çocuklarda ameliyat sonrası birinci saatte ölçülen ağrı skorlarından sonra 20 dakika ile süre doğa seslerinin dinletildiği bir çalışmada, müzik seslerinin dinletildiği vaka grubundaki ağrı skorlarında azalma gözlenmiştir. ...
Müzik Terapinin 6-12 Yaş Arası Çocuklarda Anksiyete Ve Ağrı Yönetimine Etkisi: Randomize Kontrollü Bir Çalışma
... 6,7,21,22 Promising results have also been reported for children undergoing surgery. 9,[23][24][25][26] Prior studies investigated effects of music interventions 9,23,24,26 or music entrainment 25 (entrainment describes the phenomenon that different amounts of energy transferred between moving bodies are eliminated until both bodies move synchronically, 27 eg, with foot tapping). Studies were performed in mostly schoolaged children in diverse types of surgery, ranging from major cardiac surgery to arthroscopy. ...
... 6,7,21,22 Promising results have also been reported for children undergoing surgery. 9,[23][24][25][26] Prior studies investigated effects of music interventions 9,23,24,26 or music entrainment 25 (entrainment describes the phenomenon that different amounts of energy transferred between moving bodies are eliminated until both bodies move synchronically, 27 eg, with foot tapping). Studies were performed in mostly schoolaged children in diverse types of surgery, ranging from major cardiac surgery to arthroscopy. ...
... Most studies in children used postoperative music interventions. 9,[23][24][25][26] We chose to provide preoperative music interventions to decrease both preoperative anxiety and postoperative pain in infants, as previous studies demonstrated anxiety and pain reduction from preoperative music interventions. [30][31][32] This timing, however, might have affected the intervention's effect. ...
Background:
Perioperative music interventions have been shown to reduce anxiety and pain in adults. This inexpensive, easily applicable intervention could be of benefit to children as well. Our objective was to determine the effects of music interventions on distress, anxiety, and postoperative pain in infants undergoing surgery.
Methods:
The Music Under Surgery In Children study was designed as a parallel, single-blind, randomized controlled trial with an a priori formulated hypothesis. Data were collected between August 2015 and October 2016 in a single tertiary care children's hospital. There was a 24-hour follow-up with blind primary outcome assessment. A random sample of 432 eligible 0-3 years of age infants admitted for orchidopexy, hypospadias, or inguinal hernia repair receiving general anesthesia and caudal block were asked for participation. Subjects were assigned to a preoperative music intervention, pre- and intraoperative music intervention, or no music intervention (control) via random allocation using a computer-generated list with the use of opaque envelopes. The main outcome measure was the postoperative level of distress assessed with the COMFORT-Behavior scale, which is an observational scale; furthermore, preoperative level of distress, preoperative anxiety, and physiological measurements such as heart rate (HR) and blood pressure were measured. The trial was registered at the Dutch Trial Register, number NTR5402 (www.trialregister.nl).
Results:
One hundred ninety-five infants with median age 6.9 months (interquartile range, 3.3-11.1) were randomized, 178 of whom were included in the primary analysis. A nonsignificant difference in COMFORT-Behavior scale scores between the pre- and intraoperative music intervention group and control group at 4 hours after surgery was found (mean difference, -1.22; 95% CI, 2.60-0.17; P = .085). Additional analysis showed weak nonsignificant evidence for an interaction effect between music exposure and COMFORT-Behavior score at baseline (P = .027 with a Bonferroni-adjusted significance level of .025). General linear modeling showed a statistically significantly reduced HR after the preoperative music intervention in the holding area in the combined preoperative music intervention and intraoperative music intervention group compared to the control group (P = .003). The differences in HR among the 3 study arms at all time points were not statistically significant (P = .069).
Conclusions:
Music interventions do not seem to benefit all young infants undergoing surgery. The potential benefits of music interventions in the preoperative period and in more distressed children warrant further exploration.
... Il s'agit « d'un mode d'intervention qui utilise les composantes de la musique afin d'améliorer ou de maintenir le bien-être physique et psychologique de l'individu tout en offrant une variété de modalités d'expression » [23]. Une revue de littérature réalisée par Orrigo [24] que nous avons complétée a permis d'établir une liste d'effets qui ont déjà été associés aux interventions de musicothérapie réalisées en milieu hospitalier pédiatrique : • une diminution du niveau de douleur et/ou du besoin de prise d'analgésiques [25][26][27] ; • une diminution du niveau d'anxiété [28][29][30][31] ; • une amélioration de l'engagement actif du jeune dans son environnement [32][33][34] ; • une amélioration des capacités du jeune à gérer son stress face à l'environnement hospitalier [21,34] ; • une amélioration du ressenti du soutien social reçu par les professionnels de la santé, les amis et la famille [35] ; • une amélioration de l'état émotionnel [35,25] ; • une diminution de la détresse procédurale [27] ; • une amélioration du concept de soi [36]. Cependant, il est possible de relever certaines limites associées à ce domaine de recherche, notamment le fait que peu d'études se sont penchées sur les effets obtenus auprès de la population adolescente [37], que très peu d'études ont porté sur le vécu subjectif des jeunes et qu'à notre connaissance une seule étude a mesuré le concept de soi chez cette population, et cela suite à une seule séance d'intervention de musicothérapie interactive [36]. ...
... Il s'agit « d'un mode d'intervention qui utilise les composantes de la musique afin d'améliorer ou de maintenir le bien-être physique et psychologique de l'individu tout en offrant une variété de modalités d'expression » [23]. Une revue de littérature réalisée par Orrigo [24] que nous avons complétée a permis d'établir une liste d'effets qui ont déjà été associés aux interventions de musicothérapie réalisées en milieu hospitalier pédiatrique : • une diminution du niveau de douleur et/ou du besoin de prise d'analgésiques [25][26][27] ; • une diminution du niveau d'anxiété [28][29][30][31] ; • une amélioration de l'engagement actif du jeune dans son environnement [32][33][34] ; • une amélioration des capacités du jeune à gérer son stress face à l'environnement hospitalier [21,34] ; • une amélioration du ressenti du soutien social reçu par les professionnels de la santé, les amis et la famille [35] ; • une amélioration de l'état émotionnel [35,25] ; • une diminution de la détresse procédurale [27] ; • une amélioration du concept de soi [36]. Cependant, il est possible de relever certaines limites associées à ce domaine de recherche, notamment le fait que peu d'études se sont penchées sur les effets obtenus auprès de la population adolescente [37], que très peu d'études ont porté sur le vécu subjectif des jeunes et qu'à notre connaissance une seule étude a mesuré le concept de soi chez cette population, et cela suite à une seule séance d'intervention de musicothérapie interactive [36]. ...
... Une analyse de contenu simplifiée a suggéré la présence de quatre thématiques parmi les réponses ( Bardin, 2003) Tableau 2 Résultats obtenus par les participants au test de Mann-Kendall (n = 6) Sylvain Maxime Aurélie Samantha Jeanne Magalie Autoefficacité Tau de Kendall 0,894 0,548 0,913 0,738 0,105 0,236 p 0,034* 0,235 0,074** 0,065 0,500 0,500 Émotions positives Tau de Kendall 0,837-0,913 0,333 0,738 0,738 1,000 p 0,952 0,926 0,375 0,065 0,065 0,042** Émotions négatives Tau de Kendall-0,800 0,548-0,333 0,800-0,671-0,548 p 0,042* 0,765 0,375 0,992 0,096 0,235 Concept de soi Tau de Kendall 0,600 0,000 1,000 0,949-0,105-0,333 p 0,958 0,500 0,042* 0,022* 0,500 0,833 [9]. Les résultats obtenus appuient ceux de précédentes recherches en montrant que des interventions de musicothérapie interactive sont en mesure de favoriser un engagement actif du jeune hospitalisé dans son environnement [32][33][34], d'améliorer son état émotionnel [35,25], de lui procurer une expérience positive, de réalisation [58] et d'améliorer son concept de soi [36]. Compte tenu du fait qu'il existe très peu de littérature sur les effets de cette approche auprès des adolescents [37], ces résultats viennent étayer la littérature en oncologie pédiatrique en montrant que ce type d'intervention est en mesure d'engager activement non seulement les jeunes enfants [32][33][34], mais aussi la population adolescente. ...
Cette recherche a pour objectif de: 1) évaluer dans quelle mesure quatre séances individuelles de musicothérapie interactive sont associées à des changements dans les domaines de l’auto-efficacité, des émotions et du concept de soi chez des adolescents hospitalisés en hématologie–oncologie; 2) documenter l’expérience des adolescents sur les séances de musicothérapie. Sept adolescents âgés entre 12 et 18 ans ont participé à des séances de musicothérapie interactive impliquant l’apprentissage d’une chanson à la guitare classique. Le plan de recherche comprenait sept temps d’évaluation. Après la dernière séance d’intervention, chaque adolescent a répondu à trois questions ouvertes portant sur son expérience globale en musicothérapie. Des analyses statistiques non paramétriques et thématiques ont été réalisées sur les résultats obtenus afin d’identifier les évolutions concomitantes à l’intervention. Les résultats obtenus au niveau du groupe ne mettent pas en évidence d’évolutions systématiques, mais cela cache des différences individuelles importantes. Des évolutions positives ont été observées chez 2/7 participants dans le domaine de l’auto-efficacité, chez 3/7 sur les émotions positives, 2/7 sur les émotions négatives et 3/7 sur le concept de soi. Les commentaires des adolescents mettent en évidence une expérience globalement positive marquée par un mieux-être physique et/ou psychologique. Ces résultats plaident pour la mise en place de nouvelles recherches sur les effets des interventions de musicothérapie interactive auprès des adolescents hospitalisés en hémato-oncologie en prenant en compte les trajectoires individuelles dans les groupes considérés.
... Two studies conducted by the same researchers (Kim & Kim, 2009, 2010 investigated the effect of a single group music therapy session on pain, whereas the others examined the impact of individual MT sessions. In terms of the levels of participants' music involvement, five studies (Bradt, 2001;Ghetti, 2011Ghetti, , 2013Kim & Kim, 2009;Yinger, 2012) included a more active style of engagement using recreative (e.g., singing and playing pre-composed music) and creative methods (e.g., songwriting), whereas four trials (Clark et al., 2006;Fredenburg & Silverman, 2014;Gutgsell et al., 2013;Schou, 2008) used sessions involving receptive methods (e.g., listening to live music) with passive participation. One study by Kim and Kim (2010) compared the two types of approaches by conducting two separate MT groups: one with a receptive approach and the other with a singing-centered recreative approach. ...
... Most studies provided one single MT session, but three studies (Bradt, 2001;Clark et al., 2006;Schou, 2008) implemented slightly different formats. Bradt (2001) randomized the sequence of two MT and one standard-care session, and reported results from every phase. ...
... Most studies provided one single MT session, but three studies (Bradt, 2001;Clark et al., 2006;Schou, 2008) implemented slightly different formats. Bradt (2001) randomized the sequence of two MT and one standard-care session, and reported results from every phase. Only the post-test data from the first MT session was used for this meta-analysis. ...
Background: Numerous meta-analyses have been conducted on the topic of music and pain, with the latest comprehensive study published in 2006. Since that time, more than 70 randomized controlled trials (RCTs) have been published, necessitating a new and comprehensive review.
Objective: The aim of this meta-analysis was to examine published RCT studies investigating the effect of music on pain.
Methods: The present study included RCTs published between 1995 and 2014. Studies were obtained by searching 12 databases and hand-searching related journals and reference lists. Main outcomes were pain intensity, emotional distress from pain, vital signs, and amount of analgesic intake. Study quality was evaluated according to the Cochrane Collaboration guidelines.
Results: Analysis of the 97 included studies revealed that music interventions had statistically significant effects in decreasing pain on 0–10 pain scales (MD = –1.13), other pain scales (SMD = –0.39), emotional distress from pain (MD = –10.83), anesthetic use (SMD = –0.56), opioid intake (SMD = –0.24), non-opioid intake (SMD = –0.54), heart rate (MD = –4.25), systolic blood pressure (MD = –3.34), diastolic blood pressure (MD = –1.18), and respiration rate (MD = –1.46). Subgroup and moderator analyses yielded additional clinically informative outcomes.
Conclusions: Considering all the possible benefits, music interventions may provide an effective complementary approach for the relief of acute, procedural, and cancer/chronic pain in the medical setting.
... Because the intervention used in one of the included studies consisted of a first and second live music intervention entrainment (one in the morning, one in the afternoon), these results were analyzed separately for the intergroup analysis [9]. However, in pooling the results, we could not use both entrainments because that would have duplicated the patients from this study. ...
... Table 1 gives an overview of the characteristics of the three included studies. These had a total of 196 participants, ranging in age from 1 day to 18 years old, were reported between 2006 and 2010 and carried out in the USA [9], Sweden [11] and Brazil [12]. Bradt et al included orthopaedic in-patients, Nilsson et al included patients undergoing minimally invasive day-surgery for miscellaneous conditions and Hatem et al included in-patients undergoing cardiac surgery [9,11,12]. ...
... These had a total of 196 participants, ranging in age from 1 day to 18 years old, were reported between 2006 and 2010 and carried out in the USA [9], Sweden [11] and Brazil [12]. Bradt et al included orthopaedic in-patients, Nilsson et al included patients undergoing minimally invasive day-surgery for miscellaneous conditions and Hatem et al included in-patients undergoing cardiac surgery [9,11,12]. ...
Objective:
Music interventions are widely used, but have not yet gained a place in guidelines for pediatric surgery or pediatric anesthesia. In this systematic review and meta-analysis we examined the effects of music interventions on pain, anxiety and distress in children undergoing invasive surgery.
Data sources:
We searched 25 electronic databases from their first available date until October 2014.
Study selection:
Included were all randomized controlled trials with a parallel group, crossover or cluster design that included pediatric patients from 1 month to 18 years old undergoing minimally invasive or invasive surgical procedures, and receiving either live music therapy or recorded music.
Data extraction and synthesis:
4846 records were retrieved from the searches, 26 full text reports were evaluated and data was extracted by two independent investigators.
Main outcome measures:
Pain was measured with the Visual Analogue Scale, the Coloured Analogue Scale and the Facial Pain Scale. Anxiety and distress were measured with an emotional index scale (not validated), the Spielberger short State Trait Anxiety Inventory and a Facial Affective Scale.
Results:
Three RCTs were eligible for inclusion encompassing 196 orthopedic, cardiac and day surgery patients (age of 1 day to 18 years) receiving either live music therapy or recorded music. Overall a statistically significant positive effect was demonstrated on postoperative pain (SMD -1.07; 95%CI-2.08; -0.07) and on anxiety and distress (SMD -0.34 95% CI -0.66; -0.01 and SMD -0.50; 95% CI -0.84; - 0.16.
Conclusions and relevance:
This systematic review and meta-analysis indicates that music interventions may have a statistically significant effect in reducing post-operative pain, anxiety and distress in children undergoing a surgical procedure. Evidence from this review and other reviews suggests music therapy may be considered for clinical use.
... Physiological Blood Pressure: (Hatem, 2006;Nguyen, 2010) Body Temperature: (Hatem, 2006) Heart Rate: (Hatem, 2006;Liu, 2007;Nguyen, 2010;Whitehead-Pleaux, 2006) Oxygen Saturation: (Hatem, 2006;Nguyen, 2010) Pain Threshold: Dolorimeter (Press, 2003) Respiration: (Hatem, 2006;Nguyen, 2010;Whitehead-Pleaux, 2006) Observational Anxiety: Yale Preoperative Anxiety Scale (Kain, 2001;Kain, 2004) Coping: Behavioral Coping (Robb, 2008;Whitehead-Pleaux, 2006) Pain -Vami/Thompson Pediatric Pain Questionnaire (Bradt, 2001) -WHO-Euro cross-nation study of health-related behaviours in school (Kristjánsdóttir, 2011) Self Concept: Piers-Harris Children's Self-Concept Scale (Colwell, 2005) Treatment Regimen: Question on perception of treatment duration (Grasso, 2000) "How long does CPT feel like it takes to complete?" ...
... Details of interventions are tabulated in tables 10 and 11. All fifteen studies offered interventions on an individual basis with programs that lasted anywhere from 1 minute to 60 minutes, and were offered as a single treatment except for the studies by Bradt (2001) and Grasso (2000). One of the factors known to cause heterogeneity is lack of standardized protocols (Naylor et al., 2011). ...
... Music therapy studies in this review demonstrated a wide variety of approaches, including entrainment (Bradt, 2001), three receptive interventions using live or original music (Grasso et al., 2000;Loewy et al., 2005;Whitehead-Pleaux et al., 2006), two combined but mainly active music engagements (Kain et al., 2004;Robb et al., 2008), and lastly two combined but mostly creative approaches in which participants created their own music using computer software with a therapist (Barry, 2010;Colwell et al., 2005). In the four studies that yielded positive results, two provided the intervention more than twice (Bradt, 2001;Grasso et al., 2000), three utilized children's songs (except Bradt, 2001) and three provided live music incorporating the child's preference (Bradt, 2001;Loewy et al., 2005;Robb et al., 2008). ...
The aim of this study was to systematically review the latest clinical trials in music medicine and medical music therapy for pediatric patients. Thirteen databases were searched to obtain randomized controlled/crossover design studies published between the year 2000 and 2012 in English language. Out of 1012 articles retrieved in the initial search, fifteen studies were identified based on an exclusion criteria. Overall, selected articles involved children 1 month to 18 years, sample size of 11 to 150, and total participants of 987. Studies were classified and compared as music medicine or music therapy studies through a systematic synthesis assessing general characteristics, methodological quality, measured outcomes, types of interventions and the study results. Seven music medicine and eight music therapy studies measured seven dependent variables using thirty-six different measurement tools with a large heterogeneity in the selection, type, and method of music interventions. Evaluation of the methodological quality revealed that many studies did not provide a full report of the research method, and did not meet some or most methodological standards, such as randomization, allocation concealment, double or partial blinding, and intention to treat analysis. Although overall research results were positive if not significant,
... A survey of nurses' attitudes towards music therapy in the hospital setting revealed a positive attitude towards music therapy practices, with pain accounting for one of the most common reasons for referrals in this setting (Hillmer, 2003). Research shows positive results towards effective pain management through music in a variety of healthcare settings (Bradshaw et al., 2011;Bradt, 2010;Cepeda, Carr, Lau, & Alvarez, 2010;Kenntner-Mabiala, Gorges, Alpers, Lehmann, & Pauli, 2007;Mitchel & MacDonald, 2006;Mitchel, MacDonald & Brodie, 2006;Mitchel, MacDonald, & Knussen, 2008;Mitchel, MacDonald, Serpell, & Knussen, 2007;Standley, 2000;Park, 2010). ...
... Mitchel et al., (2008) outlined that the success of music in managing a pain was dependent on music's ability to: a) effectively shift attention, and b) allow perceived control over the pain. Many researchers have demonstrated the use of preferred and/or familiar music, to successfully manage pain in a variety of settings (Bradshaw et al., 2011;Bradt, 2010;Cepeda et al., 2010;Good et al., 1999;Kenntner-Mabiala et al., 2007;Locsin, 1981;Mitchel & MacDonald, 2006;Mitchel, MacDonald & Brodie, 2006;Mitchel, MacDonald, & Knussen, 2008;Mitchel, MacDonald, Serpell, & Knussen, 2007;Park, 2010). Cepeda et al. (2010) conducted a systematic review of 51 studies that utilized music as a variable in treating pain. ...
... More recently, a large number of studies support the use of music therapy interventions to effectively manage pain (Allred, Byers, & Sole, 2008;Bailey, 1986;Bradt, 2010;Fratianne et al., 2001;Good et al., 2010;Nilsson, 2008;Standley, 1986;Standley, 1992;Standley, 1995;Tan, Yowler, Super, & Fratianne, 2010;Voss et al., 2004). Fratianne et al., (2001) examined the effectiveness of music therapy for pain management of burn patients. ...
The effect of participant-selected music listening on pain perception, pain tolerance,
and attention to pain was evaluated during a cold-pressor pain protocol. Participants
(N=50) underwent two, ice-water hand immersions in a music condition and a silence
condition. Participants were asked to engage in active music listening of their choice
during the cold-pressor music condition. The researcher collected a pain tolerance handimmersion
time, while participants self-reported on pain perception and attention to pain.
Results showed that participants reported significantly less pain perception and attention
to pain, and greater pain tolerance time under the music condition than in the silence
condition. The positive results are attributed to the ability of participant-selected music to
effectively engage attention. The participant-selected music choices were analyzed for
musical attributes that served as possible predictors for influencing attention to pain. Of
the five attributes analyzed including activation, tempo, mood, lyrics, and preference,
only preference yielded significant results in diminishing attention to pain. Conclusions
are made as to the influence of music on attention, pain tolerance, and pain perception,
and support is given for preferred music as an effective means to engage attention for
pain management.
... Using live music has shown to significantly impact patients' response to treatment in medical settings [22]. Offering live, versus recorded, music allows a music therapist to respond immediately to changes in patients' emotional and physiological states and use musical entrainment as a physiological mechanism of support [23]. Live music also allows the therapist to respond to changes in the treatment environment, nurse states of tension, and family dynamics. ...
... Music therapists are able to work in tandem with nurses, child life specialists, and surgical teams to help children cope with the stressors of hospitalization and treatments. When live music is sensitively applied by a board certified music therapist in support of medical procedures, entrainment is possible [23]. Entrainment provides a unique way of meeting patients in the moment of expressed pain and working with them to decrease perceived levels of pain and discomfort. ...
The use of music therapy for procedural support is an area of increasing interest yet has little research supporting it as an evidence-based practice. Throughout this article there is an emphasis on the use of music therapy in the pediatric hospital setting, but not exclusively. Procedural support is becoming a commonplace term in music therapy yet there is little information to unify the variety of techniques and practices involved in this particular approach to treatment. This article surveys current literature regarding procedural support, including music therapy supports, child life supports, and medical supports. Definitions of terms are offered and a working definition of procedural support is proposed.
... Other studies have found similar results showing that music can be used to treat pain in pediatric clinical settings [12,16,17]. However, none of these studies explored the use of music for sedation/analgesia in the intensive care unit setting other than during a single painful procedure. ...
... In newborns, music has been shown to be effective in reducing pain and stress behavior during procedures. Music is also associated with more stable vital signs, increased weight gain, shorter length of stay, and increased parental satisfaction with neonatal intensive care [17][18][19][20][21]. A large RCT confirmed that music is associated with better vital signs, improved feeding behavior, and prolonged time remaining settled [22]. ...
Background:
Stress induced by pain and anxiety is common in pediatric intensive care unit (PICU) patients. Sedation/analgesia in PICU is usually achieved through various analgesics and sedatives. Excessive use of these drugs can put patients at risk for hemodynamic/respiratory instability, prolonged ventilation, withdrawal, delirium, and critical illness polyneuromyopathy.The use of non-pharmacologic interventions has been recommended by sedation guidelines. However, non-pharmacological measures in PICU, including music and noise reduction, have been inadequately studied.
Methods:
The Music Use for Sedation in Critically ill Children (MUSiCC trial) pilot study is an investigator-initiated, three-arm, randomized controlled trial (RCT) on the use of music for sedation in PICU. The main goal of the study is to demonstrate feasibility of a music trial in PICU and to obtain the necessary information to plan a larger trial. The study compares music versus noise cancelation versus control in sedated and mechanically ventilated children admitted to PICU. In the music group, children receive the music (modified classical music) three times a day for 30 min at a time. Music is delivered with noise cancelation headphones. The noise cancelation group receives the same intervention but with a no music (sham playlist). The control group receives usual care with no specific intervention. Children remain in the study until extubation or a maximum of 7 days. The primary outcomes of the study are feasibility and sedation/analgesia requirements. Secondary outcomes include change in vital signs before and during the intervention, ICU delirium, and adverse effects related to the intervention. The estimated sample size is 20 subjects per group for a total of 60 children.
Discussion:
Despite being recommended by current guidelines, evidence to support the use of music in PICU is lacking. Music has the potential to reduce sedation requirements and their negative side effects. This pilot RCT will demonstrate feasibility and provide the necessary information to plan a larger trial focusing on the effectiveness of the intervention.
Trial registration:
The study was registered at ClinicalTrials.gov (NCT03497559) on April 13, 2018.
... Music-imaginative pain treatment originates from entrainment (Bradt, 2010;Dileo & Bradt, 1999;Rider, 1985) that focuses on the treatment of a symptom within the entire bio-psycho-social context of an individual (Dileo, 1997) and -in particular -on the subjective experience of the patient, including intensive psychological processes of entering, confronting, exploring, and reflecting the pain. Music-imaginative pain treatment is carried out in an individual setting lasting for at least 1 or more sessions. ...
... There are a number of studies that have provided evidence for the effectiveness of music listening or music therapy for pain reduction (for example, Cepeda, Carr, Lau, & Alvarez, 2006;Loewy, Hallan, Friedman, & Martinez, 2005;Koch, Kain, Ayoub, & Rosenbaum 1992;Silvestrini & Piguet, 2011) as well as research evidence for the effectiveness of music therapy entrainment for pain management (Bradt, 2010;Dileo, et al., 2013;Schwoebel, Coslett, Bradt, Friedman, & Dileo, 2002). The effectiveness of music-imaginative pain treatment has been recently brought in connection with processes related to neurophysiologic change. ...
In the case study of a 45-year-old patient suffering from chronic schizoaffective psychosis, the authors examine the question if severe psychiatric illness presents a contraindication for music-imaginative pain treatment. These considerations are based on the alarming fact that psychotic patients have a much lower life expectancy than the general population, because somatic illnesses are often not discovered at an early stage. Despite heterogeneous research findings, it is often assumed that persons with psychotic illness are insensitive to pain. Moreover, instruments for the assessment of (chronic) pain that are specially constructed to meet the needs of psychotic patients are not available. If, however, one pays sufficient attention to the specific characteristics of communication in the therapeutic relationship, then it becomes possible to help the affected patients through methods of music therapy and to treat chronic pain in its complex psychological and social context.
... EEG-measures (6,8) or on therapeutic processes by qualitative studies (9, 10). Up to now, outcome studies (3,11,12) show promising results, but they are not transferable to patients with somatoform pain disorders, and existing systematic reviews do not include studies on this clientele (13)(14)(15)(16). ...
Music-imaginative Pain Treatment (MIPT) is a form of music therapy addressing pain experience and affective attitudes toward pain. It includes two self-composed music pieces: one dedicated to the pain experience (pain music, PM) and the other to healing imagination (healing music, HM). Our non-experimental study addresses patients with chronic somatoform pain disorders participating in MIPT. The goal is to gain insight into the direct effect mechanisms of MIPT by combining outcome measures on both the objective physiological and subjective perception levels. The research questions are directed toward changes in pain experience and heart rate variability and their correlations. Thirty-seven hospitalized patients with chronic or somatoform pain disorders receiving MIPT participated in this study. Demographic data and psychometric measures (Symptom Check List SCL90, Childhood Trauma Questionnaire CTQ) were collected to characterize the sample. Subjective pain experience was measured by McGill Pain Questionnaire (SF-MPQ), and Heart Rate Variability by 24 h-ECG. Data analysis shows a reduction of reported pain from MT1 = 19.1 (SD = 7.3) to MT2 = 10.6 (SD = 8.0) in all dimensions of the SF-MPQ. HRV analyses shows a reduced absolute power during PM and HM, while a relative shift in the autonomic system toward higher vagal activity appears during HM. Significant correlations between HRV and MPQ could not be calculated. Findings are interpreted as a physiological correlate to the psychological processes of the patients. Future studies with more participants, a control-group design, and the integration of medium- and long-term effects are recommended.
... In pediatric research, live music has been found to reduce postoperative pain and facilitate self-regulation. 20,21 Although some research has indicated that live music may be beneficial for children and infants, 22 the use of live music for children receiving mechanical ventilation requires further investigation. ...
Background:
Music is often used as a nonpharmacological pain management strategy, but little evidence is available about its role in pediatric critical care patients.
Objective:
To determine the effect of a live music intervention versus a recorded music intervention on heart rate, blood pressure, and respiratory rate in pediatric critical care patients receiving mechanical ventilation and sedation.
Methods:
An exploratory randomized controlled trial was performed in a pediatric intensive care unit. Participants were randomly allocated to receive a live music intervention with standard care or a recorded music intervention with standard care. Each intervention was delivered by a board-certified music therapist for 15 minutes. Heart rate, respiratory rate, and blood pressure were measured at baseline and at 15-minute intervals for 60 minutes after the intervention.
Results:
A total of 33 patients aged 0 to 2 years completed the study: 17 were assigned to the live music group and 16 to the recorded music group. In the live music group, a significant reduction in heart rate was observed immediately after the intervention and was sustained at 60 minutes after the intervention. Although the live music group also exhibited a downward trend in blood pressure, those differences were not significant.
Conclusions:
The results of this study indicate that live music interventions may be more effective than recorded music interventions in reducing pain and anxiety in pediatric critical care patients. The advantage of live music may be due to the adaptability of the music delivery by a trained music therapist.
... We would add that the participant's recollection of the music improvised in an entrainment session would also involve the memory of the shared experience of pain and healing with the music therapist, providing another essential component of "active coping" that would last beyond the intervention itself. Several studies have demonstrated the effectiveness of Entrainment on pain perception (Rider, 1985;Schwoebel et al., 2002;Bradt, 2010;Hauck et al., 2013). ...
Previous studies examining EEG and LORETA in patients with chronic pain discovered an overactivation of high theta (6–9 Hz) and low beta (12–16 Hz) power in central regions. MEG studies with healthy subjects correlating evoked nociception ratings and source localization described delta and gamma changes according to two music interventions. Using similar music conditions with chronic pain patients, we examined EEG in response to two different music interventions for pain. To study this process in-depth we conducted a mixed-methods case study approach, based on three clinical cases. Effectiveness of personalized music therapy improvisations (entrainment music – EM) versus preferred music on chronic pain was examined with 16 participants. Three patients were randomly selected for follow-up EEG sessions three months post-intervention, where they listened to recordings of the music from the interventions provided during the research. To test the difference of EM versus preferred music, recordings were presented in a block design: silence, their own composed EM (depicting both “pain” and “healing”), preferred (commercially available) music, and a non-participant’s EM as a control. Participants rated their pain before and after the EEG on a 1–10 scale. We conducted a detailed single case analysis to compare all conditions, as well as a group comparison of entrainment-healing condition versus preferred music condition. Power spectrum and according LORETA distributions focused on expected changes in delta, theta, beta, and gamma frequencies, particularly in sensory-motor and central regions. Intentional moment-by-moment attention on the sounds/music rather than on pain and decreased awareness of pain was experienced from one participant. Corresponding EEG analysis showed accompanying power changes in sensory-motor regions and LORETA projection pointed to insula-related changes during entrainment-pain music. LORETA also indicated involvement of visual-spatial, motor, and language/music improvisation processing in response to his personalized EM which may reflect active recollection of creating the EM. Group-wide analysis showed common brain responses to personalized entrainment-healing music in theta and low beta range in right pre- and post-central gyrus. We observed somatosensory changes consistent with processing pain during entrainment-healing music that were not seen during preferred music. These results may depict top–down neural processes associated with active coping for pain.
... Studies using music in mechanically ventilated adults found that music was associated with lower levels of anxiety, lower sedation requirements [11,27]. In pediatrics, music has been shown to reduce procedural pain and anxiety in a variety of clinical settings, but these studies used music for distraction and did not include critically ill children [8,[28][29][30]. In newborns, music has been shown to be effective in reducing pain and stress behaviours during procedures and has also been associated with more stable vital signs, better weight gain, shorter length of stay and increased parental satisfaction [31][32][33]. ...
Objective
To demonstrate feasibility of a music medicine intervention trial in pediatric intensive care and to obtain information on sedation and analgesia dose variation to plan a larger trial.
Material and methods
Pilot randomized controlled trial (RCT) was conducted at the Stollery Children’s Hospital general and cardiac intensive care units (PICU/PCICU). The study included children 1 month to 16 years of age on mechanical ventilation and receiving sedation drugs. Patients were randomized in a 1:1:1 ratio to music, noise cancellation or control. The music group received classical music for 30 min three times/day using headphones. The noise cancellation group received the same intervention but with no music. The control group received usual care.
Results
A total of 60 patients were included. Average enrollment rate was 4.8 patients/month, with a consent rate of 69%. Protocol adherence was achieved with patients receiving > 80% of the interventions. Overall mean (SD) daily Sedation Intensity Score was 52.4 (30.3) with a mean (SD) sedation frequency of 9.75 (7.21) PRN doses per day. There was a small but statistically significant decrease in heart rate at the beginning of the music intervention. There were no study related adverse events. Eighty-eight percent of the parents thought the headphones were comfortable; 73% described their child more settled during the intervention.
Conclusions
This pilot RCT has demonstrated the feasibility of a music medicine intervention in critically ill children. The study has also provided the necessary information to plan a larger trial.
... According to this study, children in the music group had significantly lower anxiety scores after the lumbar puncture compared with those in the control group. Bradt 35 reported a reduction effect of music on postoperative anxiety in 8-to 18-yearold pediatric patients undergoing orthopaedic operations. In another study conducted with children, Hatem et al 29 reported that classical music listening for 30 minutes in the postoperative period reduced the anxiety in children. ...
Purpose
The aim of the study was to determine the effect of different auditory methods of attention distraction on postoperative pain and anxiety in children.
Design
The study was conducted as a pretest–posttest experimental study to determine the effect of classical music, Turkish music, and audiobook on the reduction of postoperative pain and anxiety in children.
Methods
The patient population of the study comprised children who had undergone a surgical operation in the pediatric surgery clinics. A total of 90 children were included in the sample of the study. The data were collected using the Visual Analog Scale, the Wong-Baker Faces Pain Scale, and the State-Trait Anxiety Inventory for children, in addition to the sociodemographic data form of the child and the parent.
Findings
Classical music, Turkish music, and audiobook methods played an effective role in decreasing postoperative pain and the anxiety state in children. Classical music listening was the most effective method in reducing the pain in children in the postoperative period in the three groups in the study.
Conclusions
We demonstrated that different auditory attention distraction methods had a decreasing effect on postoperative pain and anxiety in children.
... Three main MT techniques have been well studied for procedural support. The "Iso-principle" is a music therapy approach used to alter patient mood, behavior, and physiological state (Bradt, 2010). The MT matches a patient's current behavioral and physiological state using musical elements (e.g., tempo, volume, rhythmic complexity, melodic complexity, harmonic complexity). ...
Introduction:
In young children, EEG data acquisition during stimulation tasks is difficult due to anxiety, movement and behaviorally-related interruptions, especially in those with disabilities.
New method:
We used standardized music therapy (MT) protocols with and without acclimatization, during and prior to time-locked EEG with a published tactile testing protocol. Our prospective study leveraged a larger trial in children with/without cerebral palsy aged 7-27 months. Group1 received no preparation, Group2 received 15-minute MT prior to the EEG session, Group3 received the same as Group2 plus a rubber cap for home practice. All groups received MT procedural support during the EEG session. Sessions were stopped/started to acquire a full dataset. Trials were reviewed using a two-step artifact detection strategy by specialists masked to group allocation.
Results:
64 patients were included, 20 each in Groups 2 and 3, and 24 in Group1. Average age was 16.08 ± 6.33 months. All (100%) of children had data of sufficient quality and quantity for outcomes measurement without a second testing visit. There were no differences in useable trials by procedural group, disability status, age or stimulus condition. EEG recording time was shorter in Group3 vs. 1 (p = 0.02) and more patients in Group1 required repeat trials compared to Groups2 and 3 (p = 0.04 for both).
Comparison with old method:
Our new methods resulted in no attrition from data loss, an improvement compared to published similar studies with data loss 30-55%. Acclimatization had minimal effects.
Conclusion:
In children under 3, MT protocols result in high rates of EEG data acquisition, decrease behaviorally-related interruptions and session acquisition time. This method is successful for typically developing children and those with cerebral palsy.
... Finally, in the Transformational level, the individual enters into the pain or dialogues with the pain, intending to form a relationship with the pain. Applied music therapy methods on this level include entrainment as well as Guided Imagery and Music, including The Bonny Method of Guided Imagery and Music (Bradt 2010(Bradt , 2013Dileo & Bradt 1999;Rider 1987;Sanfi 2017;Torres 2015aTorres , 2015b. ...
The aim of the article is to examine the concept of chronic pain as a complex phenomenon and to highlight the potential role of music therapy-in particular, music imagery-in the treatment of chronic pain. Theories of pain, along with research on pain pathways and pain control in the nervous system, support the evidence from clinical practice that music interventions can alleviate the sensation of pain whilst also offering a pleasant aesthetic experience. Music therapy provides opportunities for processing psychological and existential issues and enables patients to better cope with chronic pain. Related research in neuroscience and music medicine provides supplementary evidence that music can have a considerable impact on the physiological and psychological aspects of pain. This article summarises selected theoretical, clinical, and research-based knowledge relevant for music therapy clinicians and other health professionals aiming to alleviate chronic pain.
... Agency can be attributed to exteriorized malevolent and benevolent spirits, but likewise to other entities. For example, in Western music entrainment therapy-lacking any traceable connections to indigenous animism-something very similar occurs: First, therapist and patient together identify musical sounds that "sound like the pain:' Then, a sonic quality is again agreed upon that "sounds like painless wellbeing:' After these definitions are done , the therapist (or the patient, or both, depending on the situation) improvises a piece of music, starting by emphasizing the "pain sound" and transforming the piece to finish by exclusivelyusing the "wellbeing sound:' This method is evidently effective (Bradt 2010). The principle in these two examples is the same: A specific quality of sound is correlated to a specific extra-sonic quality ; in the beginning with the illness-causing spirit or the perception of pain, and towards the end with the allied benevolent spirit or the feeling of wellbeing. ...
... The evaluation of the effects of the arts and culture on different aspect of human health has attracted an increasing attention in recent years [1][2][3][4][5][6][7][8]. Building on this rich, diverse although still fragmentary evidence, there is scope to affirm that the arts and culture may indeed have some positive impact on individual physical health [9], mental health [10], and wellbeing [11][12]. ...
... Data from the evaluation supported the findings of the realist review (8) concerning therapeutic mechanisms, providing a richer analysis of those mechanisms than has previously been available. In terms of supportive mechanisms, our results indicate that potential benefits extend beyond the capacity of music therapy to provide a temporary distraction from the effects of illness [32][33][34][35] and also offer participants the opportunity to transcend in a more fundamental way their physical difficulties and maintain their identities as rounded human beings rather than just patients. The opportunity to relax [35] can also reduce patients' pain and anxiety. ...
Background
Music therapy is increasingly used as an adjunct therapy to support symptom management in palliative care. However, studies to date have paid little attention to the processes that lead to changes in patient outcomes. To fill this gap, we examined the processes and experiences involved in the introduction of music therapy as an adjunct complementary therapy to palliative care in a hospice setting in the United Kingdom (UK).
Methods
Using a realistic evaluation approach, we conducted a qualitative study using a variety of approaches. These consisted of open text answers from patients (n = 16) on how music therapy helped meet their needs within one hospice in Northern Ireland, UK. We also conducted three focus groups with a range of palliative care practitioners (seven physicians, seven nursing staff, two social workers and three allied health professionals) to help understand their perspectives on music therapy’s impact on their work setting, and what influences its successful implementation. This was supplemented with an interview with the music therapist delivering the intervention.
Results
Music therapy contains multiple mechanisms that can provide physical, psychological, emotional, expressive, existential and social support. There is also evidence that the hospice context, animated by a holistic approach to healthcare, is an important facilitator of the effects of music therapy. Examination of patients’ responses helped identify specific benefits for different types of patients.
Conclusions
There is a synergy between the therapeutic aims of music therapy and those of palliative care, which appealed to a significant proportion of participants, who perceived it as effective.
Electronic supplementary material
The online version of this article (10.1186/s12904-017-0253-5) contains supplementary material, which is available to authorized users.
... Approximately 40 minutes of music was chosen based on each patient's preferences and was analyzed following a "music characterization system" algorithm containing 12 musical elements and 4 nonmusical elements to identify and classify each selection numerically as having greater or lesser relaxation properties as opposed to activating properties (14). On the basis of the patient's level of state anxiety and distress obtained during the assessment, individual pieces of music were connected in a sequence that moved progressively from pieces with higher levels of activating qualities to pieces with higher levels of relaxing qualities, based on the theories of musical entrainment (15) and music sedation (16) to increase comfort and orientation, reducing state anxiety. ...
Purpose:
Radiation therapy (RT) is associated with high stress levels. The role of music therapy (MT) for patients receiving RT is not well described. This study evaluates the impact of MT on anxiety and distress during simulation in patients with newly diagnosed head and neck or breast cancer.
Methods and materials:
This institutional review board-approved randomized trial of MT versus no MT at the time of simulation included the pre-State-Trait Anxiety Inventory (STAI-S Anxiety) questionnaire and Symptom Distress Thermometer (SDT). Patients randomized to MT received a consultation with a music therapist, during which music of the patients' choice to be played during simulation was selected. The no-MT patients did not receive the MT consultation, nor did they hear prerecorded music during simulation. Subsequent to the simulation, all patients repeated the STAI-S Anxiety questionnaire and the SDT.
Results:
Of the 78 patients enrolled (39 in MT group and 39 in no-MT group), 38 had breast cancer and 40 had head and neck cancer. The male-female ratio was 27:51. The overall mean pre- and post-simulation STAI-S scores were 38.7 (range, 20-60) and 35.2 (range, 20-72), respectively. The overall mean pre- and post-simulation SDT scores were 3.2 (range, 0-10) and 2.5 (range, 0-10), respectively. The MT group had mean pre- and post-simulation STAI-S scores of 39.1 and 31.0, respectively (P<.0001), and the mean SDT scores before and after simulation were 3.2 and 1.7, respectively (P<.0001). The no-MT group's mean pre- and post-simulation STAI-S scores were 38.3 and 39.5, respectively (P=.46), and the mean SDT scores were 3 and 3.2, respectively (P=.51).
Conclusions:
MT significantly lowered patient anxiety and distress during the simulation procedure on the basis of the STAI-S questionnaire and SDT. Incorporating culturally centered individualized MT may be an effective intervention to reduce stressors. Continued research defining the role of MT intervention in improving the patient experience by reducing anxiety is warranted.
... In einer speziellen musiktherapeutischen Konzeption zur Behandlung von Schmerz, der sogenannten Musik-imaginativen Schmerzbehandlung (Entrainment, vgl. Rider, 1985;Dileo & Bradt, 1999;Bradt, 2010;Metzner, 2012;Metzner & Frommer, 2014) Die auf Erfahrungen beruhenden und gedanklich entwickelten Besonderheiten von Kompositionsprozessen bedürfen einer weiteren wissenschaftlich empirischen Fundierung. ...
... Effective music-assisted relaxation uses the process of entrainment in which music is used to promote gradual reduction in elevated vital responses such as heart rate or respiratory rate . Rather than having patients listen to a preselected list of soothing music, the music therapist typically performs live music that first matches the patient's current level of arousal (i.e., isoprinciple) and then gradually changes musical qualities such as tempo and harmonies in a direction that promotes a relaxation response (Rider, 1997;Bradt, 2010). Finally, music-guided imagery is often used for anxiety and pain management . ...
Anxiety is a significant issue in the dental care of adults and children. Dental anxiety often leads to avoidance of dental care which may result in significant deterioration of oral and dental health. Nonpharmacological anxiety management interventions such as music listening are increasingly used in dental care. Although efficacy for music's anxiolytic effects has been established for pre-operative anxiety, findings regarding the use of music listening for dental anxiety are inconclusive, especially for children. The use of music for passive distraction may not be adequate for children and highly anxious adults. Instead, interventions offered by a trained music therapist may be needed to optimize music's anxiolytic impact. Music therapy interventions are individualized to the patient's presenting needs and geared at enhancing patients’ active engagement in the management of their anxiety. Interventions may include 1) active refocusing of attention, 2) music-guided deep breathing, 3) music-assisted relaxation, and 4) music-guided imagery. In addition, music therapists can teach patients music-based anxiety management skills prior to dental treatments, offer them the opportunity to express emotions related to the upcoming procedure and help them gain a sense of control and safety. Clinical guidelines for the use of music listening by dental practitioners are offered. This article is protected by copyright. All rights reserved.
... While the exact mechanisms still remain unclear, there are several plausible theories for why music may affect pain perception. (Bradt, 2010). 4. Music facilitates a sense of control over pain (Linnermann et al. 2015; Mitchell & MacDonald, 2006. 5. Music reduces pain perception by reducing stress (Linnemann et al., 2015). ...
Music is widely used by people of all ages as a stimulant and relaxant to manage everyday situations. Whether to motivate us for exercise or to help us unwind after a busy day, we seem to have an intuitive understanding about the influences music has on our bodies. The body’s responses to music are both conscious and unconscious, involving entrainment with rhythm, hormonal and neurological reactions, and changes in mood, emotion, and pain perception. This article explains these physiological responses to music and provides guidelines for consideration when selecting music to evoke desired bodily responses. Applications using music in rehabilitation are also provided to illustrate health-promoting qualities of music.
... Während sich allgemeine musiktherapeutische Behandlungsziele bei chronischem Schmerz auf die Entspannung oder die Aktivierung des Patienten sowie die Verminderung von Depressivität richten, wird bei der Musik-imaginativen Schmerzbehandlung/Entrainment eine direkte Verringerung des Schmerzerlebens intendiert(Rider 1985; Dileo u. Bradt 1999;Metzner 2009;Bradt 2010). Es handelt sich um eine individuell abgestimmte Kurzzeitintervention (2-4 Sitzungen), bei der der Patient mit Hilfe von Musikinstrumenten seinem inneren Wahrnehmen und Erleben einen musikalischen Ausdruck verleiht. ...
Am Beispiel der musiktherapeutischen Schmerzbehandlung wird gezeigt, wie Patienten ihr affektiv-sensorisches Erleben mit Hilfe von musikalischen Klängen zum Ausdruck bringen und bewerten. Aus neurobiologischer Perspektive wird durch die gerichteten Aktivitäten – motorische Bewegungsabläufe, auditive Wahrnehmung und auf ein Ziel gerichtete soziale Interaktion – eine Möglichkeit geschaffen, die den gewohnten Wahrnehmungs- und Handlungsstrukturen zugrunde liegenden neuronalen Muster in andere Bahnen zu lenken. Dabei ist von komplexen Wechselwirkungen neuronaler Musik/Schmerz- und Innen/Außenwelt-Prozessierung auszugehen, an denen eine Vielzahl von Hirnregionen beteiligt ist. Die therapeutisch psychodynamische Perspektive wiederum offenbart, dass sich die epistemische Erwartung, mentale Prozesse neurobiologisch zu fassen, angesichts von höchst subjektiven Prozessen bei der Veränderung des Schmerzerlebens nicht erfüllt.
... Approximately 40 minutes of music was chosen based on each patient's preferences and was analyzed following a "music characterization system" algorithm containing 12 musical elements and 4 nonmusical elements to identify and classify each selection numerically as having greater or lesser relaxation properties as opposed to activating properties (14). On the basis of the patient's level of state anxiety and distress obtained during the assessment, individual pieces of music were connected in a sequence that moved progressively from pieces with higher levels of activating qualities to pieces with higher levels of relaxing qualities, based on the theories of musical entrainment (15) and music sedation (16) to increase comfort and orientation, reducing state anxiety. ...
... This type of bias is referred to as performance bias and may threaten the internal and external validity of the study. I remember well the reaction of some of the pediatric patients who participated in an RCT that I conducted on the effect of music entrainment on post-operative pain perception in pediatric patients (Bradt, 2010). During the consent process, several children exclaimed: ''Of course I want to participate, because you will make my pain better, right?'' ...
Background:
Evidence from randomized controlled trials (RCTs) plays a powerful role in today's healthcare industry. At the same time, it is important that multiple types of evidence contribute to music therapy's knowledge base and that the dialogue of clinical effectiveness in music therapy is not dominated by the biomedical hierarchical model of evidence-based practice. Whether or not one agrees with the hierarchical model of evidence in the current healthcare climate, RCTs can contribute important knowledge to our field. Therefore, it is important that music therapists are prepared to design trials that meet current methodological standards and, equally important, are able to respond appropriately to those design aspects that may not be feasible in music therapy research.
Objective:
To provide practical guidelines to music therapy researchers for the design and implementation of RCTs as well as to enable music therapists to be well-informed consumers of RCT evidence.
Methods:
This article reviews key design aspects of RCTs and discusses how to best implement these standards in music therapy trials. A systematic presentation of basic randomization methods, allocation concealment strategies, issues related to blinding in music therapy trials and strategies for implementation, the use of treatment manuals, types of control groups, outcome selection, and sample size computation is provided.
Conclusions:
Despite the challenges of meeting all key design demands typical of an RCT, it is possible to design rigorous music therapy RCTs that accurately estimate music therapy treatment benefits.
... Such unexpected, even-split results bring many questions about the mechanisms underlying these effects. However, most theories are still unproven, and the mechanisms involved are poorly understood (Bradt, 2010;Burns, 2012;Dileo, 1999). ...
The purpose of this study was twofold: to critically review existing systematic
reviews and meta-analyses on the topic of music and pain; and to systematically review
and conduct a meta-analysis of clinical trials investigating the effect of music on pain
encompassing a wide range of medical diagnoses, settings, age groups, and types of pain.
For the review of systematic reviews, the author conducted a comprehensive
search and identified 14 systematic reviews and meta-analyses. These studies were
critically analyzed to present a comprehensive overview of findings, to evaluate
methodological quality of the reviews, to determine issues or gaps in the literature, and to
generate research questions for the following meta-analysis.
For the meta-analysis, the author conducted electronic searches of 12 databases
and a handsearch of related journals and reference lists of relevant systematic reviews,
with partial restrictions on design (i.e., randomized controlled trials); language (i.e.,
English, German, Korean, and Japanese); year of publication (i.e., 1995 to 2014) and
intervention (i.e., music therapy and music medicine). Analyzed studies included 87
music medicine (MM) and 10 music therapy (MT) trials; eighty-nine of the included
studies involved adults and eight trials focused on children. In terms of the types of pain,
there were 51 trials on acute, 34 on procedural, and 12 on cancer or chronic pain; the
trials were conducted in over 20 different medical specialty areas. For the assessment of
study quality, I used the risk of bias tool developed by the Cochrane collaboration, and
pooled data from the included studies were analyzed using the Revman 5.3 software
according to the effects of music on levels of pain intensity, amount of analgesic use, and
changes in vital signs.
The results indicated that music interventions resulted in a significant reduction of
1.13 units on 0-10 scales and a small to moderate pain reducing effect on other scales
(SMD = -0.39). Participants in the music group experienced a significantly lower level of
emotional distress from pain (MD = -10.8), and required significantly fewer anesthetics
(SMD = -0.56), opioids (SMD = -0.24), and non-opioid medications (SMD = -0.54).
Moreover, the music group showed statistically significant decreases in heart rate of 4.25
bpm, systolic blood pressure of 3.34 mmHg, diastolic blood pressure of 1.18 mmHg, and
respiration rate of 1.46 breaths per minute.
Findings from several analyses of moderator variables suggest: MT has a stronger
effect in reducing self-rated pain intensity than MM; MT is more effective in reducing
chronic/cancer pain than other types of pain, but MM seems to be more effective in
managing procedural pain; children benefit more from music interventions than do adults,
and more from MT than MM; providing different levels of choices in the selection of
music yields different outcomes for MM; having a rationale for selection of music greatly
improves the treatment outcome for MM; and an active MT approach is more effective in
relieving perceived levels of pain than a passive MT approach.
The results from the current meta-analysis demonstrate that music interventions
may have beneficial effects on pain, emotional distress from pain, use of anesthetics and
pain killers, and vital signs including heart rate, systolic blood pressure, diastolic blood
pressure and respiration rate. However, these results need to be interpreted with caution
due to highly heterogeneous outcomes among the included studies. Considering all the
possible benefits, music interventions may provide an effective complimentary approach
for the relief of acute, procedural and cancer/chronic pain in the medical setting.
... Entrainment provides a clinical means of influencing the body's ability to regulate through the use of purposeful music interventions. 10,11 Unlike a recording of music, music therapy fosters a live, direct means of entrainment, particularly when supported through a parent-infant application. ...
Music therapy can improve neonatal function and reduce anxiety in parents during neonatal intensive care unit (NICU) stays. Live music entrained to an infant's observed vital signs, provided by a certified music therapist with First Sounds RBL (rhythm, breath, and lullaby) training, enhanced bonding for infant-parent dyads and triads. The author's song of kin intervention, which employs parent-selected songs, is compared to the presentation of a well-known folk theme ("Twinkle") in 272 neonates. Culturally based, parent-selected, personalized musical tunes provided in song, as a noninvasive intervention, foster optimal, continuous quality of care. Music psychotherapy sessions for parents before working with their infants can instill a potent means of nonconfrontational support, allowing for expression of fear or anxiety related to the premature birth. Although most attention is typically directed to their infant, using music can support the parents' grief and assist in the expression of hope that can instill a sense of security and containment. From the NICU to home, a familiar thread-line theme can be resourced directly from the family and/or parent and applied effortlessly throughout the growing baby's transitional moments.
© 2014 New York Academy of Sciences.
... Dette er eksempel på en intervensjon basert på "entrainment" (synkronisering av kroppslige fysiologiske rytmer og eksterne rytmiske stimuli) -en behandlingsmetode som, ikke minst i forhold til smertelindring hos barn, er i ferd med å bli veldokumentert spesialnummeret, "Music, the Brain, Health, and Wellness", Music & Medicine (2010, 2). (Bradt 2010). 9 Interessen for relasjoner mellom musikk, kropp og bevissthet deler musikkterapeutene på Rikshospitalet med enkelte av sykehusets psykologer. ...
Innledning I året 2010 kunne vi feire 15 års jubileum for et kontinuerlig musikkterapeutisk naervaer ved Barneklinikken ved Oslo universitessykehus – Rikshospitalet. Denne artikkelen beskriver musikkterapeutenes arbeidsoppgaver på sykehuset; enkelte av disse er primaert knyttet til å redusere uønskede symptomer som smerter og angst for den enkelte pasient (noe vi vil gi eksempler på), men meget mer av musikkterapeutens arbeid handler om å fremme mestring, gode opplevelser og om å bidra til å skape et terapeutisk miljø. Et fellestrekk ved både de problem-og de ressursorienterte tilnaermingene, er at målet er å fremme helse, og dette gjelder om man arbeider med enkeltpasienter, med familier, grupper eller ulike sider av sykehusmiljøet. 1 "To promote health" er også et sentralt element i en meget anvendt definisjon av musikkterapi (Bruscia 1998:20) der "health" defineres som "[…] the process of becoming one's fullest potential for individual and ecological wholeness" (ibid.:84) og der "ecological wholeness" videre forklares som "[…] usually conceived as consisting of society, culture, and environ-ment […]" (ibid.: 87). Med et slikt utgangspunkt blir det meningsløst å snakke om å forholde seg til pasienten "alene" på samme måte som "musikken" ikke kan isoleres fra ulike kontekstuelle faktorer som alltid vil vaere tilstede. Et saerskilt fokus på miljø-faktorer i musikkterapien har, siden slutten av 1990-årene, resultert i ulike fremstillin-ger og teoretiske innfallsvinkler (Bruscia 1998; Aasgaard 1998, 1999a, 2004; Ansdell 2002; Stige 2003, 2006; Ansdell og Pavlicevic (red.) 2004). 1 Med "problemorientert" menes her at intervensjonen tar utgangspunkt i en sykdomsdi-agnose eller uønskede symptomer som er knyttet til sykdommen eller behandlingen. Med "ressursorientert" menes her en intervensjon som tar utgangspunkt i ressurser og interesser og ikke i patologi eller opplevde problemer. Salutogenetisk helsearbeid og forskning legger saer-lig vekt på ressurser hos den enkelte og (eventuelt) i miljøet. Vi antar at de fleste musikkter-apeuter arbeider i skjaeringspunktet mellom disse tilnaermingene.
This article presents the treatment manual developed during the MusiQual feasibility study carried out in Belfast by Queen’s University Belfast, Every Day Harmony Music Therapy, and Marie Curie Northern Ireland. The MusiQual study considered the feasibility of a multicentre randomised trial to evaluate the effectiveness of music therapy in improving the quality of life of hospice inpatients (protocol: McConnell et al. results: Porter et al.). The procedures in the manual are based fully on those implemented by the Music Therapists during the feasibility study, and it also incorporates the theoretical model defined and published following the realist review of the literature (McConnell and Porter). The manual is presented in the format in which it would be used in the potential future phase III multicentre randomised control trial. It represents a flexible approach to provide enough scope for practicing therapists to adapt their interventions to individual clients as is best practice in music therapy. It aims to provide stable guidelines both to ensure treatment fidelity in a future trial of music therapy for palliative care inpatients and to act as a relevant guide for Music Therapists practicing in this field.
Zusammenfassung
Musik in der Schmerztherapie wird in diesem Beitrag anhand des Konzepts der Musik-Medizin bzw. der anxiolytischen Musik dargestellt. Dabei handelt es sich überwiegend um den therapeutischen Einsatz bei operativen Verfahren. Der Beitrag spricht sich für einen evidenzbasierten Gebrauch der Musik in der Schmerztherapie aus. Beispielhaft werden die schmerztherapeutischen Konzepte der Sportklinik Hellersen dargestellt. Auch die klinischen Studien zum Einsatz von Musik in der Schmerztherapie werden aufgelistet.
We provide an experimental evaluation of the impact of aesthetic experiences
in terms of stress reduction (cortisol levels) and wellbeing increase. The test
experience is a visit to the vault of the Sanctuary of Vicoforte, Italy. Data have been
collected using a double step method. A structured interview in relation to the
individual subjective well-being has been administered to a sample of 100 subjects.
In addition, a sample of their saliva has been taken, and its cortisol level measured,
before and after the experience, and likewise for momentary wellbeing measured on
a Visual Analogous Scale. Subjects reported an average increase of 40% in wellbeing
and a decrease of the 60% in the cortisol level. The recorded cortisol level
values dropped on average well beyond the decrease normally associated to its
circadian cycle. The modulating role of various variables has been appreciated, and
profiling of the typical subjects who are wellbeing respondents/non-respondents and
cortisol respondents/non-respondents has been carried out. We conclude that aesthetic
experience seems to have a noticeable impact on individual physical and
mental health. In both dominions, cultural participation intensity is significantly
correlated to the response. The study underlines the potential of the arts and culture as a new platform for public health practices and new approaches to welfare policy
design.
Introduction
Premature infants are highly sensitive to pain because of their immature and vulnerable nervous systems, which lead to peripherally inserted central venous catheter (PICC) difficulty. The objective of this study was to investigate the application of a music intervention (MI) during PICC placement procedures in premature infants.
Methods
A randomized controlled trial was conducted on sixty premature infants (gestational age of 28 weeks to 36 weeks). Infants hospitalized to receive PICC puncture and meeting the study entry criteria were randomly assigned to an MI group (n = 30) or a control group (n = 30). The effects of MI were assessed by determination of heart rate, blood oxygen saturation, pain rating, cortisol concentration and operating time during PICC placement procedures in both groups. Furthermore, pain level was identified using premature infant pain profile.
Results
There was no statistically significant difference between the two groups in terms of heart rate, blood oxygen saturation and pain score before intervention (P > 0.05). During PICC placement procedures, a significant increase in term of blood oxygen saturation (P < 0.05) and reductions in terms of heart rate (P < 0.05) and cortisol accumulation were observed in the group receiving music intervention compared with the control group. Furthermore, MI led to a significant reduction in pain score (mean difference: 3.4, 95% confidence interval: [2.0, 4.8]), and remarkably decreased the time needed for PICC placement in the MI group compared to control group.
Conclusions
During PICC placement procedures for premature infants, MI significantly reduced stress hormone levels, physiological parameters and behavioral response of pain.
Dementia and delirium are common in medical and surgical inpatients. Neuropsychiatric symptoms can be challenging to manage. Non-pharmacological interventions such as music therapy have been used to manage symptoms in psychiatric hospitals and nursing homes but are not routine in general hospitals. We performed a systematic literature review to establish whether music therapy improves neuropsychiatric symptoms in adults with dementia and/or delirium in the general hospital. We searched CINAHL, Medline and PsycINFO in November 2015. Search terms included music therapy, dementia, delirium. We screened 5054 titles, and read 142 full text articles. None of these met inclusion criteria for our review. To inform future research in music in general hospitals for people with dementia and/or delirium, we qualitatively reviewed 8 articles involving 239 patients. Music delivery was feasible and had a positive effect on some aspects of neuropsychiatric symptoms in various settings, but the studies were generally small, at high risk of bias, and did not use recognized frameworks for evaluating complex interventions. We found no robust published evidence for the use of music therapy in the treatment of neuropsychiatric symptoms in patients with dementia and/or delirium in the general hospital. Well-designed studies of this promising intervention are needed.
This is the protocol for a review and there is no abstract. The objectives are as follows: The objective of this review is to evaluate the effects of using music on pain experience, relief of pain, and analgesic requirement in conditions of acute, chronic, and cancer pain.
Since music therapy has been established for anxiolysis and pain relief in the mean time, it has been increasingly considered also for clinical disciplines such as surgery in the perioperative setting. The manuscript describes the use of music or music therapy to reduce fear and pain in surgical patients. In addition to an overview on the current status of research on the topic with regard to surgery and other medical disciplines, a representative case with primary rectal cancer is reported, in particular, with regard to an individual approach using music therapy. - Music therapy can be considered a rather psychotherapeutic intervention aiming at the activation of psychic and social resources of the patient to contribute to reconvalescence. - Music therapy has been used so far based on its bio-psycho-social potential in various disciplines of somatic medicine such as neurology, cardiology and oncology. - Music therapy, as practiced by qualified music therapists, is indicated in the case of specific psychic and/or social functional disturbances, in particular, if pharmacological interventions can only provide limited effects in anxiolysis or pain relief. - So far, attentive hearing of music is used as short-term intervention in the disciplines internal medicine, surgery and intensive care - this can result in detectable effects of anxiolysis, however, due to the heterogeneity of studies with regard to population, intervention, measuring methods and general conditions, general statements can (still) not be made at presence. - In addition to published case reports and theoretical explanation attempts, there are numerous empiric proofs of efficacy - related to the relatively limited distribution of music therapy - for the use of music as non-pharmacon and music therapy as psychosomatic intervention in pain treatment. Music therapy may serve - due to its psychologic effects - as additivum and suitable tool for a selected constellation of findings, eligible patients (as part of the perioperative management) and a (possibly prolonged) reconvalescence, in particular, for pain acceptance, anxiolysis, overcoming depressed mood and preservation of treatment motivation as well as processing of disease. Since in German surgery, measures of music therapy have not used very often so far, the authors suggest a discussion on its basic indications and their increasing additive use.
Der Artikel gibt einen Überblick über die aktuellen Entwicklungen der Musiktherapie und ihre jüngere Geschichte unter Einbeziehung der Musikmedizin. Ausgehend von Formen alltäglicher Selbstbehandlung mit Musik wird Musiktherapie als eine der Künstlerischen Therapien in ihren verschiedenen Ansätzen und Arbeitsbereichen dargestellt. Diskutiert wird die Frage, inwiefern Musiktherapie als Funktionale Musik bezeichnet werden kann, welcher Musikbegriff sich in der Musiktherapie ausgeprägt hat und welche Forschungsfragen sich aus der Divergenz zwischen ästhetischer Disziplin und medizinischem Umfeld ergeben.
Der Artikel gibt einen Überblick über die aktuellen Entwicklungen der Musiktherapie und ihre jüngere Geschichte unter Einbeziehung der Musikmedizin. Ausgehend von Formen alltäglicher Selbstbehandlung mit Musik wird Musiktherapie als eine der Künstlerischen Therapien in ihren verschiedenen Ansätzen und Arbeitsbereichen dargestellt. Diskutiert wird die Frage, inwiefern Musiktherapie als funktionale Musik bezeichnet werden kann, welcher Musikbegriff sich in der Musiktherapie ausgeprägt hat und welche Forschungsfragen sich aus der Divergenz zwischen ästhetischer Disziplin und medizinischem Umfeld ergeben.
Spinal fusion for idiopathic scoliosis is one of the most painful surgeries experienced by adolescents. Music therapy, utilizing music-assisted relaxation with controlled breathing and imagery, is a promising intervention for reducing pain and anxiety for these patients. It can be challenging to teach new coping strategies to post-operative patients who are already in pain. This study evaluated the effects of introducing music-assisted relaxation training to adolescents before surgery. Outcome measures were self-reported pain and anxiety, recorded on 0-10 numeric rating scale, and observed behavioral indicators of pain and relaxation. The training intervention was a 12-minute video about music-assisted relaxation with opportunities to practice before surgery. Forty-four participants between the ages of 10 and 19 were enrolled. Participants were randomly assigned to the experimental group that watched the video at the preoperative visit or to the control group that did not watch the video. All subjects received a music therapy session with a board certified music therapist on post-operative day 2 while out of bed for the first time. Pain and anxiety were significantly reduced from immediately pre-therapy to post-therapy (paired t-test; p).
Objective:
Music therapy has experienced a rising demand as an adjunct therapy for symptom management among palliative care patients. We conducted a realist review of the literature to develop a greater understanding of how music therapy might benefit palliative care patients and the contextual mechanisms that promote or inhibit its successful implementation.
Method:
We searched electronic databases (CINAHL, Embase, Medline, and PsychINFO) for literature containing information on music therapy for palliative care. In keeping with the realist approach, we examined all relevant literature to develop theories that could explain how music therapy works.
Results:
A total of 51 articles were included in the review. Music therapy was found to have a therapeutic effect on the physical, psychological, emotional, and spiritual suffering of palliative care patients. We also identified program mechanisms that help explain music therapy's therapeutic effects, along with facilitating contexts for implementation.
Significance of results:
Music therapy may be an effective nonpharmacological approach to managing distressing symptoms in palliative care patients. The findings also suggest that group music therapy may be a cost-efficient and effective way to support staff caring for palliative care patients. We encourage others to continue developing the evidence base in order to expand our understanding of how music therapy works, with the aim of informing and improving the provision of music therapy for palliative care patients.
Background: Acute and repeated pain has long-term negative impact on infants’ development and future behaviour. The use of analgesic drugs has negative side effects, which emphasises the need for complementary approaches to pain management.Methods: Preterm and ill term neonates (n = 38) were subjected to venepuncture with and without live infant-directed lullaby singing, in a randomised order with a cross over design. Physiological data were collected and the procedures were videotaped for pain assessment. Parents (n = 11) and staff (n = 11) were interviewed about live singing as affective support. Two premature infants’ behavioural and physiological responses and the live-performed lullaby were analysed in-depth with microanalysis.Results: Live singing with premature infants is a social communicative interaction. If the vocal performance is predictable and regular from start, it may optimise homeostasis during painful procedures. Since pain involves the interaction of biopsychosocial and situational factors, more research is needed to explore the potential benefits of music therapy including the role of the parents.
Hanser presents techniques that attempt to help manage stress and reduce the perception of pain. She describes how music therapy can synchronize head and heart, bringing coherence to mind and body. Reframing and emotional-approach coping are presented as strategies that can reduce stress and anxiety. Singing and writing songs offer ways to take charge of illness and focus on communicating the meaning of the experience. Hanser elucidates how the use of entrainment through music and other creative techniques emphasizes the impermanence and malleability of pain, thus alleviating it.
During the most vulnerable period in a child’s life, preterm and sick infants are exposed to a high number of painful procedures, sometimes without the comfort and affection of their parents. Since repeated pain and frequent use of analgesic drugs may have consequences for the neurological and behaviour-oriented development of the infant, it is vital to identify effective non-pharmacological interventions with regard to procedural pain. This paper reviews the use of live lullaby singing as an adjuvant to the control of premature infant pain. The objectives of this case study were to analyse the live lullaby singing for two premature infants during venipuncture in comparison to standard care only, and the infants’ physiological and affective responses emerging before, during and after this procedure. The empirical data stem from a quantitative clinical study. From this larger study, two premature infants were selected. Through microanalysis, with in-depth analysis of video footage, and pain assessment with Behavioral Indicators of Infant Pain (BIIP), painful standard care procedures with and without live lullaby singing, were analysed. The results show that live lullaby singing with premature infants is a communicative interaction which may optimize the homeostatic mechanisms of the infant during painful procedures. This case study shows the importance of predictability of the affective support, right from the start of the live singing intervention. It is important in a painful context that vocal interactions provide regular and comforting intensity, shape and temporal structures.
У навчальному посібнику узагальнені літературні дані з теорії, історії та практичних аспектів застосування музикотерапії як одного з напрямів інтегративної медицини.
Для лікарів-слухачів закладів (факультетів) післядипломної освіти.
Anwendungen musikmedizinischer Applikationen in schulmedizinischen Fächern
This is the protocol for a review and there is no abstract. The objectives are as follows: The objective of this review is to evaluate the effects of using music on pain experience, relief of pain, and analgesic requirement in conditions of acute, chronic, and cancer pain.
Background: Music therapy, the scientific use of music interventions within a therapeutic relationship, has been shown to be a helpful adjunct in the management of pain in overseas centres. We report our local experience of providing music therapy for patients referred for pain in an acute hospital in Singapore in this case series. Methodology: Over 1 year, patients with persistent pain while on standard medical treatment were referred for music therapy. Music therapy interventions were individualized to the patient's physical and mental condition, energy level, mood, prior music experiences, and cultural background. Assessments of pain before and after treatment were completed with tools appropriate to patient's ability. Results: Of the 44 patients (M = 17, F = 27; aged 26-92 years) referred for music therapy, 37 accepted participation, 5 declined, and 2 were asleep. All 37 (100%) patients in this study appeared to show positive improvement after one session. Twenty-five (68%) patients verbally reported relief, five (13%) patients completed the body-colouring tool depicting pain relief, and nine (24%) reflected lowered scores on the observational pain-behaviour scale. The primary diagnoses for 26 (70.3%) of the patients were cancers, 9 (24%) had musculoskeletal conditions, and 2 (5%) were patients with advanced organ failures. Music therapy was also well received by caregivers where present. Discussion and conclusion: The encouraging results suggest music therapy to be positive as an allied health adjunct to standard medical treatment for pain. Further studies are awaited to delineate the effect of music interventions, evaluate the generalizability of the results, and the cost-effectiveness of music therapy.
Leventhal and Everhart make it quite clear that pain and the emotions associated with it play a significant part in the development and well-being of the physical and social self. Their emphasis is on the contribution of emotions to the subjective experience of pain, and the explanatory model that has been developed by Leventhal and his colleagues pushes back the frontier of research on pain and pain-emotion-cognition interactions.
The purpose of this controlled study was to provide a description of children's postoperative pain, including pain intensity and analgesic consumption.
Participants included 261 children, 2 to 12 years of age, undergoing routine tonsillectomy and adenoidectomy surgery. Baseline and demographic data were collected before surgery, and a standardized approach to anesthesia and surgical procedures was used. Pain and analgesic consumption were recorded for 2 weeks at home.
On the first day at home, although parents rated 86% of children as experiencing significant overall pain, 24% of children received 0 or just 1 medication dose throughout the entire day. On day 3 after surgery, although 67% of children were rated by parents as experiencing significant overall pain, 41% received 0 or 1 medication dose throughout the entire day.
We conclude that a large proportion of children receive little analgesic medication after surgery and research efforts should be directed to the discrepancy between high ratings of postoperative pain provided by parents and the low dosing of analgesics they use for their children.
Complex bodily rhythms are ubiquitous in living organisms. These rhythms arise from stochastic, nonlinear biological mechanisms interacting with a fluctuating environment. Disease often leads to alterations from normal to pathological rhythm. Fundamental questions concerning the dynamics of these rhythmic processes abound. For example, what is the origin of physiological rhythms? How do the rhythms interact with each other and the external environment? Can we decode the fluctuations in physiological rhythms to better diagnose human disease? And can we develop better methods to control pathological rhythms? Mathematical and physical techniques combined with physiological and medical studies are addressing these questions and are transforming our understanding of the rhythms of life.
It is well known that patients frequently try to gain “control” over pain by using stratagems such as focussing attention on competing sensory stimuli or concentrating on simple mathematical puzzles. The purpose of the present study was to determine some of the variables involved in attempts by subjects to control experimental pain by focussing attention on auditory stimulation. The results show that (a) the rate of increase of pain intensity represents an important variable since only slowly rising pains are amenable to “control,” (b) the amount of pain tolerated by subjects is often determined by their expectation of future pain on the basis of rate of pain increase rather than by pain intensity level as such, (c) auditory stimulation together with strong suggestion that it abolishes pain provide an effective stratagem for achieving “control” over pain (thereby enabling subjects to endure it longer) although neither auditory stimulation nor suggestion alone is sufficient to increase the duration of pain tolerance. The increased pain tolerance produced by combined auditory stimulation and suggestion lends support to the concept that pain perceptions are subserved by patterns of nerve impulses that are under dynamic control of psychological processes.
The use of music-assisted relaxation in the reduction of childrens distress associated with bone marrow aspirations was evaluated Six pediatric cancer patients ages 6 to 15 years were observed during a baseline procedure and then received music-assisted relaxation during the second of two consecutive bone marrow aspirations Childrens anticipatory and experienced feat and pain and their observed behavioral distress during the procedures were evaluated systematically using a within-subjects experimental design Analysis of the data indicated strong trends tor reductions in anticipatory fear experienced fear, and experienced pain A strong trend for reduction in anticipatory behavioral distress was found, but there was no significant reduction in total observed behavioral distress Implications for clinical applications and further research were discussed.
Pain is a personal experience, which everyone encounters at some time, that for some unfortunate individuals becomes a permanent factor in their quality of life and clinical treatment. This [book provides an] account of the experience of [chronic] pain and its implications. It was written for psychologists, doctors, therapists, counsellors, and nurses in both academic and treatment settings.
The experience of pain is examined at all stages. At every stage the discussion is based on relevant psychological concepts and a review of the latest research. The book provides an integrated, multidisciplinary account of cognitive, biological and social aspects of pain. An emphasis on social psychological processes leads to a new model of pain that will enlighten both teaching and treatment and guide further research.
Accounts of pain often deal with specific, specialised aspects but many students and healthcare professionals need a wider, more person-centred understanding of pain, and will find this book a . . . resource and guide to the experience of pain and its implications for treatment and coping. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study evaluated the effect of different types of music-mediated imagery on pain reduction, EMG tension reduction, and
imagery vividness and activity in a group of spinal pain patients (N = 23). Music conditions consisted of two minimalist selections, two conventional “relaxing” selections, one “entrainment”
selection, and two control conditions—one with no music and one with no imagery induction. The 20-minute tape-listening procedure
consisted of 10 minutes of relaxation instruction followed by 10 minutes of music, to which subjects were instructed to image
their pain being subdued by their endorphin system. The seven conditions were presented in a randomized counterbalanced, repeated-measures
design. Analysis of variance indicated significant treatment effects for both pain and EMG reduction, with the entrainment
condition being the most effective. Treatment effects were nonsignificant for both imagery conditions, although the highest
imagery scores were obtained in the entrainment condition. Pain was attenuated best by high-imagery conditions rather than
by high-preference conditions; therefore, the author concluded that imagery, especially entrainment-mediated imagery, involves
at least psychological and perhaps physiological pain relief mechanisms.
Examined the effects of music on perceived degree of pain relief, physical comfort, relaxation, and contentment, using 9 White patients with terminal malignant disease. Three conditions were presented: no intervention, background sound, and a personalized recording of music based on the S's preference and perception of calmness. Each condition was presented for 15 min twice daily for 2 days. Results show no significant difference in the dependent variables under the experimental conditions; however, contentment score differences approached significance. Findings highlight the efficacy of music as an intervention with the terminally ill. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Investigated the effects of music and relaxation techniques on pain and anxiety in 22 17–43 yr old women undergoing gynecological procedures within the office. Medical treatments performed were cryosurgery, colposcopy, and punch biopsy of the cervix. Control Ss received the usual medical procedure without music, and experimental Ss received their choice of music through headphones after having been given basic relaxation instructions. Dependent variables were pulse rate (PR), respiratory rate (RR), behavioral observation of overt pain, and self-report of pain and anxiety. Control Ss demonstrated higher PRs, RRs, behavioral indices of pain, and anxiety reports throughout the procedure; however, these scores did not differ significantly from those of experimental Ss. For punch biopsy, known to be extremely painful, control Ss had significantly higher RR and overt pain scores than did experimental Ss. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Seven expectant mothers participated in an experiment to test the effectiveness of music in decreasing responses to pain during
labor. The purpose of the music was to cue rhythmic breathing, to assist the women in relaxing by prompting positive associations
with the music, and to focus attention on the music as a diversion from discomfort and extraneous hospital sounds which might
signal anxiety. All subjects emitted fewer pain responses in the presence of a specially-designed music program as compared
to the same setting with no background music.
This study examined the efficacy of external distraction as a coping strategy. Thirty-eight dental patients were randomly assigned to one of three groups: incidental music during the dental procedure, music coupled with suggestions that music would help reduce stress, or a no-treatment control group. Patients in both music groups reported experiencing less stress (i.e., less pain. less discomfort, more control) than patients in the no-treatment group. Patient ratings made by dentists, blind to condition, provided converging evidence for the therapeutic effect of distraction. Thus, distracting music was found to be effective in reducing stress and increasing perceptions of control. The relative ease and simplicity of implementing external distraction compared to manipulating actual control in a medical setting may make this manipulation attractive to professionals involved with individuals experiencing stress.
Intensity of angry feelings and styles of expressing anger were examined for their relationship to measures of the chronic pain experience. Subjects were 142 chronic pain patients. Multiple regression analyses revealed that a style of inhibiting the expression of angry feelings was the strongest predictor of reports of pain intensity and pain behavior among a group of variables including demographics, pain history, depression, anger intensity, and other styles of anger expression. In a similar manner anger intensity contributed significantly to predictions of perceived pain interference and activity level. More conservative hierarchical regression analyses supported these findings. Results are consistent with explanatory models of pain and disability that hypothesize an etiologic role of a pervasive inability to express intense negative emotions, particularly anger.
The purpose of this experimental crossover study was to evaluate to what extent the therapeutic use of music would decrease pain in patients with cancer who were receiving scheduled analgesics. Baseline data were collected for three days. Subjects then were assigned randomly to listen to their preference of seven types of relaxing music or a control (a 60-cycle hum) twice daily for three days. Then they crossed over into the alternate group for the next three days. Finally, each subject returned to a follow-up baseline period. Pain, the dependent variable, and mood, which was proposed as an intervening variable, were measured by visual analogue scales. The convenience sample included 15 outpatients with cancer, 12 female and 3 male, ages 20 through 87. Results of the McGill Pain Questionnaire (MPQ), a reliable and valid multidimensional instrument administered upon entry into the study, indicated that the study sample was comparable to other samples of patients with cancer who were in pain. There was an inconsistent relation between pain and mood. The effect of the music on pain varied by individual; 75% had at least some response and 47% had a moderate or great response. Multivariate Analysis of Variance (MANOVA) indicated a statistically significant decrease in pain from using either the music or sound, but there was no effect on mood. Although the mean percentage of change in pain for music was twice that for sound, the results did not differ statistically. The findings support the use of music as an independent nursing intervention to relieve pain.
Two studies were conducted to examine the effects of music on analogued labor pain using volunteer nulliparous subjects who were randomly assigned to treatment groups (n = 10 per group). Assessments of the treatments were made in a 1-hour session involving twenty 80-second exposures to a laboratory pain stimulus patterned to resemble labor contractions. In the first experiment, it was hypothesized that subjects listening to easy-listening music would report lower pain ratings and cardiovascular responses than subjects listening to rock music, self-selected music, or a dissertation (placebo-attention) and subjects in a no-treatment control group. No significant group effects were found; significant time effects were found for heart rate, systolic and diastolic blood pressure. Subjects spontaneously reported using imagery as a pain reduction technique. In the second study a combination of music and imagery was examined by randomly assigning subjects to one of five groups: self-generated imagery with music (SIM), guided imagery with music (GIM), self-generated imagery without music (SI), guided imagery without music (GI), or no-treatment control. Again, no significant group effects were obtained. Significant time effects were obtained for heart rate, systolic and diastolic blood pressure.
People have long found the dental situation stressful. This is doubly true for mentally handicapped patients who may not understand the necessity of dental procedures. Attempts to develop means of reducing excessive anxiety and stress in these patients will benefit not only the patients but also make the dentist's task easier to accomplish. This study evaluates music as a distraction and relaxation technique in 24 mentally handicapped adults.
Research on the assessment and management of pain in infants and children has increased dramatically, with the consequence that a wide variety of behavioral, physiological, and psychological methods are now available for measuring pediatric pain. Although the criteria for a pain measure for children are identical to those required for any measuring instrument, special problems exist in pediatric pain measurement because the influence of developmental factors, previous pain experience, and parental attitudes on children's perceptions and expressions of pain is not known. This article reviews the recent advances in the measurement of pain in children, with special emphasis on the methods that satisfy the criteria for reliability and validity, the methods that can be used to assess multiple dimensions of pain, and the methods that may be appropriate for assessing all types of acute, recurrent, and chronic pediatric pain.
Acute pain is both produced by, and influenced by, psychological processes, and psychological considerations play an important role in pain managment. Physiologically, emotional arousal is associated with sympathetic excitation and increased muscle tension, and through these factors a vicious circle of pain can be established in which the pain persists and grows in response to the patient's reaction to it. Psychological interventions for pain involve many mental and behavioral processes such as alteration of perception, attention/distraction, muscle relaxation, manipulation of patient expectancy and belief, and the development of a sense of personal control over the pain. Such interventions are, as a whole, effective in relieving pain and related distress, reducing analgesic medication use and reducing days in the hospital.
Researchers have come to understand a great deal about pain mechanisms, especially in the past 30 years. This understanding has spawned the development of a number of psychological pain control strategies which have been extensively assessed for use with adults. Less is known about pain control strategies in children. The purpose of this study was to assess the value of 2 cognitive strategies (suggestion and music distraction) in reducing pain in children. Two hundred children, aged 4.5-6.5 years, receiving routine immunization injections were randomly assigned to one of the intervention groups in this factorial study. The groups were designated as: distraction, distraction with suggestion, suggestion and control. Subjects reported their pain using a 4-point pain scale. Distraction was found to significantly decrease pain whereas suggestion did not. Combining suggestion and distraction did not further enhance pain relief compared to use of distraction alone. Age was found to be an important determinant of the success of distraction. Furthermore, age was found to be related to amount of pain reported by children regardless of type of treatment. The results of this study support the use of music distraction in the reduction of injection pain in children.
A gate control system modulates sensory input from the skin before it evokes pain perception and response.
The study investigated the effect of music (musical preferences of subjects) on the pain of selected post-operative patients during the first 48 hours. The subjects were 24 female gynaecologic and/or obstetric patients who made the control and experimental sample, paired accordingly by age, type of surgery, educational background and previous operative experience(s). The measurement of the experimental variable was done using an Overt Pain Reaction Rating Scale (OPRRS) devised by the writer. Analgesics received, arterial blood pressures, pulse rates, and respiratory rates were also used to test the hypothesis. Significant differences were found between the groups of post-operative patients in their musculo-skeletal, and verbal pain reactions during the first 58 hours at the 0.05 level. The blood pressures showed significance only at the 0.07 level. The pulse rate during the second 24-hour period was significant at the 0.01 level; however, no significance was shown during the first 24-hour period. The respiratory rate was insignificant during the first 48-hour post-operative period. The raw data on pain-relieving medications received by the sample indicated a difference, but this was not statistically significant. The conceptual framework of the study was based on the concept of distraction following the 'Gate Control Theory' of pain by Melzack & Wall (1965). The recommendation arrived at is to use music as a nursing measure for post-operative patients.
It has long been recognized that patients receive less relief from pain than they should1,2. A recent review concluded that pain can be relieved effectively in 90 percent of patients but is not relieved effectively in 80 percent of patients3. The tendency toward undermedication for pain is even more pronounced in children than in adults4. There are large discrepancies between the amounts of postoperative analgesia ordered for and administered to adults and those ordered for and administered to children who have the same diagnoses and have undergone the same procedures5,6. Interest in pain control . . .
We undertook to explore the validity of pain measurement tools for use in children in the postoperative period. The general approach was to determine the extent to which a measurement tool conformed with the clinical expectations about pain in the postoperative period; namely, that pain is low prior to surgery, increases following surgery, decreases with pain medication and decreases over time following surgery. In children aged 6 months to 3 years, we evaluated the CHEOPS and Observer pain scales. In children 3-6 years of age, we used the CHEOPS, Observer and Faces scale. In children 6-12 years of age, we studied the CHEOPS, Faces and visual analogue scales. In all instances, each of the scales conformed with the clinical expectations about pain following surgery. In addition, these scales were correlated with each other. Within the limitations of the measurement techniques used, these data provide support for the validity of the measurement tools evaluated.
Pain has always been a salient feature for children because it occurs frequently in their everyday lives. We are only beginning to understand childhood pain. Yet, it is this understanding that influences our assessment and treatment of their pain. As with adults, pain in children is a complex matrix of biologic, psychologic, and sociologic phenomena. This article reviews what we know today about childhood pain and focuses on the psychologic perspectives that affect that pain experience. It outlines the psychologic elements that include: cognition, coping strategies, ability to communicate pain, fear, temperament, and personality as well as the sociologic factors, such as the family, culture, and economics, that influence children's perceptions and reactions to pain. The article concludes with a review of psychologic treatments of pain and an exploration of the effects of the psychology of adults, including professional anxiety and beliefs about pain and medication, on how pain is experienced by children.
The role of peripheral epinephrine in the influence of anxiety on pain was investigated by intravenously infusing epinephrine and placebo in three increasing doses. The effect of epinephrine was measured within subjects on several subjective and autonomic measures: subjective pain, skin conductance response, heart rate response due to electrical stimulation, threshold for heat pain and threshold for pressure pain. Heat pain threshold was measured both on normal skin and on skin sensitized with capsaicin, since there is evidence that effects of sympathetic stimulation are only to be found in damaged or sensitized skin. Epinephrine caused a slight increase in subjective pain due to electrical stimulation and a decrease in heat pain threshold, which was larger on capsaicin-treated than on normal skin. However, heart rate response due to electrical stimulation and pressure pain threshold were not significantly influenced, while skin conductance response was even inhibited by epinephrine. Attentional focus, which was manipulated within electrical stimulation, seemed to have a much stronger influence on pain responses than pharmacological manipulation, independent of epinephrine. It may be speculated that, although evidence was found for effects of epinephrine on pain, they may be overruled by effects of attention.
This article describes a new clinical music therapy program for application in the labor and delivery setting, and presents results of a preliminary study to evaluate effectiveness of the treatment. Over 50 women participated in the project; however, inclusion of patients in the data collection portion of the project was limited by criteria designed to minimize the effects of spurious variables. An experimental group of 13 patients participated in six individual predelivery music therapy training sessions during the third trimester of pregnancy. Experimental patients listened to preselected musical works throughout labor and delivery, with the music therapist in attendance. A control group of seven subjects participated in labor and delivery according to regular hospital routines. Data consisted of patients' responses to questionnaire items reflecting subjective perceptions and recollections of the labor/delivery experience and reports of frequency and duration of home practice. Experimental subjects achieved significantly higher "success" scores than did control subjects on five of seven indices (p less than .05). A moderate correlation between music home practice and successful childbirth outcome was demonstrated, with frequency/length of music home practice revealed as a significant predictor of success in the childbirth experience.
Pain associated with advanced cancer is multifaceted and complex, and is influenced by physiological, psychological, social, and spiritual phenomena. Suffering may be identified in patients when pain is associated with impending loss, increased dependency, and an altered understanding of one's existential purpose. Comprehensive pain management aims to address problematic symptoms in order to improve comfort, peace of mind, and quality of life. Music therapy is a treatment modality of great diversity that can offer a range of benefits to patients with advanced cancer pain and symptoms of suffering. Music therapists perform comprehensive assessments that include reviews of social, cultural, and medical history; current medical status; and the ways in which emotions are affecting the pain. A variety of music therapy techniques may be used, including vocal techniques, listening, and instrumental techniques. These techniques provide opportunities for exploration of the feelings and issues compounding the pain experience. Case examples are presented to demonstrate the "lifting", "transporting", and "bringing of peace" qualities of music that offer patients moments of release, reflection, and renewal.
The purpose of this randomized controlled trial was to investigate the effect of three nonpharmacologic nursing interventions: relaxation, music, and the combination of relaxation and music on pain following gynecologic (GYN) surgery. A total of 311 patients, ages 18 to 70, from five Midwestern hospitals, were randomly assigned using minimization to either three intervention groups or a control group and were tested during ambulation and rest on postoperative days 1 and 2. Pain sensation and distress were measured using visual analogue scales. Multivariate analysis of covariance of posttest sensation and distress was used with pretest control and a priori contrasts. The intervention groups had significantly less posttest pain than the control group (p =.022-.001) on both days. The three interventions were similar in their effect on pain. Patients who received the interventions plus patient-controlled analgesia (PCA) had 9% to 29% less pain than controls who used PCA alone. Reduced pain was related to amount of activity (ambulation or rest), mastery of the use of the intervention, and decreased pulse and respiration. Those who slept well had less pain the following day. Nurses who care for GYN surgical patients can provide soft music and relaxation tapes and instruct patients to use them during postoperative ambulation and also at rest on days 1 and 2.
Previous research suggests that response times for imagined movements provide a sensitive measure of the integrity of the motor system. In a group of 12 patients with chronic unilateral arm pain, the authors demonstrate that response times for imagined movements are influenced by the severity of pain. Simulated large-amplitude arm movements were slower for the painful as compared with the unaffected arms before, but not after, effective music therapy entrainment, suggesting that mental representations of movement are influenced by the current state of nociceptive feedback.
Empathy is a provider attribute that has been a topic of increased clinical interest, particularly as it relates to pain. This article examines various dimensions of the pain and empathy literature: definitions of empathy, research regarding the psychophysiology of empathy for pain, and research related to empathy in psychological and medical care. Research regarding topics broadly related to empathy is also reviewed, including communication skills and patient-centered care. Although this literature supports the clinical value of provider empathy and/or behaviors likely to reflect empathy, little research has explicitly examined empathy in the treatment of pain. Nonetheless, when considered in the broader context, the evidence is sufficient to draw some conclusions regarding approaches to pain care that are likely to reflect and/or elicit provider empathy and are central to effective pain management.
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Entrainment music, healing imagery, and the rhythmic language of health and disease
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Music therapy and medicine: Theoretical and clinical applications
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Music therapy pediatric pain management: Assessing and attending to the sounds of hurt, fear and anxiety
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The assessment and management of acute pain in infants, children, and adolescents
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Empathy: Necessary for effective pain management? [Review]. Current Pain and Headache Reports
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Music therapy in health and education
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(pp. 153-174). London: Jessica Kingsley.