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Musik in der Schmerztherapie
Abstract
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.
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Many patients with dental anxiety avoid dental visits. Listening to music is an effective method to reduce anxiety. Our objective was to examine the effects of musical audition in reducing anxiety and perceived pain in a sample of Romanian dental patients. We expected to find significantly reduced anxiety in the two intervention groups, and significantly lower levels of perceived pain in the intervention groups compared with the control group. The 123 participants involved were randomly assigned in control (CG-no music - 38 participants), the symphonic (41 participants), and lounge music groups (44 participants). The subjective level of anxiety was measured on a 10-points Likert scale (10 - very tensioned), whereas the objective level of anxiety was measured using the pulse rate. Perceived pain was also measured on a 10-points Likert scale (10 - very painful). Results indicate that the musical audition had no effect upon the reduction in subjective anxiety, irrespective of the type of music. This may reflect that the only variable that had an effect on subjective anxiety is ending the dental procedure. Objective levels of anxiety present a decreasing pattern in both experimental groups with no significant decrease in the control group. The severity of the intervention is a significant predictor of perceived pain, suggesting that the complexity of the dental procedure is the only variable that influences retrospectively perceived pain. Future studies should test alternative methods (music preferred by patients, or music that previously worked for them as relaxation method).
Music is increasingly used as an adjuvant for chronic pain management as it is not invasive, inexpensive, and patients usually report positive experiences with it. However, little is known about its clinical efficacy in chronic pain patients. In this systematic review and meta-analysis, we investigated randomized controlled trials (RCTs) of adult patients that reported any type of music intervention for chronic pain, chosen by the researcher or patient, lasting for any duration. Searches were performed using PsycINFO, Scopus and PubMed for RTCs published until the end of May 2016. The primary outcome was reduction in self-reported pain using a standardized pain measurement instrument reported post-intervention. The secondary outcomes were: quality of life measures, depression and anxiety measures, among others. The study was pre-registered with PROSPERO (CRD42016039837) and the meta-analysis was done using RevMan. We identified 768 titles and abstracts, and we included 14 RTCs that fulfilled our criteria. The sample size of the studies varied between 25 and 200 participants. We found that music reduced chronic pain, and depression, with higher effect size on pain and depression. We also found music had a higher effect when the participant chose the music in contrast with researcher-chosen music. The sample size of RCTs was small and sometimes with different outcome measures. Our analysis suggests that music may be beneficial as an adjuvant for chronic pain patients, as it reduces self-reported pain and its common co-morbidities. Importantly, the analgesic effect of music appears higher with self-chosen over researcher-chosen music.
This review focuses on the diagnosis and management of Parkinson-related pain which is one of the more frequently reported nonmotor symptoms in Parkinson’s disease (PD), which is the second most common neurodegenerative disease after Alzheimer’s disease. Pain is ranked high by patients as a troublesome symptom in all stages of the disease. In early-stage PD, pain is rated as the most bothersome symptom. Knowledge of the correct diagnosis of pain origin and possible methods of treatments for pain relief in PD is of great importance. The symptoms have a great negative impact on health-related quality of life. Separating PD-related pain from pain of other origins is an important challenge and can be characterized as “many syndromes under the same umbrella”. Among the different forms of PD-related pain, musculoskeletal pain is the most common form, accounting for 40%–90% of reported pain in PD patients. Augmentation by pathophysiological pathways other than those secondary to rigidity, tremor, or any of the other motor manifestations of the disease seems most probable. In PD, the basal ganglia process somatosensory information differently, and increased subjective pain sensitivity with lower electrical and heat-pain thresholds has been reported in PD patients. The mechanism is assumed to be diminished activity of the descending inhibitory control system of the basal ganglia. PD pain, like many of the nonmotor symptoms, remains underdiagnosed and, thus, poorly managed. A systematic collection of patient descriptions of type, quality, and duration of pain is, therefore, of utmost importance. Recent studies have validated new and more specific and dedicated pain scales for PD-related symptoms. Symptomatic treatments based on clinical pain classification include not only pharmacological but also nonpharmacological methods and, to some degree, invasive approaches. In the clinic, pharmacological and nonpharmacological interventions can be effective to varying degrees – as single therapies or in combination – and should be employed, because no therapeutic strategies have been validated to date for managing PD pain. Multimodal approaches should always be considered, dopamine replacement therapies should be adjusted, and analgesics and/or antidepressants should be considered, including the use of different forms of complementary therapies.
Fibromyalgia (FM) is a chronic pain disorder, with no specific treatment, characterized by increased sensitivity in skin and musculoskeletal system, associated to symptoms such as (1) sleep disorders, (2) stiffness, (3) fatigue, (4) anxiety, and (5) depression. Even though the prevalence of this syndrome during infancy is similar between both sexes, in adulthood affects women predominantly, of unknown etiology, associated to symptoms such as sleep disorders, stiffness, fatigue, anxiety, and depression. Music-induced analgesia (MIA) reduces pain, possibly due to cognitive and emotional mechanisms. We aim to study clinical, behavioral and brain functional connectivity (FC) differences of the so-called experimental pain neural network (e-PNN) between FM patients and healthy controls (HC), using resting-state functional magnetic resonance imaging (rs-fMRI).
40 women participated, answering pain, anxiety, and depression questionnaires. Pain intensity (PI) and pain unpleasantness (PU) were measured before and after each experimental condition, which consisted of two auditory backgrounds: music and pink noise (control condition). Music was familiar, pleasurable, and slow. A seed-based correlation analysis (SCA) was performed on the FC of the e-PNN.FM showed more pain catastrophizing, and more anxiety and depression symptoms. FM showed a disrupted FC when compared to HC. FM show a decrease of FC of the e-PNN after listening to music, which correlated with pain scores.
Listening to familiar, pleasurable and relaxing music reduces pain in FM. MIA in FM was correlated with a decrease of FC of the e-PNN. The characteristics of music are key elements for producing a significant analgesic effect, as consequence of top-down modulation of pain, originated by distraction, relaxation, memory-evoked emotions, or a combination of these mechanisms.
Keywords: fibromyalgia, functional connectivity, rs-fMRI, music-induced analgesia, seed-based correlation analysis.
The neurovisceral integration model (Thayer and Lane, 2000) posits that cardiac vagal tone, indexed by heart rate variability (HRV), can indicate the functional integrity of the neural networks implicated in emotion–cognition interactions. Our recent findings begin to disentangle how HRV is associated with both top-down and bottom-up cognitive processing of emotional stimuli. Higher resting HRV is associated with more adaptive and functional top-down and bottom-up cognitive modulation of emotional stimuli, which may facilitate effective emotion regulation. Conversely, lower resting HRV is associated with hyper-vigilant and maladaptive cognitive responses to emotional stimuli, which may impede emotion regulation. In the present paper, we recapitulate the neurovisceral integration model and review recent findings that shed light on the relationship between HRV and top-down and bottom-up visual perception and attention to emotional stimuli, which may play an important role in emotion regulation. Further implications of HRV on individual well-being and mental health are discussed.
Nine infants of 26-29 w PMGA (BW 780-1270 g)were exposed to the mother's voice from a tape recorder via loudspeaker (at~70 dB) 5×30′ a day between 29 and 38 w PMGA(for X 8.2 w) after conditions were stabilized. At 2 days each week the babies' behaviour (applying an A rating from 1 =quiet sleep to 6 = crying) and tcPo2 was recorded every 10″ for 1 hour, once without and once with m's voice (30′ after 30′“base line”).
Vibroacoustic therapy (VAT), traditionally considered to be a physical and receptive type of music therapy intervention, uses pulsed, sinusoidal, low-frequency sound on a specially designed bed or chair. Today VAT is viewed as a multimodal approach, whereby the therapist works with the client’s physiological and psychological experiences, incorporating a mind–body approach. This article provides current knowledge in clinical practice emphasizing the systematic and documented implementations of VAT. This includes presentation and explication of the key elements of VAT, assessments, treatment plans and procedures, documentation, and evaluation of the treatment with recommendations for follow-up care in health and rehabilitation. Recent research is presented, and directions for future research are considered. Applicable views on clinical training and required competencies are outlined.
Listening to music is amongst the most rewarding experiences for humans. Music has no functional resemblance to other rewarding stimuli, and has no demonstrated biological value, yet individuals continue listening to music for pleasure. It has been suggested that the pleasurable aspects of music listening are related to a change in emotional arousal, although this link has not been directly investigated. In this study, using methods of high temporal sensitivity we investigated whether there is a systematic relationship between dynamic increases in pleasure states and physiological indicators of emotional arousal, including changes in heart rate, respiration, electrodermal activity, body temperature, and blood volume pulse.
Twenty-six participants listened to self-selected intensely pleasurable music and "neutral" music that was individually selected for them based on low pleasure ratings they provided on other participants' music. The "chills" phenomenon was used to index intensely pleasurable responses to music. During music listening, continuous real-time recordings of subjective pleasure states and simultaneous recordings of sympathetic nervous system activity, an objective measure of emotional arousal, were obtained.
Results revealed a strong positive correlation between ratings of pleasure and emotional arousal. Importantly, a dissociation was revealed as individuals who did not experience pleasure also showed no significant increases in emotional arousal.
These results have broader implications by demonstrating that strongly felt emotions could be rewarding in themselves in the absence of a physically tangible reward or a specific functional goal.
Determining how music-based interventions have been described in published literature is an important first step in evaluating whether guidelines for reporting music-based interventions need to be developed. Twenty-two pediatric intervention studies that met specified inclusion criteria were reviewed for content in 11 areas. This review revealed significant gaps in intervention reporting. Problems were particularly pronounced in eight areas: music qualities, intervention materials, intervention components, intervention delivery schedule, interventionist, treatment fidelity, setting and music delivery method. Development of reporting guidelines for music-based interventions is needed to improve reporting and advance evidence-based practice.
Not much is known about the relative importance of different determinants of anxiety in cataract patients. This study analysed the predictive value of factors related to surgery induced anxiety.
In 128 cataract patients, recruited from two hospitals (Medical Centre Maastricht Annadal (MCMA) and Rotterdam Eye Hospital (REH)), state anxiety was assessed at four different time points using the State-Trait Anxiety Inventory (STAI). The following predictive factors of anxiety were measured: trait anxiety, outcome expectancies, doctor-patient relationship, coping strategy, social support, information supply, sociodemographic variables, and previous cataract surgery. Repeated measures ANOVA, t tests, multiple regression analysis, and correlations were used to analyse data.
In general patients reported little anxiety. The level of anxiety (scale 1-4) was the highest before surgery, decreased immediately after surgery, and increased again after the postoperative visit. Patients with higher trait anxiety levels (r = 0.41; p<0.01), and women (r = 0.30; p<0.01) reported more anxiety. The REH patients showed lower anxiety scores than the MCMA patients.
Women and patients with higher trait anxiety were more likely to experience higher levels of state anxiety. Positive outcome expectancies and social support may decrease anxiety.
Patient anxiety is a normal part of the surgical patient's 'career' and would be anticipated by nurses in a variety of settings. Anxiety causes a number of undesirable effects which may place the patient at greater perioperative risk. Factors that mitigate against the nurse being able to devote adequate time to this important aspect of patient care will not disappear overnight and arguably, without quality psychological care, patients are being placed at greater risk. This article considers the issue of perioperative anxiety with the aim to revise the concept and highlight the serious implications of giving it a lesser priority within patient care. Alternative strategies should be sought that might also help patients take back some control over their own challenging situations. Practitioners must acknowledge that there is a need to investigate their current practice and that they have a responsibility to address patient anxiety effectively.
Surgery induces release of neuroendocrine hormones (cortisol), cytokines (interleukin-6: IL-6, tumour necrosis factor-alpha: TNF-alpha), acute phase proteins (C-reactive protein: CRP, leptin). We studied the effects of general and spinal anaesthesia on stress response to haemorrhoidectomy. Patients were assigned to general and spinal anaesthesia groups (n = 7). Blood samples were drawn before induction and 24 hours after surgery. Perioperative levels of IL-6, TNF-alpha, CRP, cortisol, and leptin were comparable among the groups. Twenty four hours after surgery, TNF-alpha and cortisol did not change; IL-6 and CRP increased significantly in all patients. Significant increase in leptin levels was found in patients undergoing spinal anaesthesia. Except for the increase in leptin levels, there was no significant difference related to the effects of general and spinal anaesthesia.
Psychophysiological studies with music have not examined what exactly in the music might be responsible for the observed physiological phenomena. The authors explored the relationships between 11 structural features of 16 musical excerpts and both self-reports of felt pleasantness and arousal and different physiological measures (respiration, skin conductance, heart rate). Overall, the relationships between musical features and experienced emotions corresponded well with those known between musical structure and perceived emotions. This suggests that the internal structure of the music played a primary role in the induction of the emotions in comparison to extramusical factors. Mode, harmonic complexity, and rhythmic articulation best differentiated between negative and positive valence, whereas tempo, accentuation, and rhythmic articulation best discriminated high arousal from low arousal. Tempo, accentuation, and rhythmic articulation were the features that most strongly correlated with physiological measures. Music that induced faster breathing and higher minute ventilation, skin conductance, and heart rate was fast, accentuated, and staccato. This finding corroborates the contention that rhythmic aspects are the major determinants of physiological responses to music.
We know from animal studies that a stimulating and enriched environment can enhance recovery after stroke, but little is known about the effects of an enriched sound environment on recovery from neural damage in humans. In humans, music listening activates a wide-spread bilateral network of brain regions related to attention, semantic processing, memory, motor functions, and emotional processing. Music exposure also enhances emotional and cognitive functioning in healthy subjects and in various clinical patient groups. The potential role of music in neurological rehabilitation, however, has not been systematically investigated. This single-blind, randomized, and controlled trial was designed to determine whether everyday music listening can facilitate the recovery of cognitive functions and mood after stroke. In the acute recovery phase, 60 patients with a left or right hemisphere middle cerebral artery (MCA) stroke were randomly assigned to a music group, a language group, or a control group. During the following two months, the music and language groups listened daily to self-selected music or audio books, respectively, while the control group received no listening material. In addition, all patients received standard medical care and rehabilitation. All patients underwent an extensive neuropsychological assessment, which included a wide range of cognitive tests as well as mood and quality of life questionnaires, one week (baseline), 3 months, and 6 months after the stroke. Fifty-four patients completed the study. Results showed that recovery in the domains of verbal memory and focused attention improved significantly more in the music group than in the language and control groups. The music group also experienced less depressed and confused mood than the control group. These findings demonstrate for the first time that music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood. The neural mechanisms potentially underlying these effects are discussed.
With her qualitative study on compositional processes in music-imaginative pain treatment, the author investigates which competencies and practices patients develop in order to “musicalise” pain sensations and alleviation ideas. Methodologically, online-accessible audiographed therapy sessions were transcribed and evaluated. The dense case descriptions and comparative analyses provide insight into the patients’ implicit knowledge, subjective theories and untapped artistic abilities. This sheds light upon the unique possibilities of music therapy when treating chronic pain patients and the significance of co-creative processes in the presentation and transformation of pain experience in pain psychotherapy.
Mit ihrer qualitativen Studie zu Kompositionsprozessen in der Musik-imaginativen Schmerzbehandlung geht die Autorin der Frage nach, welche Kompetenzen und Handlungspraktiken Patienten entwickeln, um Schmerzempfindungen und Linderungsvorstellungen zu ›musikalisieren‹. Methodisch wurden audiografierte Therapiesitzungen transkribiert und ausgewertet, die online zugänglich sind. Die dichten Fallbeschreibungen und vergleichenden Analysen geben Einblick in das implizite Wissen und die subjektiven Theorien der Patienten sowie in ungeahnt künstlerische Fähigkeiten. Daran zeigen sich die besonderen Möglichkeiten der Musiktherapie in der Behandlung chronischer Schmerzpatienten und die Bedeutung von co-kreativen Prozessen bei der Darstellung und Transformation von Schmerzerleben in der Schmerzpsychotherapie.
In recent years, the effect of music interventions and music therapy has experienced increased attention in the literature. It has been shown that music has positive effects on cognitive and physical performance, such as concentration and endurance, as well as on psychological parameters, such as anxiety and relaxation. Studies within the context of medicine in particular are increasingly indicating that music may be used as an intervention for relief against anxiety, stress and pain. Music is therefore seen in actual practice as a supplement to conventional pharmacological and non-pharmacological forms of treatment – and the trend is rising. Studies involving music interventions in the field of obstetrics have shown, amongst other things, that music improves the ability to relax during pregnancy and can reduce anxiety. It was also discovered that during childbirth music interventions resulted in a reduction of pain and stress. Music also has the effect of reducing stress, pain and anxiety in expectant mothers during deliveries by caesarean section. This review intends to provide an overview of the literature on music interventions in the field of obstetrics and to give a resume on the current state of research around the topic of music in relation to pregnancy, spontaneous deliveries and caesarean sections. Furthermore, the relevance of music for everyday obstetrics will be illustrated.
Die Erfahrung der Anwendung anxiolytischer Musik in den Jahren 1973–75 bei insgesamt 7500 Patienten führte zur Formulierung der folgenden Hypothese:
»Mit vier frei wählbaren Musikprogrammen in der Operationsvorbereitung kann die Dosis einer Prämedikation mit Psyquil oder Thalamonal auf jeweils 50% der sonst üblichen Dosis gesenkt werden, ohne Verschlechterung klinisch-physiologischer Parameter und unter gleichzeitiger Verbesserung des subjektiven Befindens der Patienten. Dabei bleiben intraoperativer Anästhetika- und postoperativer Analgetika-Verbrauch unverändert.«
This chapter evaluates the effects of music on acute and chronic pain in inpatients with and without surgery. There are two goals; first to present an overview of research, and second to address issues surrounding the implementation of music in pain therapy for inpatients.
The scientific community feels disillusioned. In spite of massive support for basic research and science in expansive arenas, in rare instances are results seeming to justify the effort. We see an example of this, for instance in genetics. When the DNA sequence of the human genome was identified in 2000, it was predicted that within a decade personalized medicine would be achieved...
reasons and clinical sequela of perioperative anxiety are manyfold
Studies which have attempted to demonstrate a relationship between perioperative anxiety and postoperative pain have yielded equivocal results. It is suggested that this is due, at least in pan, to an inadequate conception of anxiety which conflates several distinct, albeit related, components: the affective, the cognitive and the behavioural. By reformulating anxiety along these lines it becomes possible to generate testable predictions concerning factors which may influence postoperative pain response as well as allowing existing results (both positive and negative) to be explained.
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.
Background:
Reactivity of the autonomic nervous system to experimental pain stimuli has been extensively studied using measures of heart rate and blood pressure. Heart rate variability (HRV) attempts to tease out the relative contributions of sympathetic and parasympathetic activity in the autonomic control of the heart and may therefore be more appropriate to investigate autonomic response to short-term nociceptive stimulation in detail. The current evidence on HRV and experimentally induced pain has not yet been synthesized within a systematic review.
Method:
English articles indexed in PubMed, EMBASE, Psyndex, PsycINFO, CINAHL and the Cochrane Library were reviewed for eligibility under pre-specified inclusion criteria. Studies were included when they reported empirical work on autonomic response (specifically, HRV) to experimentally induced pain in healthy adults. The method of pain induction, the methodological features of HRV analysis (time domain and frequency domain measures), as well as pain and HRV-related findings were derived from the studies.
Results:
The search revealed a total of 20 publications eligible for inclusion. Key results demonstrate an increase in sympathetic-baroreflex activity and a decrease in vagal-parasympathetic activity as reflected by changes in frequency domain measures of HRV.
Conclusion:
HRV has several advantages compared to other measures of autonomic reactivity in studies investigating physiological response to nociceptive stimulation. Future studies should focus on comparisons between different methods of pain induction, interindividual variability in pain sensitivity by baseline autonomic activity, and the implications of both on the use of HRV within routine clinical evaluations.
We used functional magnetic resonance imaging to investigate neural processes when music gains reward value the first time
it is heard. The degree of activity in the mesolimbic striatal regions, especially the nucleus accumbens, during music listening
was the best predictor of the amount listeners were willing to spend on previously unheard music in an auction paradigm. Importantly,
the auditory cortices, amygdala, and ventromedial prefrontal regions showed increased activity during listening conditions
requiring valuation, but did not predict reward value, which was instead predicted by increasing functional connectivity of
these regions with the nucleus accumbens as the reward value increased. Thus, aesthetic rewards arise from the interaction
between mesolimbic reward circuitry and cortical networks involved in perceptual analysis and valuation.
Anxiety is a frequent symptom during the perioperative period. This symptom has been found to correlate with high postoperative pain, increased analgesic and anaesthetic consumption, and prolonged hospital stay. In addition, anxiety may influence adversely the anaesthetic induction and patient recovery, as well as decrease patient satisfaction with perioperative experience. However, this overview has the objective of reviewing knowledge of perioperative anxiety ? psychobiology, clinical repercussion and the effect of interventions used to control perioperative anxiety. Some historic aspects, the psychobiological mechanism, clinical repercussion of perioperative anxiety, and the effect of interventions used to control perioperative anxiety have been reviewed, as well as the role of perioperative anxiety upon anaesthesia, pain and patient recovery. Also, the effect of the approach used to control perioperative anxiety is presented. From this overview, it is evident that anxiety is of fundamental importance in perioperative morbidity. However, many questions have not been answered and new studies are needed to determine the effect of interventions used to control perioperative anxiety on postoperative outcomes.
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.
Objective
The aim of the study is to show whether negative coping style has an impact on post-operative pain reporting and pain-related behaviour.
Methods
After informed consent 48 gynaecological patients were enrolled in the study. Negative coping style was assessed by using the stress coping questionnaire SVF-78 (Janke and Erdmann). Patients were dichotomised by scores of the negative coping style. Pain reporting concerned pain intensity and pain quality. Pain-related behaviour was assessed by patient-controlled analgesia (PCA). Pain intensity and pain quality were assessed prior to surgery and 24 h after surgery. Patient-controlled analgesia was recorded up to 24 h after surgery. Trait anxiety (STAI-X2) was used as a control variable.
Results
Patients with high scores in negative coping style report increased levels of pain in both affective and sensory pain perception. At the same time patient-controlled analgesia is used less frequently by this group. This result remains significant considering trait anxiety as a covariate.
Conclusions
High negative coping style may cause a discrepancy between pain reporting and pain-related behaviour. This should be taken into account in the perioperative care of patients.
Although it has been postulated that minimally invasive cardiac surgery using the port access method would reduce operative stress and postoperative pain and accelerate postoperative recovery to a good quality of life, few data are currently available to document this intuitively appealing claim. Therefore, this study was designed to examine differences in stress response, postoperative pain, rapidity of recovery, and quality of life after port access (PA) isolated coronary artery bypass surgery compared with standard sternotomy (STD) isolated coronary bypass surgery.
Fourteen PA and 15 STD coronary bypass patients were studied postoperatively for pain score, FEV, catecholamine and cortisol levels, resumption of activity, and Duke Activity Scale ratings. The surgical approach was based on the surgeon's preference. Although the PA patients were younger, there were no other differences between the groups in gender or preoperative risk factors.
There were no operative deaths and no differences between the groups in perioperative complications. Repeated measures analysis of variance showed lower pain scale ratings over the first 4 postoperative weeks in the PA group (P < 0.001). The PA patients also had less muscle soreness, shortness of breath, fatigue, and poor appetite at 1, 2, 4, and 8 weeks (P < 0.05), better FEV at 1 day (1.59 vs. 0.97 l/s; P < 0.02) and 3 days (2.20 vs. 1.49 l/s; P < 0.03), and lower norepinephrine levels at days 1, 2, and 3 (P = 0.005). The Duke Activity Scale questionnaire results demonstrated that more PA patients were able to walk 1-2 blocks at 1 week, climb stairs at 1 and 2 weeks, perform light or moderate housework at 1 and 2 weeks, and engage in moderate recreational activities and perform heavy housework at 4 and 8 weeks (P < 0.05).
These results show that compared with STD coronary bypass patients PA patients enjoyed significant postoperative physiologic and quality of life advantages with less pain, less early stress response, better pulmonary function, and superior Duke Activity scores during the first 2 postoperative months.
This paper reviews the use of music as an adjuvant to the control of pain, especially in medical procedures. Surgery causes stress and anxiety that exacerbates the experience of pain. Self-report of and physiological measures on post-surgical patients indicate that music therapy or music stimulation reduces the perception of pain, both alone and when part of a multimodal pain management program, and can reduce the need for pharmaceutical interventions. However, multimodal pain therapy, including non-pharmacological interventions after surgery, is still rare in medical practice. We summarize how music can enhance medical therapies and can be used as an adjuvant with other pain-management programs to increase the effectiveness of those therapies. As summarized, we currently know that musical pieces chosen by the patient are commonly, but not always, more effective than pieces chosen by another person. Further research should focus both on finding the specific indications and contra-indications of music therapy and on the biological and neurological pathways responsible for those findings (related evidence has implicated brain opioid and oxytocin mechanisms in affective changes evoked by music). In turn, these findings will allow medical investigators and practitioners to design guidelines and reliable, standardized applications for this promising method of pain management in modern medicine.
Music therapy is increasingly used in end-of-life care, with a growing number of music therapists being employed in hospices and hospital-based palliative care programs each year. Music therapy in end-of-life care aims to improve a person's quality of life by helping relieve symptoms, addressing psychological needs, offering support and comfort, facilitating communication, and meeting spiritual needs. In addition, music therapists assist family and caregivers with coping, communication, and grief/bereavement. Music therapy requires the implementation of a music intervention by a trained music therapist, the presence of a therapeutic process, and the use of personally tailored music experiences. These music experiences may include listening to live, therapist-composed, improvised, or pre-recorded music, performing music on an instrument, improvising music spontaneously using voice or instruments, composing music, and music combined with other modalities (e.g. movement, imagery, art). Results indicate that music therapy may have a beneficial effect on the quality of life of people in end-of-life care. However, the results stem from a limited number of studies and the quality of the evidence is not strong. More research is needed. No evidence of effect was found for pain or anxiety. This may be due to the fact that only two studies with very small samples examined the effects of music therapy on these outcomes. There were insufficient data to examine the effect of music therapy on other physical, psychological, or social outcomes. More research is needed.
Reactions to music are considered subjective, but previous studies suggested that cardiorespiratory variables increase with faster tempo independent of individual preference. We tested whether compositions characterized by variable emphasis could produce parallel instantaneous cardiovascular/respiratory responses and whether these changes mirrored music profiles.
Twenty-four young healthy subjects, 12 musicians (choristers) and 12 nonmusician control subjects, listened (in random order) to music with vocal (Puccini's "Turandot") or orchestral (Beethoven's 9th Symphony adagio) progressive crescendos, more uniform emphasis (Bach cantata), 10-second period (ie, similar to Mayer waves) rhythmic phrases (Giuseppe Verdi's arias "Va pensiero" and "Libiam nei lieti calici"), or silence while heart rate, respiration, blood pressures, middle cerebral artery flow velocity, and skin vasomotion were recorded.Common responses were recognized by averaging instantaneous cardiorespiratory responses regressed against changes in music profiles and by coherence analysis during rhythmic phrases. Vocal and orchestral crescendos produced significant (P=0.05 or better) correlations between cardiovascular or respiratory signals and music profile, particularly skin vasoconstriction and blood pressures, proportional to crescendo, in contrast to uniform emphasis, which induced skin vasodilation and reduction in blood pressures. Correlations were significant both in individual and group-averaged signals. Phrases at 10-second periods by Verdi entrained the cardiovascular autonomic variables. No qualitative differences in recorded measurements were seen between musicians and nonmusicians.
Music emphasis and rhythmic phrases are tracked consistently by physiological variables. Autonomic responses are synchronized with music, which might therefore convey emotions through autonomic arousal during crescendos or rhythmic phrases.
When children experience nausea and vomiting (N/V) as side effects of anesthesia or chemotherapy, a major role for nurses is to promote comfort. In addition to the discomfort of N/V in children, other detrimental effects include dehydration, weight loss, fluid and electrolyte imbalance, and emotional distress. This article describes the physiological pathways through which the vomiting center is stimulated to cause nausea and vomiting and identifies appropriate interventions for blocking these pathways using both pharmacological and nonpharmacological means. Medications used to control nausea and vomiting, including phenothiazines, substituted benzamide, corticosteroids, benzodiazepines, antihistamines, and serotonin antagonists, are discussed. Nonpharmacological interventions that are described include reducing anxiety, music therapy, hypnosis, progressive muscle relaxation, dietary modifications, and acupressure.
To compare the efficacy of a local anesthetic cream and music distraction in reducing or preventing pain from needle puncture (intravenous cannulation) in children. A secondary aim was to examine the influence of age on the pain report and behavior and on the therapeutic outcome.
Children aged 4 to 16 years (N = 180) who were to undergo surgery under general anesthesia via intravenous cannulation were randomly allocated to one of three interventions. The comparison of lidocaine-prilocaine emulsion (EMLA, Astra) and a placebo emulsion was double-blind. Stratification by age group (4 to 6, 7 to 11, 12 to 16) ensured an equal number of children (20) in each intervention/age group category. A global assessment of the behavioral reaction to the procedure was made by the principal investigator, taking into account vocal, verbal, facial, and motor responses. The child was asked to assess pain severity on the Faces Pain Scale (FPS) and a visual analogue toy (VAT). The scales were applied conservatively as ordinal scales: FPS 0 to 6; VAT 0 to 10.
Children who received lidocaine-prilocaine emulsion reported less pain (mean FPS score = 1.42) compared with placebo emulsion (mean FPS score = 2.58) and with music distraction (mean FPS = 2.62). There was a highly significant therapeutic effect (P < .001) on the self-report and behavioral scores. Younger children, regardless of intervention, reported significantly more pain than the older children (mean FPS scores: 2.85, 2.33, 1.43 for age groups 4 to 6, 7 to 11, and 12 to 16 respectively; P < .001). The superiority of the local anesthetic emulsion was maximal in the youngest age group (4 to 6) almost eliminating pain-related behavior, and multiple regression analysis confirmed significant age and treatment effects and revealed interaction between therapeutic effect and age. Although a trend favoring the active emulsion was evident in the older children (7 to 11, 12 to 16) the differences were not significant. The pain scores were influenced by the type (gauge) of cannula, but this did not affect the conclusion regarding therapeutic and age effects. There was no influence of sex, experience with venipuncture, or whether the child was anxious on arrival in the operating room.
The results show that lidocaine-prilocaine emulsion is highly effective in preventing pain from venipunctures in young children, the group in most need of prevention.
It has long been held that the acute-phase and neuroendocrine response to stress requires afferent neural input for its propagation. To further clarify the role of afferent neural impulses in this process and to determine the ability of epidural anesthesia to attenuate the normal perioperative stress response, 39 patients undergoing uncomplicated abdominal aortic replacement were randomized to receive either general anesthesia with postoperative patient-controlled intravenous morphine (n = 19) or combined regional/general anesthesia with intraoperative epidural catheter anesthesia using Bupivacaine to the T4 dermatome level followed by postoperative epidural morphine (n = 20). The stress response was quantitated by blinded measurement of baseline and postoperative (0, 12, 24, 48, and 72 hours) serum cortisol, epinephrine norepinephrine, total catecholamines, interleukin (IL)-1beta, IL-6, tumor necrosis factor (TNF)-alpha, and C-reactive protein (CRP). Total operative time (4.2 +/- 0.3 vs 4.3 +/- 0.4 hours), 72-hour fluid requirement (7.0 +/- 0.6 vs 6.8 +/- 0.71 mL), and length of hospitalization (7.8 +/- 1.4 vs 8.1 +/- 1.2 days) were not different between groups. All patients showed a significant increase in cortisol, epinephrine, norepinephrine, total catecholamines, CRP, and IL-6 in the postoperative period (P < 0.05). IL-1beta and TNF-alpha were less predictable and undetectable in most patients. There was no difference in any of the stress response indices between those patients receiving patient-controlled or epidural catheter anesthesia. In fact, the only parameter that was predictive of increased activation of the stress response was the length of operation, irrespective of anesthetic method. Those patients with operative times greater than 5 hours (n = 10) developed significantly higher CRP, IL-1beta, IL-6, and TNF-alpha levels (P < 0.05) at 12 and 24 hours postoperatively than those with total operative times less than 4 hours (n = 16). The neuroendocrine response to major surgical stress is propagated normally despite epidural blockade and is intensified with prolonged operative times. The inflammatory cytokines appear to play a major role in this process.
The scientific approach to preoperative stress includes the identification of stressors and the measurement of stress responses. The stress responses include physiological (sympathetic nervous system, hypothalamic--hypophyseal and adrenocortical system), psychological (anxiety, depression etc.) and behavioural ones. The choice of variables to be measured should allow answers for our questions, i.e., they must be adequate and economic, without or only minimal disturbance of the preoperative situation. The value of physiological and biochemical parameters is often overestimated. Their assessment is indicated in special scientific settings. For simple questions such as premedication studies, the measurement of blood pressure and heart rate is sufficient. Anxiety should be self-estimated by the patient, using visual analogue scales, questionnaires or adjective check lists. Depression and other emotional stress responses can be assessed if necessary. For physicians and nurses, an observation of the patient's behavioural stress responses is a useful criterion for assessing patient stress. One important stress-reducing approach is prevention: identification and avoidance of stressors. This includes organisation and a high degree of self-control by the medical personnel. Premedication with benzodiazepines is the most successful pharmacological approach.
This comparative analysis examined the cost-effectiveness of music therapy as a procedural support in the pediatric healthcare setting. Many healthcare organizations are actively attempting to reduce the amount of sedation for pediatric patients undergoing various procedures. Patients receiving music therapy-assisted computerized tomography scans ( n = 57), echocardiograms ( n = 92), and other procedures ( n = 17) were included in the analysis. Results of music therapy-assisted procedures indicate successful elimination of patient sedation, reduction in procedural times, and decrease in the number of staff members present for procedures. Implications for nurses and music therapists in the healthcare setting are discussed.
Music stimulation has been shown to provide significant benefits to preterm infants. We hypothesized that live music therapy was more beneficial than recorded music and might improve physiological and behavioral parameters of stable preterm infants in the neonatal intensive care unit.
Thirty-one stable infants randomly received live music, recorded music, and no music therapy over 3 consecutive days. A control of the environment noise level was imposed. Each therapy was delivered for 30 minutes. Inclusion criteria were postconceptional age > or = 32 weeks, weight > or = 1,500 g, hearing confirmed by distortion product otoacoustic emissions (DPOAEs), and no active illness or documentation of hyperresponsiveness to the music. Heart rate, respiratory rate, oxygen saturation, and a behavioral assessment were recorded, every 5 minutes, before, during, and after therapy, allowing 30 minutes for each interval. The infant's state was given a numerical score as follows: 1, deep sleep; 2, light sleep; 3, drowsy; 4, quiet awake or alert; 5, actively awake and aroused; 6, highly aroused, upset, or crying; and 7, prolonged respiratory pause > 8 seconds. The volume range of both music therapies was from 55 to 70 dB. Parents and medical personnel completed a brief questionnaire indicating the effect of the three therapies.
Live music therapy had no significant effect on physiological and behavioral parameters during the 30-minute therapy; however, at the 30-minute interval after the therapy ended, it significantly reduced heart rate (150 +/- 3.3 beats/min before therapy vs 127 +/- 6.5 beats/min after therapy) and improved the behavioral score (3.1 +/- 0.8 before therapy vs 1.3 +/- 0.6 after therapy, p < 0.001). Recorded music and no music therapies had no significant effect on any of the tested parameters during all intervals. Both medical personnel and parents preferred live music therapy to recorded music and no music therapies; however, parents considered live music therapy significantly more effective than the other therapies.
Compared with recorded music or no music therapy, live music therapy is associated with a reduced heart rate and a deeper sleep at 30 minutes after therapy in stable preterm infants. Both recorded and no music therapies had no significant effect on the tested physiological and behavioral parameters.
Die Biologie des Wohlklangs
- N D Cook
- T Hayashi
Cook ND, Hayashi T. Die Biologie des Wohlklangs. Spektrum der Wissenschaft 2009; 3: 64-70.
Anxiolytic effect of music on dental treatment. Part 1: subjective and objective evaluation
- K Hatano
- T Oyama
- T Kogure
- I Ohkura
- R Spintge
Hatano K, Oyama T, Kogure T, Ohkura I, Spintge
R. Anxiolytic effect of music on dental treatment.
Part 1: subjective and objective evaluation. Journal
Japanese Society of Dental Anesthesiology 1983;
11: 332-337.