Music/Music Therapy

Music/Music Therapy

PEP Topic 
Acute Pain
Description 

Music therapy involves using music to influence physiologic, psychological, and emotional functioning. Music therapy is often used with other behavioral techniques, such as relaxation. Music interventions vary and range from simply listening to recorded music or live music to formal therapy sessions provided by music therapists. Professional music therapy involves individualization of the intervention; may include the patient in music making; and incorporates a systematic therapeutic process of assessment, treatment, and evaluation. Music and music therapy have been evaluated for effects on anxiety, chemotherapy-induced nausea and vomiting, depression, dyspnea, pain, fatigue, and caregiver strain and burden.

Likely to Be Effective

Systematic Review/Meta-Analysis

Archie, P., Bruera, E., & Cohen, L. (2013). Music-based interventions in palliative cancer care: A review of quantitative studies and neurobiological literature. Supportive Care in Cancer, 21, 2609–2624.

doi: 10.1007/s00520-013-1841-4
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Purpose:

STUDY PURPOSE: To review the evidence for efficacy of music interventions for patients with cancer receiving palliative care and review the neurobiological evidence to explain pathways by which music may have an effect

TYPE OF STUDY: Systematic review

Search Strategy:

DATABASES USED: PubMed, CINAHL, Plus, Ovid, PsycINFO, PoQuest, and the Cochrane Library

KEYWORDS:  music; music therapy; cancer; oncology; palliative care; pain; anxiety; depression; mood; quality of life; neuroscience; endogenous opioids; dopamine; GABA; 5HT; permutations

INCLUSION CRITERIA: RCT; meta-analysis or systematic review from 1970–2012

EXCLUSION CRITERIA: Not reported

Literature Evaluated:

TOTAL REFERENCES RETRIEVED: Not reported

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Not reported

Sample Characteristics:

  • FINAL NUMBER STUDIES INCLUDED = six studies regarding pain, eight studies for anxiety, four studies regarding quality of life, four studies involving effect on mood, and eight studies exploring the neurobiologic evidence
  • SAMPLE RANGE ACROSS STUDIES, TOTAL PATIENTS INCLUDED IN REVIEW = 527 in pain (range: 30–136) and 410 for anxiety (range: 20–136)
  • KEY SAMPLE CHARACTERISTICS: Samples included adults and children. Most interventions were done during a diagnostic or other procedure.

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Multiple phases of care     
  • APPLICATIONS: Palliative care

Results:

In the acute pain setting, music had a moderate analgesic effect with SMD of -.059, 95% CI -0.90, -0.27 (p = .0003). Effect for chronic pain is not known and has not been well studied. The study cites results of a Cochrane review of effects of music on anxiety (SMD -11.2, p = .0088). It is noted that effect on anxiety only has been studied in the acute, situational setting. Longer-term effects and application in palliative care are unknown. Review of neurobiologic evidence suggests that music may affect specific pathways that are implicated in the pathophysiology of pain, anxiety, and depression.

Conclusions:

Music interventions have a moderate positive effect on procedural pain and acute, situational anxiety.

Limitations:

  • This review does not report results of the literature search nor any quality evaluation of manuscripts retrieved. 
  • For pain analysis, no description is provided of methods to calculate SMD or any findings regarding heterogeneity. 
  • For anxiety, this report just repeats findings from a previous Cochrane review. 
  • Although inclusion criteria stated RCT, the authors did include at least one single-group trial in the review.

Nursing Implications:

Music may be helpful to reduce acute anxiety and procedure-related pain. This is a simple intervention nurses could use in a variety of settings. Longer-term effects and effects in different situations are not known.

Bradt, J., Dileo, C., Grocke, D., & Magill, L. (2011). Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database of Systematic Reviews, 8, CD006911.
 
 
doi:10.1002/14651858.CD006911.pub2
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Purpose:

STUDY PURPOSE: To examine the effects of music therapy or music medicine interventions on psychological and physical outcomes in patients with cancer

STUDY TYPE: Systematic review

Search Strategy:

DATABASES USED: Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2010, Issue 10), MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, Science Citation Index, CANCERLIT, MusicTherapyWorld.net, CAIRSS, and ProQuest Digital

KEYWORDS: Music therapy, cancer, and neoplasm

INCLUSION CRITERIA:

  • Randomized, controlled trials or quasi-experimental designs
  • Patients diagnosed with any type of cancer
  • Comparison of the music intervention with standard care alone or in combination with other treatments or placebos

EXCLUSION CRITERIA: Not specified

Literature Evaluated:

TOTAL REFERENCES RETRIEVED: 773

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Study quality was assessed by the authors with a scale developed and described in this study.

Sample Characteristics:

  • FINAL NUMBER STUDIES INCLUDED = 36 (involving 30 clinical trials)
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,891
  • SAMPLE RANGE ACROSS STUDIES: 8–260 patients

Results:

Psychological Effects
  • Distress: Two trials examined the involvement of adolescents and children in creating music videos when undergoing stem cell transplantation. The intervention was associated with a nonsignificant lower mean distress score.
  • Depression: Five trials were included in a meta-analysis. The pooled estimates did not support any effects of music interventions.
  • Body image: One study of 11 women with breast cancer showed that a music intervention was more effective than a cognitive behavioral intervention in improving body image.
  • Mood: Pooled estimates from three trials suggest that music interventions may improve mood. Results were inconsistent.
Physical Effects
  • Pain: Seven trials compared music interventions to standard care. Five of these studies included in the meta-analysis showed a moderate effect of music on pain (standard mean difference = -0.59, 95% CI, -0.92 – -0.27, p = 0.0003).
  • Respiratory rate: Two trials showed that music may reduce respiratory rate (mean difference = 2.34, 95% CI, -4.51 – -0.17, p = 0.03).
  • No overall significant positive effects were seen for fatigue, physical status, blood pressure, oxygen saturation, immune function, or quality of life.
General Findings
  • Seventeen studies used prerecorded music, and 13 trials involved active patient participation.
  • The frequency and duration of interventions varied widely, and in studies with prerecorded music, there was little description of the music was used or selected.
  • A large number of the studies had a high risk of bias in the trial methodology.

Conclusions:

Music therapy may have a beneficial effect on anxiety, mood, and quality of life. No effect was seen on fatigue or general physical status. Music therapy appears to have a moderate pain-reducing effect.

Nursing Implications:

The use of music therapy as adjunct therapy for pain management can be beneficial for patients with cancer-related pain. The timing of the intervention and approach used should be considered as one study showed that patients using music for procedure-related pain did not like wearing headphones as it interfered with their communication with the procedural physician and caused higher anxiety. More research to determine the relationship of frequency, duration, and type of music on outcomes is needed.

Cepeda, M.S., Carr, D.B., Lau, J., & Alvarez, H. (2010). Music for pain relief. Cochrane Database of Systematic Reviews 2010(8).

doi: 10.1002/14651858.CD004843.pub2
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Purpose:

To evaluate the effect of listening to music on acute or chronic cancer pain; to relate the effect of listening to music on analgesic requirements

Search Strategy:

  • Databases searched were the Cochrane Pain, Palliative & Supportive Care Group Trials Register and the Cochrane Central Register of Controlled Trials (Sept. 14, 2004); MEDLINE (1966–Oct. 4, 2004); EMBASE (1980–Sept. 15, 2004); PsycINFO (1985–Sept. 24, 2004); and LILACS (1982–Sept. 8, 2004).
  • Search keywords included free text, MeSH, and Emtree terms: music, music therapy, analges*, and pain. The report provides an extensive list of search terms.
  • Studies were included if they
    • Were randomized controlled trials.
    • Evaluated the effect of music on acute, chronic neuropathic cancer pain or experimental pain in children or adults.
    • Involved evaluation of pain intensity, pain relief, global improvement, or opioid requirement.
  • Studies were excluded if a music intervention was combined with any nonpharmaceutical approach to pain.

Literature Evaluated:

  • Investigators retrieved 113 studies, 62 of which the investigators excluded.
  • Authors assessed study quality by scoring subject assignment, study blinding, dropout rate, and intention-to-treat analysis.

Sample Characteristics:

  • The final sample included 51 studies.
  • The 51 studies comprised 1,867 patients who received a music intervention and 1,796 control patients, who did not.
  • Eight studies evaluated the use of music to treat the pain of children and neonates.
  • The range of patients in a sample was 11–233. Median sample size was 53.
  • Samples included patients with chronic pain, acute pain, postoperative pain, and labor pain.

Results:

  • Pain intensity: Meta-analysis involved 30 studies that used the same scale of pain intensity. The pooled estimate of effect was a 0.46 reduction on a 0–10 point scale (95% CI = –0.75 through –0.17, not significant). The studies comprised significant heterogeneity, and authors' analysis showed that one study had a major influence on overall effect size. When this study was removed, the effect of music was deleterious, being associated with a pain increase of 0.3.
  • Studies of children: In the eight studies of children, four studies did not provide quantitative data. Overall, no effect on pain proved significant, though some positive results were reported.
  • Pain relief: Four studies showed that 70% of those who used music had a greater probability of at least a 50% reduction in pain, relative risk (RR) – 1.70 (95% CI 1.21–2.37, p = 0.002).
  • Opioid requirement: Thirteen studies evaluated differences in opioid requirements. These studies were of patients who had procedural or postoperative pain. The mean difference (MD) supported use of the music intervention: –1.29, (95% CI –2.22 through –0.37, p = 0.006)
  • Authors judged that half the analyzed studies were of low quality. Authors noted a high level of heterogeneity in most subgroup analyses.

Conclusions:

Music has limited utility in clinical practice for pain reduction: A music intervention was associated with minimal reduction in pain intensity. A music intervention was associated with a small reduction in opioid use for the treatment of acute pain. The reduction was smaller than that associated with the use of an NSAID or paracetamol.

Nursing Implications:

The analysis provided little support for the effectiveness of music in the reduction of pain: The size of effects is small, and their clinical relevance is unclear. On the other hand, the analysis revealed no negative effects from the music intervention. Clinicians should be aware of the limited utility of music for pain management. Most of the studies in the analysis did not include patients with cancer; however, the highest effect sizes were in the setting of chronic pain, so a music intervention may be relevant to patients with cancer. Use of music along with other nonpharmaceutical and maximal pharmaceutical pain management may be helpful for some patients. Further research in this area would be useful.

Keenan, A., & Keithley, J.K. (2015). Integrative review: Effects of music on cancer pain in adults. Oncology Nursing Forum, 42, E368–E675. 

doi: 10.1188/15.ONF.E368-E375
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Purpose:

STUDY PURPOSE: To evaluate published evidence regarding the effects of music on cancer-related pain 

TYPE OF STUDY: Systematic review

Search Strategy:

DATABASES USED: PubMed, CINAHL, and Scopus
 
KEYWORDS: Pain, neoplasm, music, music therapy, complementary therapies, and randomized clinical trial
 
INCLUSION CRITERIA: Patients aged 21 years or older; experimental studies specifically to investigate music as an intervention for cancer related pain
 
EXCLUSION CRITERIA: Cognitive impairment among patients

Literature Evaluated:

TOTAL REFERENCES RETRIEVED: 82
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: No evaluation of study quality was reported.

Sample Characteristics:

  • FINAL NUMBER STUDIES INCLUDED =  5
  • TOTAL PATIENTS INCLUDED IN REVIEW = 248
  • SAMPLE RANGE ACROSS STUDIES: 9–126 patients

Phase of Care and Clinical Applications:

PHASE OF CARE: Multiple phases of care
 
APPLICATIONS: Palliative care 

Results:

Out of the five studies included, two showed significant differences in self-reported pain scores associated with the music intervention. Most studies were done outside of the United States, and in most studies, patients were offered a limited variety of prerecorded music for listening.

Conclusions:

This review showed mixed results regarding the effects of listening to music on pain among patients with cancer in various phases of care.

Limitations:

  • There were few studies included.
  • There was no evaluation of study quality.
  • Three out of five studies were done prior to 2000.

Nursing Implications:

This review did not add substantially to the body of evidence regarding the use of music for cancer-related pain. There are a number of more recent studies that have shown greater efficacy and are of higher quality than those reviewed here.

Rheingans, J.I. (2007). A systematic review of nonpharmacologic adjunctive therapies for symptom management in children with cancer. Journal of Pediatric Oncology Nursing: Official Journal of the Association of Pediatric Oncology Nurses, 24(2), 81–94.

doi: 10.1177/1043454206298837
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Purpose:

To assist the health care practitioner by summarizing research studies that have examined the use of nonpharmacologic adjunctive therapies (NATs) for symptom management in pediatric oncology patients

Search Strategy:

  • Databases searched were Cochrane Library, PubMed, CINAHL, and PsycINFO.
  • Authors included an extensive list of search keywords. Of particular relevance to the pediatric oncology setting were pain, cancer, oncology, self-care, nausea, vomiting, fatigue, and coping.
  • Studies were included if they dealt with nonpharmacologic therapies to help alleviate symptoms associated with cancer treatment in children.

Literature Evaluated:

Investigators retrieved and reviewed 41 studies. Their review related to symptoms studied, modalities used, study design, sample size, and study results. The analysis included all 41 studies. The studies pertained to multiple modalities, including hypnosis, imagery, breathing, distraction, relaxation, cognitive behavioral therapy, art therapy, and music therapy.

Sample Characteristics:

  • Sample sizes ranged from N – 1 to 122 patients.
  • Across studies, participants included in the samples were pediatric patients receiving chemotherapy, needlesticks, radiation, lumbar punctures, bone marrow aspiration, IV insertion, MRI, or port placement for the treatment of unspecified disease.

Results:

Over all the studies, the results are mixed in regard to the effect of NATs on procedural pain. Some studies indicated that hypnosis produced promising results in reducing procedural pain. Cognitive behavioral therapy and distraction showed both an effect and no effect on pain. One study (based on observation and self-reporting) indicated that NATs had no effect on procedural pain. In a few studies, hypnosis (along with distraction and relaxation and cognitive behavioral therapy) produced significant pain reduction. Studies found that music therapy had little to no effect on the pain of bone marrow aspiration.

Conclusions:

This review of NATs produced mixed results.

Limitations:

  • The samples studied were inconsistent in regard to modality.
  • Some terms (e.g., anxiety and distress) were found to be interchangeable; on the other hand, hypnosis encompassed several definitions.
  • The sample size of some of the studies was small.
  • In the pediatric populations studied, the intervention provider (patient, professional, or parent) was unclear.

Nursing Implications:

More research needs to be done in this area. Health care practitioners, patients, and families need education about NATs and their application to pediatric oncology.

Tsai, H.F., Chen, Y.R., Chung, M.H., Liao, Y.M., Chi, M.J., Chang, C.C., & Chou, K.R. (2014). Effectiveness of music intervention in ameliorating cancer patients' anxiety, depression, pain, and fatigue: A meta-analysis. Cancer Nursing, 37, E35–E50.

doi: 10.1097/NCC.0000000000000116
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Purpose:

STUDY PURPOSE: To evaluate the effects of music on symptoms in patients with cancer

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy:

DATABASES USED: Ovid, PsycARTICLES, and PsycINFO (2002–2012)

KEYWORDS: neoplasms, cancer, and music or melody

INCLUSION CRITERIA: Used a music intervention in patients with cancer; quantitative methods; quasi-experimental or experimental design; reported statistical information to describe results; evaluated effects on anxiety, depression, pain, or fatigue

EXCLUSION CRITERIA: Qualitative design, case studies, or single-group studies

Literature Evaluated:

TOTAL REFERENCES RETRIEVED = 367

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Quality assessment with adapted Cochrane guidelines; the k value between reviewers was 0.9.

Sample Characteristics:

  • FINAL NUMBER STUDIES INCLUDED =  21–17 for anxiety, 8 for depression, 6 for pain, and 5 for fatigue
  • SAMPLE RANGE ACROSS STUDIES = 32–126

Phase of Care and Clinical Applications:

  • APPLICATIONS: Pediatrics, palliative care

Results:

For anxiety, music therapy had a moderate and significant effect with an effect size of -0.553 (Hedges; g) (95% CI -0.716, -0.398). There was significant heterogeneity in the sample. For depression, music therapy moderately and significantly reduced depression with an effect size for each study ranging from -0.151 to -0.787. Results were homogenous. Five of eight studies showed significant effects. For pain, music had an overall effect size of -0.656 (Hedges' g) (95% CI -1.016 to about -0.295), showing moderate-level effects on pain. There was significant heterogeneity among studies. For fatigue, music therapy had a small effect size of -0.422 (Hedges' g) (95% CI -0.669, -0.175). Results were homogenous. Studies were seen to be of good quality. Results of subgroup analysis suggest that music therapy is more effective in adults than children and more beneficial when the music is selected by the patient rather than the therapist.

Conclusions:

This analysis shows that music interventions can reduce anxiety, depression, pain, and fatigue in patients with cancer with small-to-moderate effect sizes.

Limitations:

In several areas, there was high heterogeneity. Sample sizes, timing, and types of music interventions varied substantially, and, in most, the impact was evaluated immediately after the music intervention. Whether music has ongoing effectiveness with continued use or any lasting effect on the symptoms assessed is unclear.

Nursing Implications:

Music interventions can be a good adjunctive and non-medication therapy that is of benefit in reducing anxiety, depression, pain, and fatigue in patients with cancer. The most beneficial ways and times to use music therapy are unclear. Nurses can suggest that patients use listening to music as part of self-care and can advocate for use of music as a low-risk intervention to ameliorate acute anxiety and pain symptoms.

Research Evidence Summaries

Bradt, J., Potvin, N., Kesslick, A., Shim, M., Radl, D., Schriver, E., . . . Komarnicky-Kocher, L.T. (2015). The impact of music therapy versus music medicine on psychological outcomes and pain in cancer patients: A mixed methods study. Supportive Care in Cancer, 23, 1261–1271. 

doi: 10.1007/s00520-014-2478-7
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Study Purpose:

To compare the effects of music therapy and music medicine on pain and psychological outcomes, and to explore relevant patient experiences

Intervention Characteristics/Basic Study Process:

Patients were randomly assigned to receive either two music therapy or two music medicine interventions during a two-week timeframe. After two weeks, subjects were crossed over to the other intervention. Music therapy was provided by a certified therapist and included a brief discussion of patients' concerns followed by the provision of live music based on assessed needs. Participants were invited to play an instrument, participate in breathing exercises, and express thoughts and emotions. Music medicine involved providing music based on preferences. Patients were asked not to engage in any other activity during listening. A blinded assessor interviewed patients after each music session and after the final session. Verbatim transcripts were analyzed by two coders to identify reported benefits or harms from descriptions of the experience.

Sample Characteristics:

  • N = 31  
  • MEAN AGE = 53.8 years (range = 32–88 years)
  • MALES: 22.3%, FEMALES: 67.7%
  • KEY DISEASE CHARACTERISTICS: Multiple tumor types with breast being most common
  • OTHER KEY SAMPLE CHARACTERISTICS: 77% had high school or less education; 74.2% African American; 71% outpatient; and 29% inpatient

Setting:

  • SITE: Single site  
  • SETTING TYPE: Multiple settings    
  • LOCATION: Philadelphia, PA

Phase of Care and Clinical Applications:

  • APPLICATIONS: Palliative care 

Study Design:

Single-blinded, randomized crossover trial

Measurement Instruments/Methods:

  • 100 mm Visual Analog Scale (VAS) for mood and anxiety
  • 11-point Numeric Rating Scale (NRS) for pain

Results:

Anxiety was reduced by 15 points with music therapy and 12 points with music medicine (p < 0.0001). There was no difference between the two conditions. Pain was reduced by 0.9–1.1 points (p < 0.0005) with no difference between the groups. Common themes from the qualitative analysis were experiencing the music as relaxing, peaceful, and soothing, and many patients appreciated the playful nature of interactive therapy sessions.

Conclusions:

Both music therapy and listening to preferred music were associated with reductions in pain and anxiety.

Limitations:

  • Small sample (< 100)
  • Risk of bias (sample characteristics)
  • Other limitations/explanation: The sample was predominantly African American. Although findings were statistically significant, the actual change in outcomes measured was small. Whether this level of change was clinically meaningful was not clear. VAS measurement for anxiety has questionable reliability. The context in which patients were involved was not stated, so there was no way to determine whether patients were in anxiety-producing situations.

Nursing Implications:

Listening to music was shown to be as effective as music therapy provided by a therapist to assist in reducing pain and anxiety. Although the degree of change shown here was small and this study had several limitations, listening to music is a low-risk and simple intervention that may be beneficial to patients. Nurses should consider employing this technique with patients in anxiety-producing situations and as part of pain management.

Burrai, F., Micheluzzi, V., & Bugani, V. (2014). Effects of live sax music on various physiological parameters, pain level, and mood level in cancer patients. Holistic Nursing Practice, 28, 301–311. 

doi: 10.1097/HNP.0000000000000041
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Study Purpose:

To examine the effects of live saxophone music in patients with cancer

Intervention Characteristics/Basic Study Process:

Patients were randomly assigned to music or control groups. A holistic nurse played the saxophone music for patients in a hospital room with the patient lying in bed and the door closed. Sound could not be heard in other rooms. Patients chose five or six musical pieces of different styles from a large playlist. The patient listened for about 30 minutes, then returned to the regular hospital room. The intervention was given weekly for four weeks. Control group patients had a 30-minute rest period. Physiologic parameters and mood and pain data were obtained after the intervention or rest period weekly. Patients were receiving chemotherapy in an inpatient setting.

Sample Characteristics:

  • N = 52
  • MEAN AGE = 64.9 years (SD = 12.7 years)
  • MALES: 17.3%, FEMALES: 82.7%
  • KEY DISEASE CHARACTERISTICS: Disease types not described; 86.6% had metastatic disease
  • OTHER KEY SAMPLE CHARACTERISTICS: Overall, 98% of participants listened to music regularly and 61.5% were receiving analgesics.

Setting:

  • SITE: Single site  
  • SETTING TYPE: Inpatient  
  • LOCATION: Italy

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active antitumor treatment
  • APPLICATIONS: Palliative care 

Study Design:

Single-blinded, randomized, controlled trial

Measurement Instruments/Methods:

  • Physiologic parameters including systolic and diastolic blood pressure, pulse rate, glycemia, and oxygen saturation
  • Visual Analog Scale (VAS) for pain (0–10)
  • VAS for mood from (0 = great mood, and 10 = worst possible mood)

Results:

Oxygen saturation in the experimental group increased from an average of 98 to 99 postintervention. Pain levels in the experimental group decreased on average from 1.8 (SD = 1.9) to 0.7 (SD = 1.1, p = 0.001). Mood changed from a 5 on average to 2.2 in the experimental group (p = 0.000). There were no significant changes in the control group. Differences between the groups were not significant for pain or mood.

Conclusions:

The findings of this study did not show a significant effect on pain from live music compared to usual care. Listening to live music was associated with improved mood.

Limitations:

  • Small sample (< 100)
  • Baseline sample/group differences of import
  • Risk of bias (no blinding)
  • Unintended interventions or applicable interventions not described that would influence results
  • Measurement validity/reliability questionable
  • Other limitations/explanation: More patients in the experimental group were receiving analgesics at baseline. The types of analgesics or any change in analgesics were not discussed. Baseline pain levels were low, suggesting potential floor effects. The mood measurement was not a validated tool. Measures were taken immediately after the intervention, and it was not clear what value from the weekly measures was used in the final analysis. No description of the types of pain was given.

Nursing Implications:

The findings of this study suggest that listening to live music can improve patients’ moods. This study did not provide strong evidence for the effects of music on pain, and the study report had multiple limitations. Music interventions are low-risk and may be helpful for some patients. The intervention can be provided in multiple ways in multiple settings although the use of live music therapy can be more limiting because of available settings.

Chu-Hui-Lin Chi, G., Young, A., McFarlane, J., Watson, M., Coleman, R.L., Eifel, P.J., . . . Richardson, M. (2015). Effects of music relaxation video on pain and anxiety for women with gynaecological cancer receiving intracavitary brachytherapy: A randomised controlled trial. Journal of Research in Nursing, 20, 129–144. 

doi: 10.1177/1744987114529298
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Study Purpose:

To determine the effect of watching a music relaxation video on pain and anxiety in women diagnosed with gynecological cancer who were undergoing intra-cavitary brachytherapy

Intervention Characteristics/Basic Study Process:

A music relaxation video was played four times for a total of 120 minutes during the first 44 hours of brachytherapy treatment, with monitoring of pain scores, opioid consumption, and perceived anxiety scores compared to usual nursing care during the same time period.

Sample Characteristics:

  • N = 60  
  • MEAN AGE = 46 years (range = 23-70 years)
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Gynecological cancer, cervix, uterus. 
  • OTHER KEY SAMPLE CHARACTERISTICS: 51% white women, 67% married, 55% high school as the highest degree

Setting:

  • SITE: Single site    
  • SETTING TYPE: Inpatient    
  • LOCATION: Academic cancer care center in the southwestern United States

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active antitumor treatment

Study Design:

  • Randomized, controlled trial

Measurement Instruments/Methods:

  • Pain severity was measured with a visual rating scale
  • Opioid consumption was measured with a PCA pump
  • Anxiety was measured using the Strat-Trait Anxiety Inventory

Results:

Women in the intervention group reported less pain. There was no difference in levels of opioid consumption between the intervention and control groups. Participants in the music viewing group indicated significantly reduced anxiety levels in analysis (p = 0.001).

Conclusions:

Nurses and other medical personnel should consider using music relaxation videos to help reduce pain and anxiety during intracavitary brachytherapy and other procedures that may be uncomfortable.  The intervention is non-invasive, with beneficial effects.

Limitations:

  • Small sample (less than 100 participants)
  • Risk of bias (no appropriate attentional control condition)
  • Other limitations/explanation: Baseline pain was higher in the experimental group

Nursing Implications:

This non-invasive intervention could be nurse-driven without a physician’s order.  Women undergoing brachytherapy must lie still in a shielded isolation room for 2-3 days with limitations on visitors, resulting in physical and psychological discomforts, including pain. This study shows that pain experiences may be lessened with music relaxation videos.

Li, X.M., Yan, H., Zhou, K.N., Dang, S.N., Wang, D.L., & Zhang, Y.P. (2011). Effects of music therapy on pain among female breast cancer patients after radical mastectomy: Results from a randomized controlled trial. Breast Cancer Research and Treatment, 128(2), 411–419.

doi: 10.1007/s10549-011-1533-z
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Study Purpose:

To explore the effects of music on pain, in patients with breast cancer, after radical mastectomy  

Intervention Characteristics/Basic Study Process:

The intervention group consisted of 60 patients who received MP3 players with headphones. The players were loaded with 202 selections of music; the music was of four types. Patients were instructed to listen to music, during the postoperative period and two chemotherapy periods (18.9 days, SD = 7.1 days), for 30 minutes twice a day, between 6 and 8 a.m. and between 9 and 11 p.m. While patients were in the hospital, a researcher encouraged adherence to the schedule. After the patients were discharged, a researcher used the telephone to encourage adherence. The control group consisted of 60 patients who were not blinded regarding the music intervention. All patients took four tests (one at baseline and three postrandomization). Pain levels were assessed before the surgery, on the first preoperative day; on the day before disharge; and upon admission for the first and second chemotherapy sessions. Cycle lengths for chemotherapy were 14, 21, or 28 days. The assesment one day prior to discharge was known as the first post-test. The assesments before the chemotherapy sessions were known as the second and third post-tests, respectively.

 

Sample Characteristics:

  • The sample was composed of 120 breast cancer patients.
  • The age range of patients was 25–65 years.
  • All patients were female.
  • All patients had breast cancer and underwent radical, modified radical, or extensive radical mastectomy. All patients received patient-controlled analgesia following surgery.

Setting:

  • Single site
  • Inpatient
  • Surgical department of oncology center, First Affiliated Hospital of Xi’an, Jiaotong University, Shanghai
     

Phase of Care and Clinical Applications:

Clinical applications: late effects and survivorship

Study Design:

Randomized controlled trial

Measurement Instruments/Methods:

  • General questionnaire    
  • Chinese version of Short-Form McGill Pain Questionnaire (which included a visual analog scale, VAS, and a measure of present pain intensity, PPI)
  • Pain Rating Index

Results:

Both groups reported improvement in all areas of assessment from baseline through the third post-test. At the first post-test (day prior to discharge), the difference between the two groups was –2.38% in favor of music (p < 0.05). By the third post-test, the differences had decreased to –1.87 (p < 0.05).

Conclusions:

Findings show that listening to music was associated with reduction in pain severity.

Limitations:

  • The report provided no information regarding the use or nonuse of any form of analgesia in the postoperative period and during chemotherapy. 
  • Limitations outlined by the authors include an assessment procedure that depended on self-reporting, which is affected by many factors; the use of quantitative research only; the lack of biomarkers or physiological measurements; the fact that the assessor was not blinded to patient assignment to intervention or control group; and risk of bias due to no attentional control condition.

Nursing Implications:

This study should be refined to determine and differentiate types and quality of pain and to consider the fact that pain typically decreases during the postoperative period. The differences noted between groups may indicate that music could play a role in reducing the pain that patients experience in the period immediately following surgery.

Tsivian, M., Qi, P., Kimura, M., Chen, V.H., Chen, S.H., Gan, T.J., & Polascik, T.J. (2012). The effect of noise-cancelling headphones or music on pain perception and anxiety in men undergoing transrectal prostate biopsy. Urology, 79, 32–36.

doi: 10.1016/j.urology.2011.09.037
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Study Purpose:

To assess the effect of noise-canceling headphones, with or without music, on patient pain and anxiety associated with routine, office-based transrectal ultrasound-guided prostate biopsy  

Intervention Characteristics/Basic Study Process:

Patients were randomly assigned to one of three groups: control group (no noise-canceling headphones), headphones group (patients wore noise-canceling headphones), or music group (which listened to Bach's Brandenburg Concertos through noise-canceling headphones). Patients donned headphones immediately before the procedure, after hearing a thorough description of the procedure and getting into position for the procedure.

Sample Characteristics:

  • The study reported on a sample of 88 patients: 28 in the control group, 29 in the headphones group, and 31 in the music group.  
  • Mean patient age was 62.5 years: 60 years in the control group, 68 in the headphones group, and 61.4 years in the music group.
  • The sample was 100% male.
  • Patients had an elevated prostate-specific antigen level or abnormal findings as revealed by a digital rectal examination.
  • The sample was predominantly white.

Setting:

  • Site was unspecified.
  • Office-type setting, although authors did not state the location of the office site or whether practitioners in more than one office participated in the study. (Authors are from the Duke University Medical Center, in Durham, N.C.)

Study Design:

Randomized controlled trial

Measurement Instruments/Methods:

  • Verbal response scale (VRS), to measure pain
  • Visual analog scale (VAS), to measure pain
  • McGill Pain Questionnaire
  • State-Trait Anxiety Inventory
  • Physiologic measures: systolic blood pressure, diastolic blood pressure, differential blood pressure, heart rate, and respiratory rate

Results:

Mean VRS scores showed that pain significantly increased from baseline to postprocedure for all groups (control group, 0.79–2.49, p = 0.001; headphones group, 0.89–2.29, p = 0.009; music group, 0.52–2.13, p < 0.001). In no group did anxiety level change from baseline to postprocedure. The music group had the lowest overall mean State-Trait Anxiety score. Blood pressure levels remained fairly stable from baseline to postprocedure. The control group’s mean diastolic blood pressure increased from 82.3 to 88.4, the headphones group’s mean diastolic blood pressure increased from 79.38 to 81.9, and the music group’s mean diastolic blood pressure increased from 82.5 to 84.9. Authors reported that these changes were not statistically significant.

Conclusions:

According to this study, music or noise-canceling headphones do not appear to relieve pain perception and anxiety during transrectal prostate biopsy; however, further research is warranted due to the small sample size.

Limitations:

  • The study had a small sample size, with fewer than 100 patients.
  • The patients and physician were not blinded.
  • The volume setting (the music played at a comfortable level) and genre of music may have been a limitation; because the biopsy gun was quite loud, those in the noise-canceling headphones group could hear the biopsy gun.

Nursing Implications:

Although this study did not find music or noise-canceling headphones to be effective in decreasing pain perception and anxiety, nurses may want to ask patients if they would like to listen to music in the circumstances outlined. Listening to music may be a distraction and potentially mitigate pain.

Wang, Y., Tang, H., Guo, Q., Liu, J., Liu, X., Luo, J., & Yang, W. (2015). Effects of intravenous patient-controlled sufentanil analgesia and music therapy on pain and hemodynamics after surgery for lung cancer: A randomized parallel study. Journal of Alternative and Complementary Medicine, 21, 667–672. 

doi: 10.1089/acm.2014.0310
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Study Purpose:

To determine the effect of postoperative intravenous sufentanil for patient-controlled analgesia (PCA) use combined with music therapy on pain and hemodynamics in patients with lung cancer after surgery

Intervention Characteristics/Basic Study Process:

Before operation, a music therapist guided patient to hypnosis with music-assisted progressive muscle relation. During the operation, the music intervention was suspended. At three, seven, 15, and 19 hours after the operation, the music intervention was implemented in one-hour sessions in the intensive care unit.

Sample Characteristics:

  • N = 60  
  • AVERAGE AGE = 53.8 years (SD = 11.2 years) control; 53.5 years (SD = 10.7 years) music
  • MALES: 58%, FEMALES: 42%
  • KEY DISEASE CHARACTERISTICS: Patients with stages 1 and 2 lung cancer receiving resection
  • OTHER KEY SAMPLE CHARACTERISTICS: Exclusion criteria included opioid allergies, blood coagulation dysfunction, asthma, peptic ulcers, liver and kidney disease, hearing impairments, alcohol or drug abuse, mental illness or memory dysfunction, inability to operate PCA, and professional music background.

Setting:

  • SITE: Single site    
  • SETTING TYPE: Inpatient    
  • LOCATION: Intensive care units

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Multiple phases of care

Study Design:

Randomized, controlled, single-blinded trial

Measurement Instruments/Methods:

  • Self-Rating Anxiety Scale (SAS)
  • Visual Analog Scale (VAS)
  • Hemodynamic measurements included systolic blood pressure, diastolic blood pressure, heart rate, arterial oxygen saturation, and respiratory rate.
  • Sufentanil consumption and adverse reactions

Results:

Participants in the music therapy group had significantly lower VAS scores, blood pressure, heart rate, SAS scores, postoperative analgesic use, and sufentanil doses within 24 hours after surgery when compared to the control group.

Conclusions:

Intravenous sufentanil PCA combined with music therapy improved PCA use after lung cancer surgery. Lower doses of sufentanil and less frequent PCA use were reported. In addition, combined therapy reduced blood pressure and heart rate.

Limitations:

  • Small sample (< 100)
  • Risk of bias (no blinding)
  • Measurement validity/reliability questionable

Nursing Implications:

This study suggested that combined music and sufentanil therapy can effectively improve PCA effects and reduce the dose of sufentanil needed while decreasing the blood pressure and heart rate in patients who received lung cancer resections.

Zavotsky, K.E., Banavage, A., James, P., Easter, K., Pontieri-Lewis, V., & Lutwin, L. (2014). The effects of music on pain and anxiety during screening mammography. Clinical Journal of Oncology Nursing, 18, E45–E49.

doi: 10.1188/14.CJON.E45-E49
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Study Purpose:

To test whether women who listened to music during screening mammography report lower levels of pain and anxiety than women who did not listen to music

Intervention Characteristics/Basic Study Process:

On three days of the week, patients listened to music during screening mammorgraphy, and on two days of the week, music was not provided. An MP3 player was preloaded with various types of music. Patients who were part of the music group were asked to select the music of their choice. Patients rated pain and anxiety immediately after completing the mammography.

Sample Characteristics:

  • N = 100
  • MEAN AGE = 54.1 years
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Most were Caucasian. About 45% had had 13 or more previous mammographies.
     

Setting:

  • SITE: Multi-site 
  • SETTING TYPE: Outpatient 
  • LOCATION: United States

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Diagnostic

Study Design:

  • Non-random, two-group comparison

Measurement Instruments/Methods:

  • 10-point Likert-type scale for pain and anxiety

Results:

No significant differences in pain or anxiety were seen between groups.

Conclusions:

This study did not show an effect of listening to music during mammography on pain or anxiety.

Limitations:

  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Measurement validity/reliability questionable
  • No baseline anxiety measures—if patients were not anxious to begin with, they unlikely would have a result.

Nursing Implications:

This study did not show an effect of listening to music during screening mammography, but evidence has shown effectiveness of music in reducing anxiety during invasive procedures. Listening to music during mammography is a low-cost and low-risk intervention that may be helpful to some patients. This study had multiple limitations.

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