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The effects of music listening on the management of pain in primary dysmenorrhea: A randomized controlled clinical trial
Abstract
Introduction
This study aims to explore the effects of music listening, compared to silence, on pain management in primary dysmenorrhea (PD).
Method
A researcher-blinded randomized controlled clinical trial was conducted from September 2017 to April 2018 at the Universidad del Rosario (Bogota, Colombia). Women with PD aged between 18 years and 26 years old were included. The intervention was provided during the first 12 hours of menses. Participants were instructed to avoid analgesics until the intervention. The music group (n = 29) listened to a C major musical composition with a tempo of 60 beats per minute and no percussion nor lyrics. Silence was used for the control group (n = 23). Both interventions lasted 29ʹ32” and participants wore headphones in both groups. Pain (using a 10-cm visual analogue scale), anxiety (using the Zung scale), and the expressed desire to use other analgesic treatments were evaluated immediately after and 3–6 hours after the intervention. The primary outcome was change in pain from pre to post intervention measurements.
Results
Homogeneity between groups was reached. Adjusted mean pain scores after the interventions were significantly lower (p = 0.006; R ² = 0.545) in the music group (adjusted mean 3.13) than the silence group (adjusted mean 4.56). Logistic regression showed that music group was more likely to reduce analgesic use after the intervention (OR 5.4, 95% CI 1.4–21, R ² = 0.28).
Discussion
Music listening during the first 12 hours of menses significantly reduced pain and the need for analgesics in PD compared to silence.
Trial registration
NCT03593850; ClinicalTrials.gov
... Using these terms will allow researchers to objectively categorize music and standardize interventions. Although there are no definitive results in the literature on the reduction of menstrual pain in terms of rhythm, sound level, or decibel, it is stated that the sound level should not be at the noise level (51 to 75 dB) in the management of pain [25,26]. Recent neuroscientific studies have shown that music can reduce the physiological arousal and pain that increases during stress. ...
... Sociodemographic characteristics included questions such as age, height, weight, body mass index (BMI), mother's education level, mother's employment status, father's education level, father's employment status, income status, family type, smoking status, alcohol consumption status, physical exercise status, place of residence during education, dominant personality structure, and perspective on life. Menstrual cycle-related characteristics included age at first menarche, duration and frequency of menstrual cycle, regularity of menstrual cycle, reaction to waiting for menstruation before menstruation, cramping pain in the lower abdomen (dysmenorrhea) in the first days of menstrual cycle, The questionnaire included questions on the problems experienced during the menstrual cycle and coping methods, duration of dysmenorrhea complaint, use of pharmacological treatment methods in dysmenorrhea, use of traditional and alternative treatment methods in dysmenorrhea, information source and sharing with health professionals if using, and the status and frequency of emergency room visits with dysmenorrhea complaint [21,25,26]. The researchers prepared the questions in line with the literature, and expert opinion was obtained after the questionnaire was prepared. ...
... While composing the song, the researcher aimed to create music that would reduce the pain and suffering felt by people, activate positive and positive emotions, and make the person feel at peace and relax. The song composed by the author is available online as part of the article published in the literature (https://soundcloud.com/jssmartin/occasio-adolore) [25]. Written permission was obtained from Juan Sebastian Martin-Saavedra to use the song in the study. ...
Aim
To examine the effect of listening to music and drawing on coping with dysmenorrhea complaints of nursing students.
Methods
The study was a double-blind, three parallel-group randomized controlled trial conducted between August 2023 and May 2024 at Bartın University, Faculty of Health Sciences, Department of Nursing. Ninety-six dysmenorrheic nursing students with regular menstrual cycles were included in the study and randomly assigned to three groups as drawing, music and control groups. Visual Analog Scale (100mmVAS of pain), Perceived Stress Scale (PSS) and Menstrual Symptoms Scale (MSS) were applied to the students at baseline, 1st and 2nd months. The interventions were as follows: the music group listened to a 29-minute and 32-second song three days before menstruation and on the first day of menstruation in the third month composed by Juan Sebastian Martin-Saavedra, while the drawing group created art for the same duration. The pain scores, perceived stress, and menstrual symptoms were measured in all groups after the interventions.
Results
Pretest, 1st and 2nd months 100mmVAS of pain score averages were 7.16 ± 1.99, 7.16 ± 1.99 and 7.50 ± 1.98 for the control group, 7.22 ± 1.64, 4.84 ± 1.80 and 2.13 ± 1.45 for the music group and 6.69 ± 1.80, 5.09 ± 1.55 and 2.91 ± 1.33 for the drawing group, respectively. Pretest, 1st and 2nd months PSS score averages were 28.75 ± 3.71, 29.09 ± 3.87 and 30.03 ± 4.16 for the control group, 29.91 ± 3.98, 14.06 ± 4.06 and 3.59 ± 3.82 for the music group and 27.38 ± 3.63, 18.13 ± 5.60 and 8.34 ± 5.46 for the drawing group, respectively. Pretest, 1st and 2nd months MSS score averages were 79.25 ± 15.41, 88.00 ± 20.08 and 90.66 ± 19.13 for the control group, 85.41 ± 10.77, 62.41 ± 15.23 and 34.00 ± 12.62 for the music group and 80.69 ± 11.07, 65.53 ± 15.37 and 47.31 ± 15.11 for the drawing group, respectively. Mean menstrual pain intensity, mean perceived stress level, and mean menstrual symptoms level in the art and music group decreased significantly at 1st and 2nd months post-intervention (p < .001). A significant increase in score levels was observed in the control group.
Conclusions
Both art and music practices are effective in significantly reducing menstrual pain, perceived stress, and menstrual symptoms in nursing students with dysmenorrhea. It is important to include listening to music and drawing on women’s health and disease nursing practices to control menstrual pain, perceived stress, and menstrual symptoms in dysmenorrhea.
Clinical trials registration number
https://clinicaltrials.gov identifier NCT06027489; registered August 30, 2023.
... Non-pharmacological therapy can be recommended because it has few side effects, does not cost money and is easy to do. 7 Music therapy can release sensory stimuli that can cause the release of endorphins. Endorphins are produced by the brain and function as natural sedatives that work by blocking the transmission of painful stimuli. ...
... than the control group. 7 Although previous research has been conducted, the effectiveness of classical music therapy on anxiety in dysmenorrheal pain has not been yet discussed. The experimental research involving music conducted between the intervention and control groups necessitates the implementation of randomization to ensure the reduction of research bias. ...
... What was obtained was corresponding with the research journal that had been previously conducted by Juan Sebastian Martin-Saavedra and Angela Maria Ruiz-Sternberg that found a decrease in anxiety levels in the group given classical music therapy compared to the control group with p value = 0.049. 7 The theory also said that classical music therapy can produce the release of endorphin hormones in the descending control system which will stimulate alpha waves to provide calm and comfort. So that endorphins not only help to reduce pain but also help to reduce anxiety. ...
p> Introduction: Dysmenorrhea is menstrual pain that often occurs in young women. The pain felt in every women can be different from one another. Anxiety experienced by each women can also worsen the menstrual pain. Efforts to treat dysmenorrhea can be in the form of non-pharmacological therapy, one of which is music therapy.
Aim: This study uses an experimental method with random allocation to divide 122 respondents who are medical students of Pelita Harapan University into a control group and an intervention group.
Methodology: The intervention group has been given anexperiment of random allocationin the form of classical music therapy for 20 minutes on the first day of the respondent getting menstruation. As for the control group given 40Hz sound for 20 minutes. The data analyzed using chi-square and wilcoxon test.
Results: The results of the study found that the average menstrual pain in the control group before the intervention was 6.11 and after the intervention was 6.07. Meanwhile, in the intervention group, the average menstrual pain before being given classical music therapy was 6.46 and after the intervention was 3.39.
Conclusion: So that classical music therapy is effective for reducing anxiety by 0.77 and the menstrual pain scale is 3.07 in the group given classical music therapy with P value <0.001.</p
... 4 clinical trial in Colombia investigated the effects of music listening (n=29) compared to silence (n=23) on pain management in women with PD. The results showed that pain and the need for analgesics were significantly reduced in the music group compared to the silence during the first 12 hours of menstruation [21]. Two studies in Indonesia were published, and one of them determined that music medicine was significantly more effective in reducing pain than the guided imagery and control groups [18]. ...
... The aim of the song was to create a relaxing musical piece that could evoke positive feelings to relieve pain. The composition is available online (https://soundcloud.com/jss-martin/occasio-adolore) [21], and permission has been obtained from Juan Sebastian Martin-Saavedra to use this song. ...
... significantly after the intervention (p<0.05). In this study, we used the music created by Martin-Saavedra and Ruiz-Sternberg [21], which has shown to be usable for pain relief in PD. ...
Introduction
Music medicine and dark chocolate are effective methods of helping reduce pain and anxiety in primary dysmenorrhea. The aim of the study was to determine the effects of music medicine and dark chocolate on primary dysmenorrhea related pain intensity and anxiety level in young women.
Methods
It was a non-blinded, three-parallel group randomized controlled trial. The study included 18–25-year-old nulliparous nursing students with PD having a regular menstruation cycle and a Visual Analog Scale (VAS) severity of menstrual pain of 5 and over in the previous 6 months. Ninety nursing students were randomly allocated into one of the three groups, including dark chocolate, music, or control. The study was completed with 84 nursing students because some participants did not want to continue the study and used analgesics. In the first month, 84 students (chocolate: 30, music: 25, control: 29) completed the State-Trait Anxiety Inventory (STAI). In the second month, menstrual pain intensity and state anxiety were measured on the first day of menstruation using VAS and STAI, respectively, in 84 students. The dark chocolate group had dark chocolate for three days before menstruation and on the first day of menstruation in the third month. The music group listened to a song for the same four days. The pain scores and state anxiety were measured in all groups after the interventions.
Results
Mean menstrual pain intensity and mean anxiety level in the dark chocolate and music group decreased significantly after the intervention. No significant difference was observed in the control group. The difference between menstrual pain intensity and anxiety levels of the groups was tested by analysis of variance, and the standardized effect size calculated at 95% confidence level, and α= 0.05 was 0.35 and 0.42, respectively.
Conclusions
Both dark chocolate and music medicine significantly reduced menstrual pain and anxiety in young women with primary dysmenorrhea. Further research is needed to draw stronger conclusions on their impact on controlling menstrual pain and anxiety in primary dysmenorrhea as a nursing intervention.
... Menurut kajian literatur yang dilakukan oleh (Saavedra and Ruiz-Sternberg, 2020); (Rachmawati et al., 2020) menyatakan bahwa Upaya penanganan untuk mengurangi dismenore adalah dengan pemberian terapi non-farmakologi. Salah satu cara yang digunakan untuk meredakan dismenore yaitu dengan melakukan terapi musik klasik dan senam dismenore. ...
... Selanjutnya Penelitian ini juga sejalan dengan , bahwa senam secara signifikan lebih efektif daripada jahe untuk menghilangkan rasa sakit pada remaja dengan dismenore primer. Berikutnya penelitian ini juga sejalan dengan (Saavedra and Ruiz-Sternberg, 2020), bahwa dismenore sebelum diberikan intervensi ρ-value 0.802 >0.05 dan dismenore setelah diberikan intervensi ρ-value 0.006 <0.005 kesimpulannya musik klasik dapat mengurangi nyeri setelah intervensi. Peneliti berasumsi bahwa senam dismenore sama efektifnya dengan musik klasik Mozart dalam pengobatan dismenore. ...
Latar belakang: dismenore merupakan nyeri atau kram perut bagian bawah pada saat menstruasi. Dampak dismenore yang terjadi pada remaja yaitu dapat mengganggu aktivitas sehari-hari. Upaya untuk mengatasi dismenore dapat dilakukan secara farmakologi dan non-farmakologi. Memberikan terapi senam dismenore dan musik klasik mozart dapat membantu mengurangi nyeri secara non farmakologi. Tujuan: penelitian menganalisis efektivitas senam dismenore dan music klasik terhadap penurunan dismenore pada remaja. Metode: quasy eksperimen dengan rancangan two group pretest-posttest. menggunakan purposive sampling, jumlah sampel 92 orang yang terbagi menjadi 46 remaja senam dismenore dan 46 remaja musik klasik. analisis data menggunakan wilcoxon dan mann-whitney. Hasil: uji wilcoxon didapatkan rata-rata sebelum dan sesudah diberikan senam dismenore ρ-value 0.000 <0.05, dan musik klasik ρ-value 0.000 <0.05. berdasarkan uji mann-whitney didapatkan rata-rata sesudah diberikan senam dismenore dan musik klasik menunjukkan ρ-value (0.313 >0.05) artinya tidak terdapat perbedaan penurunan dismenore yang signifikan antara senam dan musik klasik sesudah diberikan perlakukan pada remaja putri. Kesimpulan: senam dismenore dan musik klasik sama-sama efektif menurunkan dismenore.
... The physical, behavioral, and psychological complaints that arise in the late luteal phase and disappear within a few days after the onset of menstruation are defined as premenstrual symptoms [1]. If these complaints recur in every cycle and affect the activities of daily living, this condition is called premenstrual syndrome (PMS) [2]. Although PMS is thought to have a neurobiological basis, its etiology is still not completely understood. ...
... decreased the premenstrual symptoms and, thus, improved the quality of life. In the literature, the studies conducted on music medicine until recently have been aimed at reducing the pain during labor, pain during episiotomy repair, anxiety during cesarean section, and dysmenorrhea [2,[32][33][34][35]. In addition to pharmacological methods, non-pharmacological treatment methods have also been used in the recent years to reduce the premenstrual syndrome [10,[12][13][14]. ...
Background
Premenstrual syndrome is an important health problem affecting women of reproductive age. This study aimed to show that music medicine can be used to reduce the premenstrual syndrome levels and increase the quality of life of women.
Design
A prospective, single-blinded randomized controlled trial.
Materials
The study was conducted between January and April 2021 on 97 college students. The participants consisted of women over 20 years of age and suffering from premenstrual syndrome. The participants were randomized into music and control groups.
Results
Immediately post-intervention, the women in the experimental groups had significantly higher reduced premenstrual syndrome levels and an improved quality of life. Muusic and control groups were evaluated with The Premenstrual Syndrome Scale (PMSS) and the short form of the Short of World Health Organization quality of life questionnaire (WHOQOL‐BREF). Comparing these two groups, music significantly reduced the premenstrual syndrome level after application (PMSS-1123.23 ± 32.06 vs. 105.90 ± 27.55, respectively, PMSS-2 94.21 ± 28.42 vs. 119.44 ± 27.29, respectively, p < .05). Comparing the music medicine and control groups had significantly increased WHOQOL-BREF scores (Physical, psychological, and environmental) after the application (13.71 vs. 13.14; 14.33 vs. 15.44 vs.14.66, respectively, p < .05).
Conclusion
Premenstrual symptoms were significantly reduced in the music medicine group than the control group. Additionally, music medicine improves the quality of life.
... These findings are in line with those reported by Bakhtshirin et al. [52] showing that aromatherapy massage was beneficial for primary dysmenorrhea alleviation in young women or with those published by Merlot et al. [53] reporting pelvic pain reductions in women with endometriosis with an immersive digital therapeutic tool that included relaxing music (alpha/theta binaural beats, nature-based sounds). Similarly, music therapy has also been shown to be effective at ameliorating pain intensity in those undergoing oocyte retrieval treatments [54], and in both primary dysmenorrhea [55] and menstrual discomfort in young women [56]. ...
Background and Objectives: To evaluate the effectiveness of an integral HAMMAM experience, a 4-week therapeutic program that combined hydrotherapy and Swedish massage, applied in a multisensorial immersive environment, on pain, well-being and quality of life (QoL) in women with endometriosis-related chronic pelvic pain that is unresponsive to conventional treatment. Materials and Methods: This randomized controlled trial included 44 women with endometriosis. They were randomly allocated to either the ‘HAMMAM’ group (n = 21) or to a control group (n = 23). The primary outcome, pain intensity, was evaluated using numeric rating scales (NRSs). The secondary outcomes were pain interference, pain-related catastrophic thoughts, pressure pain thresholds (PPTs), subjective well-being, functional capacity and QoL, which were evaluated using the brief pain inventory (BPI), the pain catastrophizing scale (PCS), algometry, the subjective well-being scale-20 (EBS-20), the Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) and the Endometriosis Health Profile-30 Questionnaire (EHP-30), respectively. The primary and secondary outcomes were measured at the baseline and after the intervention. The statistical (between-group analyses of covariance) and clinical effects were analyzed by the intention to treat. Results: The adherence rate was 100.0% and the mean (± standard deviation) satisfaction was 9.71 ± 0.46 out of 10. No remarkable health problems were reported during the trial. The ‘HAMMAM’ intervention improved dysmenorrhea and dyspareunia after the intervention with large and moderate effect sizes, respectively. Improvements in pain interference during sleep and PPTs in the pelvic region were also observed in women allocated to the ‘HAMMAM’ group. No effects were observed in catastrophizing thoughts, well-being nor QoL, except for the sleep subscale. Conclusions: A 4-week program of an integral ‘HAMMAM’ experience combining hydrotherapy and massage in a multisensorial immersive environment is a feasible and effective intervention to alleviate pain during menstruation and sexual intercourse as well as pain interference with sleep in women with endometriosis.
... Current studies support music therapy as an effective way to reduce anxiety and pain. [5][6][7] Evidence of memory and awareness during general anesthesia indicates that some cognitive functions are preserved in surgical patients who appear to be adequately anesthetized (i.e., unaware of what is happening in the operating room). This finding has important implications for both clinical studies and memory research. ...
Background:
Controversy remains about the positive role of music during general anesthesia and postoperative recovery. We, therefore, tested the hypothesis that intraoperative exposure to classical music reduces the propofol necessary to maintain the bispectral index (BIS) close to 50 during vitrectomy surgery.
Materials and methods:
This double-blind clinical study is evaluating 50 patients undergoing vitrectomy surgery under general anesthesia. Patients were randomly assigned to music and white noise groups, and relevant sounds were played to patients after induction of anesthesia. The two groups were compared for the use of propofol as an anesthetic to maintain a BIS near 50 and for postoperative pain, anxiety, nausea, and vomiting.
Results:
Propofol consumption to maintain the set BIS score was much lower in the music group than in the white noise group (78.72 ± 25.76 microgram/kg/min and 117.91 ± 36.78 microgram/kg/min, respectively, P-value = 0.000). Postoperative pain scores were also much lower in the music group than in the white noise group (P-value = 0.000) and anxiety levels between these two groups did not differ (P-value = 0.870). No patient in the music group had complaints of postoperative nausea and vomiting (PONV) compared to six patients in the white noise group (P-value = 0.011).
Conclusions:
Listening to music during general anesthesia for vitrectomy surgery can reduce the use of anesthetics, postoperative pain, and PONV. Further, controlled studies are necessary to confirm our results.
In modern times there is increasing acceptance that music-based interventions are useful aids in the clinical treatment of a range of neurological and psychiatric conditions, including helping to reduce the perception of pain. Indeed, the belief that music, whether listening or performing, can alter human pain experiences has a long history, dating back to the ancient Greeks, and its potential healing properties have long been appreciated by indigenous cultures around the world. The subjective experience of acute or chronic pain is complex, influenced by many intersecting physiological and psychological factors, and it is therefore to be expected that the impact of music therapy on the pain experience may vary from one situation to another, and from one person to another. Where pain persists and becomes chronic, aberrant central processing is a key feature associated with the ongoing pain experience. Nonetheless, beneficial effects of exposure to music on pain relief have been reported across a wide range of acute and chronic conditions, and it has been shown to be effective in neonates, children and adults. In this comprehensive review we examine the various neurochemical, physiological and psychological factors that underpin the impact of music on the pain experience, factors that potentially operate at many levels – the periphery, spinal cord, brainstem, limbic system and multiple areas of cerebral cortex. We discuss the extent to which these factors, individually or in combination, influence how music affects both the quality and intensity of pain, noting that there remains controversy about the respective roles that diverse central and peripheral processes play in this experience. Better understanding of the mechanisms that underlie music’s impact on pain perception together with insights into central processing of pain should aid in developing more effective synergistic approaches when music therapy is combined with clinical treatments. The ubiquitous nature of music also facilitates application from the therapeutic environment into daily life, for ongoing individual and social benefit.
Dysmenorrhea is pelvic pain associated with menstruation and is one of the most common pain conditions among reproductive-age women. It is commonly treated with medications, complementary and alternative medicine, and self-management techniques. However, there is increased focus on psychological interventions which modify thoughts, beliefs, emotions, and behavioral responses to dysmenorrhea. This review examined the efficacy of psychological interventions on dysmenorrhea pain severity and interference. We conducted a systematic search of the literature using PsycINFO, PubMed, CINHAL, and Embase. A total of 22 studies were included; 21 examined within-group improvement (i.e., within-group analysis) and 14 examined between-group improvement (i.e., between-group analysis). Random-effects meta-analyses were conducted on pain severity and interference, with average effect sizes calculated using Hedges's g. Within-group analyses showed decreased pain severity and interference at post-treatment (g = 0.986 and 0.949, respectively) and first follow-up (g = 1.239 and 0.842, respectively). Between-group analyses showed decreased pain severity at post-treatment (g = 0.909) and decreased pain severity and interference at first follow-up (g = 0.964 and 0.884, respectively) compared to control groups. This review supports the efficacy of psychological interventions for dysmenorrhea, but conclusions are tempered by suboptimal methodological quality of the included studies and high heterogeneity across studies. Additional, rigorous research is needed to determine the clinical utility of psychological interventions for dysmenorrhea.
The auditory cortex is well-known to be critical for music perception, including the perception of consonance and dissonance. Studies on the neural correlates of consonance and dissonance perception have largely employed non-invasive electrophysiological and functional imaging techniques in humans as well as neurophysiological recordings in animals, but the fine-grained spatiotemporal dynamics within the human auditory cortex remain unknown. We recorded electrocorticographic (ECoG) signals directly from the lateral surface of either the left or right temporal lobe of eight patients undergoing neurosurgical treatment as they passively listened to highly consonant and highly dissonant musical chords. We assessed ECoG activity in the high gamma (γhigh, 70–150 Hz) frequency range within the superior temporal gyrus (STG) and observed two types of cortical sites of interest in both hemispheres: one type showed no significant difference in γhigh activity between consonant and dissonant chords, and another type showed increased γhigh responses to dissonant chords between 75 and 200 ms post-stimulus onset. Furthermore, a subset of these sites exhibited additional sensitivity towards different types of dissonant chords, and a positive correlation between changes in γhigh power and the degree of stimulus roughness was observed in both hemispheres. We also observed a distinct spatial organization of cortical sites in the right STG, with dissonant-sensitive sites located anterior to non-sensitive sites. In sum, these findings demonstrate differential processing of consonance and dissonance in bilateral STG with the right hemisphere exhibiting robust and spatially organized sensitivity toward dissonance.
BACKGROUND Primary dysmenorrhea, or painful menstruation in the absence of pelvic pathology, is a common, and often debilitating, gynecological
condition that affects between 45 and 95% of menstruating women. Despite the high prevalence, dysmenorrhea is often poorly
treated, and even disregarded, by health professionals, pain researchers, and the women themselves, who may accept it as a
normal part of the menstrual cycle. This review reports on current knowledge, particularly with regards to the impact and
consequences of recurrent menstrual pain on pain sensitivity, mood, quality of life and sleep in women with primary dysmenorrhea.
Music is a non-invasive, safe, and inexpensive intervention that can be delivered easily and successfully. We did a systematic review and meta-analysis to assess whether music improves recovery after surgical procedures.
We included randomised controlled trials (RCTs) of adult patients undergoing surgical procedures, excluding those involving the central nervous system or head and neck, published in any language. We included RCTs in which any form of music initiated before, during, or after surgery was compared with standard care or other non-drug interventions. We searched MEDLINE, Embase, CINAHL, and Cochrane Central. We did meta-analysis with RevMan (version 5.2), with standardised mean differences (SMD) and random-effects models, and used Stata (version 12) for meta-regression. This study is registered with PROSPERO, number CRD42013005220.
We identified 4261 titles and abstracts, and included 73 RCTs in the systematic review, with size varying between 20 and 458 participants. Choice of music, timing, and duration varied. Comparators included routine care, headphones with no music, white noise, and undisturbed bed rest. Music reduced postoperative pain (SMD -0·77 [95% CI -0·99 to -0·56]), anxiety (-0·68 [-0·95 to -0·41]), and analgesia use (-0·37 [-0·54 to -0·20]), and increased patient satisfaction (1·09 [0·51 to 1·68]), but length of stay did not differ (SMD -0·11 [-0·35 to 0·12]). Subgroup analyses showed that choice of music and timing of delivery made little difference to outcomes. Meta-regression identified no causes of heterogeneity in eight variables assessed. Music was effective even when patients were under general anaesthetic.
Music could be offered as a way to help patients reduce pain and anxiety during the postoperative period. Timing and delivery can be adapted to individual clinical settings and medical teams.
None.
Copyright © 2015 Elsevier Ltd. All rights reserved.
The human brain can dynamically adapt to the changing surroundings. To explore this issue, we adopted graph theoretical tools to examine changes in electroencephalography (EEG) functional networks while listening to music. Three different excerpts of Chinese Guqin music were played to sixteen non-musician subjects. For the main frequency intervals, synchronizations between all pair-wise combinations of EEG electrodes were evaluated with phase lag index (PLI). Then, weighted connectivity networks were created and their organizations were characterized in terms of an average clustering coefficient and characteristic path length. We found an enhanced synchronization level in the alpha2 band during music listening. Music perception showed a decrease of both normalized clustering coefficient and path length in the alpha2 band. Moreover, differences in network measures were not observed between musical excerpts. These experimental results demonstrate an increase of functional connectivity as well as a more random network structure in the alpha2 band during music perception. The present study offers support for the effects of music on human brain functional networks with a trend towards a more efficient but less economical architecture.
Many natural sounds are periodic and consist of frequencies (harmonics) that are integer multiples of a common fundamental frequency (F0). Such harmonic complex tones (HCTs) evoke a pitch corresponding to their F0, which plays a key role in the perception of speech and music. "Pitch-selective" neurons have been identified in non-primary auditory cortex of marmoset monkeys. Noninvasive studies point to a putative "pitch center" located in a homologous cortical region in humans. It remains unclear whether there is sufficient spectral and temporal information available at the level of primary auditory cortex (A1) to enable reliable pitch extraction in non-primary auditory cortex. Here we evaluated multiunit responses to HCTs in A1 of awake macaques using a stimulus design employed in auditory nerve studies of pitch encoding. The F0 of the HCTs was varied in small increments, such that harmonics of the HCTs fell either on the peak or on the sides of the neuronal pure tone tuning functions. Resultant response-amplitude-versus-harmonic-number functions ("rate-place profiles") displayed a periodic pattern reflecting the neuronal representation of individual HCT harmonics. Consistent with psychoacoustic findings in humans, lower harmonics were better resolved in rate-place profiles than higher harmonics. Lower F0s were also temporally represented by neuronal phase-locking to the periodic waveform of the HCTs. Findings indicate that population responses in A1 contain sufficient spectral and temporal information for extracting the pitch of HCTs by neurons in downstream cortical areas that receive their input from A1.
Music-based interventions are used to address a variety of problems experienced by individuals across the developmental lifespan (infants to elderly adults). In order to improve the transparency and specificity of reporting music-based interventions, a set of specific reporting guidelines is recommended. Recommendations pertain to seven different components of music-based interventions, including theory, content, delivery schedule, interventionist, treatment fidelity, setting, and unit of delivery. Recommendations are intended to support Consolidated Standards for Reporting Trials (CONSORT) and Transparent Reporting of Evaluations with Non-randomized Designs (TREND) statements for transparent reporting of interventions while taking into account the variety, complexity, and uniqueness of music-based interventions.
The purpose of the study was to investigate the effects of music on pain reaction and anxiety during labour.
Music therapy has been used on clinical medicine. Only few scientific studies validate the value on labour women.
Randomised controlled trial.
Sixty primiparas expected to have a normal spontaneous delivery were randomly assigned to either the experimental group (n = 30) or the control group (n = 30). The experimental group received routine care and music therapy, whereas the control group received routine care only. A self-report visual analogue scale for pain and a nurse-rated present behavioural intensity were used to measure labour pain. Anxiety was measured with a visual analogue scale for anxiety and finger temperature. Pain and anxiety between groups were compared during the latent phase (2-4 cm cervical dilation) and active phase (5-7 cm) separately.
Our results revealed that compared with the control group, the experimental group had significantly lower pain, anxiety and a higher finger temperature during the latent phase of labour. However, no significant differences were found between the two groups on all outcome measures during the active phase.
This study provides evidence for the use of music as an empirically based intervention of women for labour pain and anxiety during the latent phase of labour.
The findings support that music listening is an acceptable and non-medical coping strategy for labouring women. Especially, apply in reducing the pain and anxiety for women who are at the early phase of labour.
Background: The Zung’s rating instrument for anxiety disorders has been used in various Colombian researches. Its internal consistency and factor structure have not been reported among university students. Objective: To calculate the internal consistency and explore the factor structure of three versions of the Zung’s rating instrument for anxiety disorders among university students. Method: Two-hundred twenty-one medicine and psychology students of a private university in Cartagena completed the 20-item version of the Zung’s rating instrument for anxiety disorders. The mean of age of students was 20.5 (SD=2.6), 64.4% were women, and 54.3% studied medicine. Cronbach alpha was computed and exploratory factor analysis was done for three versions. Results: The 20-item version of the Zung’s rating instrument for anxiety disorders presents Cronbach alpha coefficient of 0.77 and three principal factors accounted for 40.1% of the total variance. The 10-item version showed Cronbach alpha of 0.83 and two-dimensional structure responsible of 54% of the total variance. The 5-item version showed Cronbach alpha of 0.74 and one-dimensional structure accounted for 49.5% of the total variance. Conclusions: The 10- and 5-item version of the Zung’s rating instrument for anxiety disorders present better psychometric properties than the original 20-item version. It is necessary to estimate the properties of these versions compared with a criterion reference.
During labor, women experience a high level of intense, stressful and steady pain that may negatively affect both mothers and neonates. Painkillers have previously been used for childbearing women, but nowadays, owing to some well-known limitations and serious side effects, nonpharmacologic methods such as massage and music therapies are being broadly recommended. The present clinical trial was conducted to compare the effects of massage and music therapies on the severity of labor pain in the Ilam province of western Iran.
Overall, 101 primigravidae who were hospitalized for vaginal delivery were recruited and randomly stratified into two groups of either massage (n = 51) or music (n = 50) therapies. Pain was measured using the visual analog scale and the two groups were compared in terms of pain severity before and after the interventions.
Mothers in the massage therapy group had a lower level of pain compared with those in the music therapy group (p = 0.009). A significant difference was observed between the two groups in terms of pain severity after intervention (p = 0.01). Agonizing, or most severe, labor pain was significantly relieved after massage therapy (p = 0.001).
Massage therapy was an effective method for reducing and relieving labor pain compared with music therapy and can be clinically recommended as an alternative, safe and affordable method of pain relief where using either pharmacological or nonpharmacological methods are optional.
Antecedentes: La escala de Zung para ansiedad se ha usado en varias investigaciones en Colombia. Sin embargo, no se ha informado la consistencia interna y la estructura de factores en estudiantes universitarios.Objetivo: Estimar la consistencia interna y la estructura factorial de tres versiones de la escala de Zung para ansiedad en estudiantes de una universidad privada de Cartagena, Colombia.Método: Doscientos veintiún estudiantes de medicina y psicología completaron la versión de 20 puntos de la escala de Zung para ansiedad. La media para la edad fue 20.5 (DE=2.6), 64.4% eran mujeres y 55.3% estudiaban medicina. Se calculó el alfa de Cronbach y se realizó un análisis de factores exploratorio para las tres versiones.Resultados: La escala de 20 puntos mostró un coeficiente de alfa de Cronbach de 0.77 y tres factores principales responsables de 40.1% de la varianza total. La versión de 10 puntos mostró una consistencia interna de 0.83 y una estructura bidimensional que explicaba 54% de la varianza. La versión de cinco puntos mostró una consistencia interna de 0.74 y una estructura unidimensional que daba cuenta de 49.5% de la varianza.Conclusiones: Las versiones de diez y cinco puntos de la escala de Zung para ansiedad presentan mejor comportamiento psicométrico que la versión original de 20 puntos. Se necesita estimar el comportamiento psicométrico de estas versiones frente a un criterio de referencia.
Some musical chords sound pleasant, or consonant, while others sound unpleasant, or dissonant. Helmholtz's psychoacoustic theory of consonance and dissonance attributes the perception of dissonance to the sensation of "beats" and "roughness" caused by interactions in the auditory periphery between adjacent partials of complex tones comprising a musical chord. Conversely, consonance is characterized by the relative absence of beats and roughness. Physiological studies in monkeys suggest that roughness may be represented in primary auditory cortex (A1) by oscillatory neuronal ensemble responses phase-locked to the amplitude-modulated temporal envelope of complex sounds. However, it remains unknown whether phase-locked responses also underlie the representation of dissonance in auditory cortex. In the present study, responses evoked by musical chords with varying degrees of consonance and dissonance were recorded in A1 of awake macaques and evaluated using auditory-evoked potential (AEP), multiunit activity (MUA), and current-source density (CSD) techniques. In parallel studies, intracranial AEPs evoked by the same musical chords were recorded directly from the auditory cortex of two human subjects undergoing surgical evaluation for medically intractable epilepsy. Chords were composed of two simultaneous harmonic complex tones. The magnitude of oscillatory phase-locked activity in A1 of the monkey correlates with the perceived dissonance of the musical chords. Responses evoked by dissonant chords, such as minor and major seconds, display oscillations phase-locked to the predicted difference frequencies, whereas responses evoked by consonant chords, such as octaves and perfect fifths, display little or no phase-locked activity. AEPs recorded in Heschl's gyrus display strikingly similar oscillatory patterns to those observed in monkey A1, with dissonant chords eliciting greater phase-locked activity than consonant chords. In contrast to recordings in Heschl's gyrus, AEPs recorded in the planum temporale do not display significant phase-locked activity, suggesting functional differentiation of auditory cortical regions in humans. These findings support the relevance of synchronous phase-locked neural ensemble activity in A1 for the physiological representation of sensory dissonance in humans and highlight the merits of complementary monkey/human studies in the investigation of neural substrates underlying auditory perception.
Members of this consensus group were selected based on individual expertise to represent a range of practical and academic experience both in terms of location in Canada and type of practice, as well as subspecialty expertise along with general gynaecology backgrounds. The consensus group reviewed all available evidence through the English and French medical literature and available data from a survey of Canadian women. Recommendations were established as consensus statements. The final document was reviewed and approved by the Executive and Council of the SOGC.
This document provides a summary of up-to-date evidence regarding the diagnosis, investigations, and medical and surgical management of dysmenorrhea. The resulting recommendations may be adapted by individual health care workers when serving women who suffer from this condition.
Dysmenorrhea is an extremely common and sometimes debilitating condition for women of reproductive age. A multidisciplinary approach involving a combination of lifestyle, medications, and allied health services should be used to limit the impact of this condition on activities of daily living. In some circumstances, surgery is required to offer the desired relief.
This guideline discusses the various options in managing dysmenorrhea. Patient information materials may be derived from these guidelines in order to educate women in terms of their options and possible risks and benefits of various treatment strategies. Women who find an acceptable management strategy for this condition may benefit from an improved quality of life.
Purpose: To evaluate if music characteristics like tempo, harmony, melody, instrumentation, volume, and pitch, as defined by musical theory, are described in randomized clinical trials (RCTs) evaluating the effects of music-listening on the quantified pain perception of adults, and if these characteristics influence music's overall therapeutic effect. Methods: A systematic review and meta-analysis of RCTs evaluating music-listening for pain management on adults was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. The databases Pubmed, Scopus, SCIELO, SpringerLink, Global Health Library, Cochrane, EMBASE, and LILACS were searched. Studies published between 2004 and 2017 with quantified measurements of pain were included. Quality was evaluated using the Scottish Intercollegiate Guidelines Network methodology checklist for RCT, and effect sizes were reported with standardized mean differences. Results: A total of 85 studies were included for qualitative analysis but only 56.47% described at least one music characteristic. Overall meta-analysis found a significant effect, with high heterogeneity, of music for pain management (SMD -0.59, I2 = 85%). Only instrumentation characteristics (lack of lyrics, of percussion or of nature sounds), and 60–80 bpm tempo were described sufficiently for analysis. All three instrumentation characteristics had significant effects, but only the lack of lyrics showed an acceptable heterogeneity. Conclusions: Results show that music without lyrics is effective for the management of pain. Due to insufficient data, no ideal music characteristics for the management of pain were identified suggesting that music, as an intervention, needs standardization through an objective language such as that of music theory.
Aim:
This study aims to analyze and describe the effects of music listening in the management of pain in adult patients, as reported in systematic reviews and meta-analysis.
Methods:
A search of articles published between 2004 and 2017 was conducted on Pubmed, ScienceDirect, Scopus, SCIELO, SpringerLink, Global Health Library, Cochrane, EMBASE and LILACS. Search, quality assessment, and data extraction was done independently by two researchers.
Results:
Most of reviews found a significant effect of music on pain. All analyses had a high heterogeneity, and only acute pain and music delivered under general anesthesia had moderate heterogeneity. No differences were found when music was chosen by the patient. Music type and its characteristics are scantly described and in terms that lack validity.
Conclusions:
More focused trials and reviews, objective language for music, and trials with music chosen by its characteristics are required.
P values and accompanying methods of statistical significance testing are creating challenges in biomedical science and other disciplines. The vast majority (96%) of articles that report P values in the abstract, full text, or both include some values of .05 or less.¹ However, many of the claims that these reports highlight are likely false.² Recognizing the major importance of the statistical significance conundrum, the American Statistical Association (ASA) published³ a statement on P values in 2016. The status quo is widely believed to be problematic, but how exactly to fix the problem is far more contentious. The contributors to the ASA statement also wrote 20 independent, accompanying commentaries focusing on different aspects and prioritizing different solutions. Another large coalition of 72 methodologists recently proposed⁴ a specific, simple move: lowering the routine P value threshold for claiming statistical significance from .05 to .005 for new discoveries. The proposal met with strong endorsement in some circles and concerns in others.
Introduction
Concomitant with the growth of music intervention research, are concerns about inadequate intervention reporting and inconsistent terminology, which limits validity, replicability, and clinical application of findings.
Objective
Examine reporting quality of music intervention research, in chronic and acute medical settings, using the Checklist for Reporting Music-based Interventions. In addition, describe patient populations and primary outcomes, intervention content and corresponding interventionist qualifications, and terminology.
Methods
Searching MEDLINE, PubMed, CINAHL, HealthSTAR, and PsycINFO we identified articles meeting inclusion/exclusion criteria for a five-year period (2010-2015) and extracted relevant data. Coded material included reporting quality across seven areas (theory, content, delivery schedule, interventionist qualifications, treatment fidelity, setting, unit of delivery), author/journal information, patient population/outcomes, and terminology.
Results
Of 860 articles, 187 met review criteria (128 experimental; 59 quasi-experimental), with 121 publishing journals, and authors from 31 countries. Overall reporting quality was poor with < 50% providing information for four of the seven checklist components (theory, interventionist qualifications, treatment fidelity, setting).
Intervention
content reporting was also poor with <50% providing information about the music used, decibel levels/volume controls, or materials. Credentialed music therapists and registered nurses delivered most interventions, with clear differences in content and delivery. Terminology was varied and inconsistent.
Conclusions
Problems with reporting quality impedes meaningful interpretation and cross-study comparisons. Inconsistent and misapplied terminology also create barriers to interprofessional communication and translation of findings to patient care. Improved reporting quality and creation of shared language will advance scientific rigor and clinical relevance of music intervention research.
Incomplete and inadequate reporting is an avoidable waste that reduces the usefulness of research. The CONSORT (Consolidated Standards of Reporting Trials) Statement is an evidence-based reporting guideline that aims to improve research transparency and reduce waste. In 2008, the CONSORT Group developed an extension to the original statement that addressed methodological issues specific to trials of nonpharmacologic treatments (NPTs), such as surgery, rehabilitation, or psychotherapy. This article describes an update of that extension and presents an extension for reporting abstracts of NPT trials. To develop these materials, the authors reviewed pertinent literature published up to July 2016; surveyed authors of NPT trials; and conducted a consensus meeting with editors, trialists, and methodologists. Changes to the CONSORT Statement extension for NPT trials include wording modifications to improve readers' understanding and the addition of 3 new items. These items address whether and how adherence of participants to interventions is assessed or enhanced, description of attempts to limit bias if blinding is not possible, and specification of the delay between randomization and initiation of the intervention. The CONSORT extension for abstracts of NPT trials includes 2 new items that were not specified in the original CONSORT Statement for abstracts. The first addresses reporting of eligibility criteria for centers where the intervention is performed and for care providers. The second addresses reporting of important changes to the intervention versus what was planned. Both the updated CONSORT extension for NPT trials and the CONSORT extension for NPT trial abstracts should help authors, editors, and peer reviewers improve the transparency of NPT trial reports.
The roles of orexinergic system (orexin-A, orexin-B) and their receptors (orexin receptor type-1, orexin receptor type-2) in various physiological processes such as arousal, reward seeking behavior, energy homeostasis, sensory modulation, stress processing, cognition, endocrine functions, visceral functions and pain modulation have been established. This review summarizes the studies investigating orexin antinociceptive effects and their cellular mechanisms in various types of pain including neuropathic pain, migraine and cluster headache, visceral and orofacial pains. Moreover, the role of orexins in stress induced analgesia and on the development of morphine analgesic tolerance has been discussed. The antinociceptive effects of orexins have been shown in several pain models including thermal, mechanical and chemical induced nociception. Orexins modulate pain perception at both spinal and supraspinal levels. The periaqueductal gray (PAG) is one important supraspinal sites of orexin pain modulation. A possible involvement of endocannabinoids in supraspinal orexin-induced analgesia has been proposed. This review suggests a potential role of orexins in the management of pain.
Background:
Having cancer may result in extensive emotional, physical and social suffering. Music interventions have been used to alleviate symptoms and treatment side effects in cancer patients.
Objectives:
To assess and compare the effects of music therapy and music medicine interventions for psychological and physical outcomes in people with cancer.
Search methods:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 1), MEDLINE, Embase, CINAHL, PsycINFO, LILACS, Science Citation Index, CancerLit, CAIRSS, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, the RILM Abstracts of Music Literature, http://www.wfmt.info/Musictherapyworld/ and the National Research Register. We searched all databases, except for the last two, from their inception to January 2016; the other two are no longer functional, so we searched them until their termination date. We handsearched music therapy journals, reviewed reference lists and contacted experts. There was no language restriction.
Selection criteria:
We included all randomized and quasi-randomized controlled trials of music interventions for improving psychological and physical outcomes in adult and pediatric patients with cancer. We excluded participants undergoing biopsy and aspiration for diagnostic purposes.
Data collection and analysis:
Two review authors independently extracted the data and assessed the risk of bias. Where possible, we presented results in meta-analyses using mean differences and standardized mean differences. We used post-test scores. In cases of significant baseline difference, we used change scores.
Main results:
We identified 22 new trials for inclusion in this update. In total, the evidence of this review rests on 52 trials with a total of 3731 participants. We included music therapy interventions offered by trained music therapists, as well as music medicine interventions, which are defined as listening to pre-recorded music, offered by medical staff. We categorized 23 trials as music therapy trials and 29 as music medicine trials.The results suggest that music interventions may have a beneficial effect on anxiety in people with cancer, with a reported average anxiety reduction of 8.54 units (95% confidence interval (CI) -12.04 to -5.05, P < 0.0001) on the Spielberger State Anxiety Inventory - State Anxiety (STAI-S) scale (range 20 to 80) and -0.71 standardized units (13 studies, 1028 participants; 95% CI -0.98 to -0.43, P < 0.00001; low quality evidence) on other anxiety scales, a moderate to strong effect. Results also suggested a moderately strong, positive impact on depression (7 studies, 723 participants; standardized mean difference (SMD): -0.40, 95% CI -0.74 to -0.06, P = 0.02; very low quality evidence), but because of the very low quality of the evidence for this outcome, this result needs to be interpreted with caution. We found no support for an effect of music interventions on mood or distress.Music interventions may lead to small reductions in heart rate, respiratory rate and blood pressure but do not appear to impact oxygen saturation level. We found a large pain-reducing effect (7 studies, 528 participants; SMD: -0.91, 95% CI -1.46 to -0.36, P = 0.001, low quality evidence). In addition, music interventions had a small to moderate treatment effect on fatigue (6 studies, 253 participants; SMD: -0.38, 95% CI -0.72 to -0.04, P = 0.03; low quality evidence), but we did not find strong evidence for improvement in physical functioning.The results suggest a large effect of music interventions on patients' quality of life (QoL), but the results were highly inconsistent across studies, and the pooled effect size for the music medicine and music therapy studies was accompanied by a large confidence interval (SMD: 0.98, 95% CI -0.36 to 2.33, P = 0.15, low quality evidence). A comparison between music therapy and music medicine interventions suggests a moderate effect of music therapy interventions for patients' quality of life (QoL) (3 studies, 132 participants; SMD: 0.42, 95% CI 0.06 to 0.78, P = 0.02; very low quality evidence), but we found no evidence of an effect for music medicine interventions. A comparison between music therapy and music medicine studies was also possible for anxiety, depression and mood, but we found no difference between the two types of interventions for these outcomes.The results of single studies suggest that music listening may reduce the need for anesthetics and analgesics as well as decrease recovery time and duration of hospitalization, but more research is needed for these outcomes.We could not draw any conclusions regarding the effect of music interventions on immunologic functioning, coping, resilience or communication outcomes because either we could not pool the results of the studies that included these outcomes or we could only identify one trial. For spiritual well-being, we found no evidence of an effect in adolescents or young adults, and we could not draw any conclusions in adults.The majority of studies included in this review update presented a high risk of bias, and therefore the quality of evidence is low.
Authors' conclusions:
This systematic review indicates that music interventions may have beneficial effects on anxiety, pain, fatigue and QoL in people with cancer. Furthermore, music may have a small effect on heart rate, respiratory rate and blood pressure. Most trials were at high risk of bias and, therefore, these results need to be interpreted with caution.
Background & aim
Pain is a common experience for women during labor. In the present study, we compared the effect of two types of non-pharmacological pain relief methods “music therapy” and “Hoku point ice massage” on the severity of labor pain.
Methods
This prospective, randomized, controlled trial was conducted in Shahrekord, Iran, from September 2013 to June 2014. We randomly assigned 90 primiparous women who expected a normal childbirth into three groups: group “A” received music therapy, group “B” received Hoku point ice massage, and group “C” received usual labor care. At the beginning of the active phase (4 cm cervical dilation) and before and after each intervention (at dilations 4, 6, and 8 cm), the intensities of labor pain were measured using Visual Analogue Scale (VAS).
Results
At the beginning of the active phase, the mean VAS scores were 5.58 ± 1.29, 5.42 ± 1.31, and 6.13 ± 1.37 in the women in groups “A,” “B,” and “C,” respectively (P > 0.05). After the intervention, the mean pain scores were significantly lower at all of the time points in groups “A” and “B” than in group “C” women (P < 0.05). Although the pain scores showed a more decreasing trend after the intervention in group “A” than that in group “B,” the difference between the two groups was not statistically significant (P > 0.05).
Conclusions
Music therapy and Hoku point ice massage are easily available and inexpensive methods and have a similar effect in relieving labor pain.
: Primary dysmenorrhea is the most common gynecologic complaint among adolescents. Conventional treatments include nonsteroidal anti-inflammatory drugs and hormonal contraceptives, but complementary and alternative medicine is a growing area of interest. As patients seek such treatments, pediatric nurse practitioners should be aware of these options to offer the best advice to patients.
Objective
Endoscopies are common clinical examinations that are somewhat painful and even cause fear and anxiety for patients. We performed this systematic review and meta-analysis of randomized controlled trials to determine the effect of music on patients undergoing various endoscopic procedures.Methods
We searched the Cochrane Library, Issue 6, 2013, PubMed, and EMBASE databases up to July 2013. Randomized controlled trials comparing endoscopies, with and without the use of music, were included. Two authors independently abstracted data and assessed risk of bias. Subgroup analyses were performed to examine the impact of music on different types of endoscopic procedures.ResultsTwenty-one randomized controlled trials involving 2,134 patients were included. The overall effect of music on patients undergoing a variety of endoscopic procedures significantly improved pain score (weighted mean difference [WMD] = −1.53, 95% confidence interval [CI] [−2.53, −0.53]), anxiety (WMD = −6.04, 95% CI [−9.61, −2.48]), heart rate (P = 0.01), arterial pressure (P < 0.05), and satisfaction score (SMD = 1.83, 95% CI [0.76, 2.91]). Duration of the procedure (P = 0.29), except for gastrointestinal endoscopy (P = 0.03), and sedative or analgesic medication dose (P = 0.23, P = 0.12, respectively) were not significantly decreased in the music group, compared with the control group. Furthermore, music had little effect for patients undergoing colposcopy and bronchoscopy in the subanalysis.Conclusion
Our meta-analysis suggested that music may offer benefits for patients undergoing endoscopy, except in colposcopy and bronchoscopy.
Unlabelled:
The oldest known method for relieving pain is music, and yet, to date, the underlying neural mechanisms have not been studied. Here, we investigate these neural mechanisms by applying a well-defined painful stimulus while participants listened to their favorite music or to no music. Neural responses in the brain, brain stem, and spinal cord were mapped with functional magnetic resonance imaging spanning the cortex, brain stem, and spinal cord. Subjective pain ratings were observed to be significantly lower when pain was administered with music than without music. The pain stimulus without music elicited neural activity in brain regions that are consistent with previous studies. Brain regions associated with pleasurable music listening included limbic, frontal, and auditory regions, when comparing music to non-music pain conditions. In addition, regions demonstrated activity indicative of descending pain modulation when contrasting the 2 conditions. These regions include the dorsolateral prefrontal cortex, periaqueductal gray matter, rostral ventromedial medulla, and dorsal gray matter of the spinal cord. This is the first imaging study to characterize the neural response of pain and how pain is mitigated by music, and it provides new insights into the neural mechanism of music-induced analgesia within the central nervous system.
Perspective:
This article presents the first investigation of neural processes underlying music analgesia in human participants. Music modulates pain responses in the brain, brain stem, and spinal cord, and neural activity changes are consistent with engagement of the descending analgesia system.
A systematic review is a summary of existing evidence that answers a specific clinical question, contains a thorough, unbiased search of the relevant literature, explicit criteria for assessing studies and structured presentation of the results. A systematic review that incorporates quantitative pooling of similar studies to produce an overall summary of treatment effects is a meta-analysis. A systematic review should have clear, focused clinical objectives containing four elements expressed through the acronym PICO (Patient, group of patients, or problem, an Intervention, a Comparison intervention and specific Outcomes). Explicit and thorough search of the literature is a pre-requisite of any good systematic review. Reviews should have pre-defined explicit criteria for what studies would be included and the analysis should include only those studies that fit the inclusion criteria. The quality (risk of bias) of the primary studies should be critically appraised. Particularly the role of publication and language bias should be acknowledged and addressed by the review, whenever possible. Structured reporting of the results with quantitative pooling of the data must be attempted, whenever appropriate. The review should include interpretation of the data, including implications for clinical practice and further research. Overall, the current quality of reporting of systematic reviews remains highly variable.
This is the first study to use meta-analysis as a scientific technique to provide an integrated analysis of the effectiveness of music intervention in cancer patients.
The purpose of this study was, using the meta-analysis method, to present a summary of existing research and explore the effectiveness of music intervention in ameliorating anxiety, depression, pain, and fatigue in cancer patients.
The present study collected quantitative study designs sought of music intervention for cancer patients published from 2002 to 2012. These studies were then cross-referenced using Medical Subject Headings for topics on music intervention and cancer patients. Outcome indicators were anxiety, depression, pain, and fatigue. The quality of the studies was evaluated using Cochrane Collaboration Guidelines. The effect size on outcome indicators used the formula devised by Hedges and Olkin (1985).
Results showed that music interventions were significantly effective in ameliorating anxiety (g = -0.553), depression (g = -0.510), pain (g = -0.656), and fatigue (g = -0.422) in cancer patients. Subgroup analyses revealed that age and who selected the music were major factors influencing the effect size on anxiety reduction.
Music interventions significantly ameliorate anxiety, depression, pain, and fatigue in cancer patients, especially adults. Music interventions were more effective in adults than in children or adolescents and more effective when patients, rather than researchers, chose the music.
Our findings provide important information for future music-intervention planners to improve the design and processes that will benefit patients in such programs.
Marijuana has been used to relieve pain for centuries, but its analgesic mechanism has only been understood during the past two decades. It is mainly mediated by its constituents, cannabinoids, through activating central cannabinoid 1 (CB1) receptors, as well as peripheral CB1 and CB2 receptors. CB2-selective agonists have the benefit of lacking CB1 receptor-mediated CNS side effects. Anandamide and 2-arachidonoylglycerol (2-AG) are two intensively studied endogenous lipid ligands of cannabinoid receptors, termed endocannabinoids, which are synthesized on demand and rapidly degraded. Thus, inhibitors of their degradation enzymes, fatty acid amide hydrolase and monoacylglycerol lipase (MAGL), respectively, may be superior to direct cannabinoid receptor ligands as a promising strategy for pain relief. In addition to the antinociceptive properties of exogenous cannabinoids and endocannabinoids, involving their biosynthesis and degradation processes, we also review recent studies that revealed a novel analgesic mechanism, involving 2-AG in the periaqueductal gray (PAG), a midbrain region for initiating descending pain inhibition. It is initiated by Gq-protein-coupled receptor (GqPCR) activation of the phospholipase C (PLC)-diacylglycerol lipase (DAGL) enzymatic cascade, generating 2-AG that produces inhibition of GABAergic transmission (disinhibition) in the PAG, thereby leading to analgesia. This GqPCR-PLC-DAGL-2-AG retrograde disinhibition mechanism in the PAG can be initiated by activating type 5 metabotropic glutamate receptor (mGluR5), muscarinic acetylcholine (M1/M3), and orexin (OX1) receptors. mGluR5-mediated disinhibition can be initiated by glutamate transporter inhibitors, or indirectly by substance P, neurotensin, cholecystokinin, capsaicin, and AM404, the bioactive metabolite of acetaminophen in the brain. The putative role of 2-AG generated after activating the above neurotransmitter receptors in stress-induced analgesia is also discussed.
The efficacy of music for the treatment of pain has not been established.
To evaluate the effect of music on acute, chronic or cancer pain intensity, pain relief, and analgesic requirements.
We searched The Cochrane Library, MEDLINE, EMBASE, PsycINFO, LILACS and the references in retrieved manuscripts. There was no language restriction.
We included randomized controlled trials (RCTs) that evaluated the effect of music on any type of pain in children or adults. We excluded trials that reported results of concurrent non-pharmacological therapies.
Data was extracted by two independent review authors. We calculated the mean difference in pain intensity levels, percentage of patients with at least 50% pain relief, and opioid requirements. We converted opioid consumption to morphine equivalents. To explore heterogeneity, studies that evaluated adults, children, acute, chronic, malignant, labor, procedural, or experimental pain were evaluated separately, as well as those studies in which patients chose the type of music.
Fifty-one studies involving 1867 subjects exposed to music and 1796 controls met inclusion criteria.In the 31 studies evaluating mean pain intensity there was a considerable variation in the effect of music, indicating statistical heterogeneity ( I(2) = 85.3%). After grouping the studies according to the pain model, this heterogeneity remained, with the exception of the studies that evaluated acute postoperative pain. In this last group, patients exposed to music had pain intensity that was 0.5 units lower on a zero to ten scale than unexposed subjects (95% CI: -0.9 to -0.2). Studies that permitted patients to select the music did not reveal a benefit from music; the decline in pain intensity was 0.2 units, 95% CI (-0.7 to 0.2).Four studies reported the proportion of subjects with at least 50% pain relief; subjects exposed to music had a 70% higher likelihood of having pain relief than unexposed subjects (95% CI: 1.21 to 2.37). NNT = 5 (95% CI: 4 to 13). Three studies evaluated opioid requirements two hours after surgery: subjects exposed to music required 1.0 mg (18.4%) less morphine (95% CI: -2.0 to -0.2) than unexposed subjects. Five studies assessed requirements 24 hours after surgery: the music group required 5.7 mg (15.4%) less morphine than the unexposed group (95% CI: -8.8 to -2.6). Five studies evaluated requirements during painful procedures: the difference in requirements showed a trend towards favoring the music group (-0.7 mg, 95% CI: -1.8 to 0.4).
Listening to music reduces pain intensity levels and opioid requirements, but the magnitude of these benefits is small and, therefore, its clinical importance unclear.
THIS article is from the manuscript of an address delivered by the national chairman of the MENC Committee on Functional Music at the Functional Music Forum, March 21, at the St. Louis Biennial Convention. Dr. Gaston is professor of music education and chairman of the department at the University of Kansas, Lawrence.
Music has served as an auxiliary analgesic in perioperative settings. This study evaluates the impact of intraoperative music added to routine pain control measures during first trimester surgical abortion.
We analyzed data from 101 women randomized to undergo abortion with routine pain control measures only (ibuprofen and paracervical block) or with the addition of intraoperative music via headphones. The primary outcome was the change in preoperative and postoperative pain scores on a 100-mm visual analog scale. Secondary outcomes included change in anxiety and vital signs, and satisfaction.
Baseline characteristics were similar between groups. The magnitude of increase in pain scores was greater in the intervention than in the control group (+51.0 mm versus +39.3 mm, p=.045). Overall pain control was rated as good or very good by 70% of the intervention and 75% of the control group (p=.65).
Intraoperative music added to routine pain control measures increases pain reported during abortion.
To evaluate the prevalence, impact and treatment of primary dysmenorrhea among Mexican university students.
A multiple-choice questionnaire was administered to 1539 students in six university programs: medicine, nursing, nutrition, dentistry, pharmacy and psychology. Data on the presence, severity, symptoms, treatment and limitations caused by dysmenorrhea were obtained and analyzed.
The mean+/-SD age of the women was 20.4+/-2.0 years; the mean age of menarche was 12.3+/-1.5 years. A total of 64% of the women experienced dysmenorrhea. Dysmenorrhea was more prevalent among nutrition and psychology students than among medicine, pharmacy and dentistry students (p<0.05). Dysmenorrhea was mild in 36.1% of women, moderate in 43.8% and severe in 20.1%. Nursing students showed an intensity of pain that was significantly higher than that of medicine and dentistry students (p<0.05). Sixty-five percent of the women with dysmenorrhea reported that it limited their daily activities, and 42.1% reported school absenteeism (SA) as a result. Of those who experienced dysmenorrhea, 25.9% consulted a physician, and 61.7% practiced self-medication (SM). The most common medications used were an over-the-counter (OTC) medication with paracetamol (an analgesic), pamabrom (a diuretic), and pyrilamine (a histamine antagonist), another OTC with metamizol (a non-steroidal anti-inflammatory drug [NSAID]) plus butylhioscine (an antispasmodic drug) and naproxen (a NSAID). Of those women using prescribed medications, 18.4% reported complete remission of their symptoms, while 78.1% reported little to moderate alleviation, and 3.6% reported no effect on their menstrual distress. Similarly, of the women who practiced SM, 23.4% reported complete relief, 75.5% reported little to moderate effectiveness, and 1.0% reported no efficacy.
The prevalence of dysmenorrhea among Mexican university students is high, and the pain that these women suffer can be severe, disabling and result in short-term SA. The pain is often not completely relieved despite the use of medication. It is necessary to improve the therapeutic options for relief of pain caused by dysmenorrhea and to minimize the impact of dysmenorrhea on social, economic and school activities.
Statistical tests of heterogeneity and bias, in particular publication bias, are very popular in meta-analyses. These tests use statistical approaches whose limitations are often not recognized. Moreover, it is often implied with inappropriate confidence that these tests can provide reliable answers to questions that in essence are not of statistical nature. Statistical heterogeneity is only a correlate of clinical and pragmatic heterogeneity and the correlation may sometimes be weak. Similarly, statistical signals may hint to bias, but seen in isolation they cannot fully prove or disprove bias in general, let alone specific causes of bias, such as publication bias in particular. Both false-positive and false-negative signals of heterogeneity and bias can be common and their prevalence may be anticipated based on some rational considerations. Here I discuss the major common challenges and flaws that emerge in using and interpreting statistical tests of heterogeneity and bias in meta-analyses. I discuss misinterpretations that can occur at the level of statistical inference, clinical/pragmatic inference and specific cause attribution. Suggestions are made on how to avoid these flaws, use these tests properly and learn from them.
After cesarean section surgery, routine pharmacologic methods of analgesia--opioids and benzodiazepines--may impair the immediate close contact of mother and neonate for their sedative and emetic effects.
The aim of this study was to explore the effect of patient-selected music on postoperative pain, anxiety, opioid requirement, and hemodynamic profile.
A total of 80 patients, American Society of Anesthesiologists (ASA) physical status I-II, scheduled to undergo general anesthesia and elective cesarean section surgery were enrolled. Patients were randomly allocated to receive 30 minutes of music or silence via headphones postoperatively. Pain and anxiety were measured with a visual analogue scale. Total postoperative morphine requirement as well as blood pressure and heart rate were recorded after the intervention period.
Pain score and postoperative cumulative opioid consumption were significantly lower among patients in the music group (p < 0.05), while there were no group differences in terms of anxiety score, blood pressure, or heart rate (p > 0.05).
Postoperative use of patient-selected music in cesarean section surgery would alleviate the pain and reduce the need for other analgesics, thus improving the recovery and early contact of mothers with their children.
This experimental study compared the effects of jaw relaxation and music, individually and combined, on sensory and affective pain following surgery. Abdominal surgical patients (N = 84) were randomly assigned to four groups: relaxation, music, a combination of relaxation and music, and control. Interventions were taught preoperatively and used by subjects during the first ambulation after surgery. Indicators of the sensory component of pain were sensation and 24-hour narcotic intake. Indicators of the affective component of pain were distress and anxiety of pain. With preambulatory sensation, distress, narcotic intake, and preoperative anxiety as covariates, the four groups were compared using orthogonal a priori contrasts and analysis of covariance. The interventions were neither effective nor significantly different from one another during ambulation. However, after keeping the taped interventions for 2 postoperative days, 89% of experimental subjects reported them helpful for sensation and distress of pain.
One acoustic feature that plays an important role in pitch perception is frequency. Studies on the processing of frequency in the human and animal brain have shown that the auditory cortex is tonotopically organized: low frequencies are represented laterally whereas high frequencies are represented medially. To date, the study of the functional organization of the human auditory cortex in the processing of frequency has been limited to the use of either scalp-recorded auditory evoked potentials (AEPs), which have relatively poor spatial resolving power, or functional imagery techniques, which have poor temporal resolving power. The present study uses intracerebrally recorded AEPs to explore this topic in the primary and secondary auditory cortices of both hemispheres of the human brain. Recordings were carried out in 45 adult patients with drug-resistant partial seizures. In the right hemisphere, clear spectrally organized tonotopic maps were observed with distinct separations between different frequency-processing regions. AEPs for high frequencies were recorded medially, whereas AEPs for low frequencies were recorded laterally. In the left hemisphere, however, this tonotopic organization was less evident, with different regions involved in the processing of a range of frequencies. The hemisphere-related difference in the processing of tonal frequency is discussed in relation to pitch perception.
Open-heart surgery patients report anxiety and pain with chair rest despite opioid analgesic use. The effectiveness of non-pharmacological complementary methods (sedative music and scheduled rest) in reducing anxiety and pain during chair rest was tested using a three-group pretest-posttest experimental design with 61 adult postoperative open-heart surgery patients. Patients were randomly assigned to receive 30 min of sedative music (N=19), scheduled rest (N=21), or treatment as usual (N=21) during chair rest. Anxiety, pain sensation, and pain distress were measured with visual analogue scales at chair rest initiation and 30 min later. Repeated measures MANOVA indicated significant group differences in anxiety, pain sensation, and pain distress from pretest to posttest, P<0.001. Univariate repeated measures ANOVA (P< or =0.001) and post hoc dependent t-tests indicated that in the sedative music and scheduled rest groups, anxiety, pain sensation, and pain distress all decreased significantly, P<0.001-0.015; while in the treatment as usual group, no significant differences occurred. Further, independent t-tests indicated significantly less posttest anxiety, pain sensation, and pain distress in the sedative music group than in the scheduled rest or treatment as usual groups (P<0.001-0.006). Thus, in this randomized control trial, sedative music was more effective than scheduled rest and treatment as usual in decreasing anxiety and pain in open-heart surgery patients during first time chair rest. Patients should be encouraged to use sedative music as an adjuvant to medication during chair rest.
The perception of pain due to an acute injury or in clinical pain states undergoes substantial processing at supraspinal levels. Supraspinal, brain mechanisms are increasingly recognized as playing a major role in the representation and modulation of pain experience. These neural mechanisms may then contribute to interindividual variations and disabilities associated with chronic pain conditions.
To systematically review the literature regarding how activity in diverse brain regions creates and modulates the experience of acute and chronic pain states, emphasizing the contribution of various imaging techniques to emerging concepts.
MEDLINE and PRE-MEDLINE searches were performed to identify all English-language articles that examine human brain activity during pain, using hemodynamic (PET, fMRI), neuroelectrical (EEG, MEG) and neurochemical methods (MRS, receptor binding and neurotransmitter modulation), from January 1, 1988 to March 1, 2003. Additional studies were identified through bibliographies.
Studies were selected based on consensus across all four authors. The criteria included well-designed experimental procedures, as well as landmark studies that have significantly advanced the field.
Sixty-eight hemodynamic studies of experimental pain in normal subjects, 30 in clinical pain conditions, and 30 using neuroelectrical methods met selection criteria and were used in a meta-analysis. Another 24 articles were identified where brain neurochemistry of pain was examined. Technical issues that may explain differences between studies across laboratories are expounded. The evidence for and the respective incidences of brain areas constituting the brain network for acute pain are presented. The main components of this network are: primary and secondary somatosensory, insular, anterior cingulate, and prefrontal cortices (S1, S2, IC, ACC, PFC) and thalamus (Th). Evidence for somatotopic organization, based on 10 studies, and psychological modulation, based on 20 studies, is discussed, as well as the temporal sequence of the afferent volley to the cortex, based on neuroelectrical studies. A meta-analysis highlights important methodological differences in identifying the brain network underlying acute pain perception. It also shows that the brain network for acute pain perception in normal subjects is at least partially distinct from that seen in chronic clinical pain conditions and that chronic pain engages brain regions critical for cognitive/emotional assessments, implying that this component of pain may be a distinctive feature between chronic and acute pain. The neurochemical studies highlight the role of opiate and catecholamine transmitters and receptors in pain states, and in the modulation of pain with environmental and genetic influences.
The nociceptive system is now recognized as a sensory system in its own right, from primary afferents to multiple brain areas. Pain experience is strongly modulated by interactions of ascending and descending pathways. Understanding these modulatory mechanisms in health and in disease is critical for developing fully effective therapies for the treatment of clinical pain conditions.
Music should not be considered a first line treatment for pain relief as the magnitude of its benefits is small. Listening to music for treatment of pain offers potential advantages of low cost, ease of provision, and safety. This systematic review included 51 studies involving 3663 subjects. The review authors found that music reduced pain, increased the number of patients who reported at least 50% pain relief, and reduced requirements for morphine-like analgesics. However, as the magnitude of these positive effects is small, the clinical relevance of music for pain relief in clinical practice is unclear
Dysmenorrhea is the most common gynecologic complaint among adolescent and young adult females. Dysmenorrhea in adolescents and young adults is usually primary (functional), and is associated with normal ovulatory cycles and with no pelvic pathology. In approximately 10% of adolescents and young adults with severe dysmenorrhea symptoms, pelvic abnormalities such as endometriosis or uterine anomalies may be found. Potent prostaglandins and potent leukotrienes play an important role in generating dysmenorrhea symptoms. Nonsteroidal anti-inflammatory drugs (NSAID) are the most common pharmacologic treatment for dysmenorrhea. Adolescents and young adults with symptoms that do not respond to treatment with NSAIDs for 3 menstrual periods should be offered combined estrogen/progestin oral contraceptive pills for 3 menstrual cycles. Adolescents and young adults with dysmenorrhea who do not respond to this treatment should be evaluated for secondary causes of dysmenorrhea. The care provider's role is to explain about pathophysiology of dysmenorrhea to every adolescent and young adult female, address any concern that the patient has about her menstrual period, and review effective treatment options for dysmenorrhea with the patient.
Neurocognitive research has the potential to identify the relevant effects of music therapy. In this study, we examined the effect of music mode (major vs. minor) on stress reduction using optical topography and an endocrinological stress marker. In salivary cortisol levels, we observed that stressful conditions such as mental fatigue (thinking and creating a response) was reduced more by major mode music than by minor mode music. We suggest that music specifically induces an emotional response similar to a pleasant experience or happiness. Moreover, we demonstrated the typical asymmetrical pattern of stress responses in upper temporal cortex areas, and suggested that happiness/sadness emotional processing might be related to stress reduction by music.
Music has been utilized as a therapeutic tool during colonoscopy, but various randomized controlled trials (RCTs) have been inconsistent. We conducted a meta-analysis to analyze the effect of music on patients undergoing colonoscopy.
Multiple medical databases were searched (12/06). Only RCTs on adult subjects that compared music versus no music during colonoscopy were included. Meta-analysis was analyzed for total procedure time, dose of sedative medications (midazolam and mepiridine), and patients' pain scores, experience, and willingness to repeat the same procedure in the future.
Eight studies (N = 712) met the inclusion criteria. Patients' overall experience scores (P < 0.01) were significantly improved with music. No significant differences were noted for patients' pain scores (P = 0.09), mean doses of midazolam (P = 0.10), mean doses of meperidine (P = 0.23), procedure times (P = 0.06), and willingness to repeat the same procedure in future (P = 0.10).
Music improves patients' overall experience with colonoscopy.
Review article: Targeting the cannabinoid system for pain relief?
- L.-C Chiou
- S S Hu
- .-J Ho
Chiou, L.-C., Hu, S. S.-J., & Ho, Y.-C. (2013). Review article: Targeting the cannabinoid system for
pain relief? Acta Anaesthesiologica Taiwanica, 51(4), 161-170. https://doi.org/10.1016/j.aat.2013.
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Voice classification and fach: Recent, historical and conflicting systems of voice 480
- S Cotton
Cotton, S. (2007). Voice classification and fach: Recent, historical and conflicting systems of voice
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