677383

research-article2016
JHNXXX10.1177/0898010116677383Journal of Holistic NursingMusic and Pain / Schneider

23

jhn
Quantitative Research

The Effect of Listening to Music

on Postoperative Pain in Adult Journal of Holistic Nursing

Orthopedic Patients American Holistic Nurses Association

Volume 36 Number 1
March 2018 23­–32
© The Author(s) 2016
10.1177/0898010116677383
Melissa A. Schneider, DNP, RN-BC, ONC, CNRN journals.sagepub.com/home/jhn

York Hospital

Purpose: Pain is a common occurrence after orthopedic surgery. Patients need additional resources to
manage their pain. The purpose of this study was to determine if listening to music has a positive effect
on pain scores and satisfaction in the postoperative adult orthopedic patient. There are limited studies
demonstrating statistically significant decreases in postoperative pain in this group. A secondary pur-
pose was to expose nurses on a standard medical-surgical unit to an intervention, supported by the
holistic nursing model that they could use in their care. Design and Method: This study was a descrip-
tive, comparative, quasi-experimental design. Patients listened to prerecorded music on individual CD
players and recorded pre–post pain scores with the intervention. A satisfactory survey was completed at
discharge. Findings: Results demonstrated a statistically significant reduction in patients’ pain scores
after listening to music. Length of listening time had no effect. Patients expressed overall satisfaction,
and 100% of participants would recommend this intervention to others. Conclusions: Listening to
music is beneficial as an adjunct to pain medication and contributes to increased patient satisfaction.
It is hoped that the information gained from this study will lead to an enhancement in the standard of
care for postoperative patients.

Keywords: music therapy; pain and pain management; adults; nurses

Introduction and Background
The health care environment today challenges
nurses to use relationship-based care to improve
patient outcomes and be more attentive to patient
needs (Woolley et al., 2012). Nurses and patients
can benefit from an optimal healing environment
(OHE) in which the components support healing
through principles such as the mind–body connec-
tion. An OHE incorporates tangible expressions of
care and compassion, such as music, guided imagery,
and energy-based healing (Lincoln & Johnson,
2009). Holistic nursing encourages the use of com-
plementary and alternative modalities to improve
care (American Holistic Nurses Association, 2016).
This aligns with an OHE, and leading nursing organ-
izations support the integration of holistic care in a
variety of care settings. On the unit that participated
in this study, the majority of nurses lacked sufficient
knowledge about this type of care and how to inte-
grate holistic practices into acute patient care. It is
important that nurses assist patients to maximize the
healing environment (Lincoln & Johnson, 2009).
The purpose of this study was to determine if listen-
ing to music had an effect on postoperative pain
after orthopedic surgery while exposing bedside
nurses to an element of holistic nursing practice.
Pain control is one area where healing therapies
such as music and guided imagery have shown much
promise (Economidou, Klimi, Vivilaki, & Lykeridou,
2012). Pain affects patients of all ages, ethnic
Author’s Note: The author would like to thank Dr. Brenda Artz
and Lori Abel for their assistance in data collection; Rod Grim,
Ted Bell, and the Emig Research Department, the Staff of Tower
3—York Hospital; and Greg Maroney for permission to use his
music. Please address correspondence to Melissa A. Schneider,
DNP, RN-BC, ONC, CNRN, York Hospital, 1001 S. George
Street, York, PA 17405; e-mail: mschneider@wellspan.org.
24  Journal of Holistic Nursing / Vol. 36, No. 1, March 2018
groups, and socioeconomic backgrounds. It is esti-
mated that 50% to 75% of patients do not receive
adequate relief from their postoperative pain (Good
et al., 2010). Uncontrolled pain contributes to
increased suffering, additional complications,
delayed recovery, and higher health care costs (Good
et al., 2010). Guidelines for pain management
include prompt recognition and treatment, involve-
ment of patients in their pain treatment plan, and
individual adjustments in pain management
(Glowacki, 2015).
Acute pain is a common occurrence after ortho-
pedic surgery and is often cited as one of the most
painful surgeries (Allred, Byers, & Sole, 2010). This
is especially true of total knee replacement surgery,
which is associated with a great deal of pain in the
postoperative period (Moucha, Weiser, & Levin,
2016). One of the main reasons is the significant
muscle and skeletal tissue involvement during the
surgical procedure. Successful rehabilitation after
orthopedic surgery is dependent on the patients’
cooperative participation and pain can delay their
progress. Pain puts additional stress on the body,
which can interfere with recovery (Lin, Lin, Huang,
Hsu, & Lin, 2011). Increased pain can interfere
with mobility, sleep, appetite/bowel function, and
cause increased stress and anxiety (Economidou
et al., 2012). These emotions can intensify the pain
(Vaajoki, Kankkunen, Pietila, Kokki, & Vehvilainen-
Julkunen, 2012). Patients are better able to respond
to stress if pain is controlled (Glowacki, 2015).
Inadequate pain control can also lead to long-term
complications such as depression and chronic pain
(Ignacio, Chan, Teo, Tsen, & Goy, 2012). If patients
can achieve optimal pain control, they will be able to
demonstrate early postoperative mobility, participate
in physical therapy, and possibly be discharged
sooner. Nurses want additional modalities to help
patients cope with and manage their pain. Using
music as an intervention can help with pain control
as well as positively affect patient-coping behaviors
(Kleiber & Adamek, 2012).
Pain is multifactorial and all domains of health
must be considered for successful management.
These should include the physical, psychosocial,
and spiritual because pain causes physical, psycho-
logical, and emotional manifestations. Pain percep-
tion is very individualized, and patients need to feel
that they have some measure of control over their
pain (Glowacki, 2015). Patients may feel powerless,
vulnerable, and they fear the inability to manage
their pain (Lukas, 2004). Nurses also feel frustra-
tion when patients are dealing with uncontrolled
pain (Bernhofer, 2014). Using adjunctive therapy,
such as listening to music, empowers patients by
increasing their knowledge and self-efficacy (Good
et al., 2010). In a caring, healing environment, not
only do patients report better management of pain,
but nurses also report decreased stress levels
(Woolley et al., 2012). This can lead to increased
nursing satisfaction as nurses feel they have done a
better job of promoting a healing environment for
patients. Better pain control also contributes to
increased patient satisfaction with their surgery and
the overall hospital experience (D’Arcy, 2011;
Glowacki, 2015).
In the orthopedic population, successful pain
management requires a multifaceted approach that
includes nonpharmacologic techniques (Allred
et al., 2010). Music is one of the nontraditional
therapies that can be used to relieve pain, decrease
anxiety, and improve the patient experience. One of
the main theories as to why this intervention is
effective is that music acts as a distracter (Nilsson,
2008). Music is described as the universal language
that allows patients to “escape” negative experiences
such as pain (Economidou et al., 2012). Another
similar mechanism used to explain music’s effects
on pain is the gate control theory (Economidou
et al., 2012). The gate control theory states that
nonnoxious stimuli help “close the gate” and prevent
pain from traveling to the brain. Any therapy that
uses distraction and/or tension reduction, such as
listening to music or other relaxation techniques,
interrupts the pain impulses and decreases pain per-
ception. The melody and rhythm of the music
affects the perimeter system of the brain and hypo-
thalamus, which influences physiological reactions
(Lin et al., 2011).
Music as an intervention has existed in various
cultures for hundreds of years, but recently the use
of music therapy in hospitals has received increased
attention and interest (Joanna Briggs Institute,
2011; Vaajoki, Pietila, Kankkunen, & Vehvilainen-
Julkunen, 2013). Even Florence Nightingale calmed
her patients using music (Bjorkman, Karlsson,
Lundberg, & Frisman, 2013). Although in this study
music listening was used, it is important to differen-
tiate between “music therapy” and “listening to
music.” The American Music Therapy Association

(2015) officially defines music therapy as “clinical
and evidence-based use of music interventions to
accomplish individualized goals within a therapeutic
relationship by a credentialed professional who has
completed an approved music therapy program.”
Allowing the patient to listen to prerecorded music
is different from “music therapy,” but this “music
exposure” also has value as an adjunctive therapy for
pain control and anxiety reduction (Kleiber &
Adamek, 2012).
Rose and Bartsch (2009) discuss two main types
of music intervention that can be used—active and
receptive. In active music therapy, the patient makes
music usually under the guidance of a licensed
music therapist. Receptive therapy is more passive
and involves listening, which evokes an emotional
and physical response (McCaffrey, 2008; Rose &
Bartsch, 2009). This type of intervention is valuable
for relaxation, anxiety reduction, and pain control
(Finnerty, 2011). Listening to music is noninvasive,
inexpensive, and safe (McCaffrey, 2008). The use of
music as a nursing intervention is based on the
theory of holistic nursing, which focuses on the
interconnectedness of mind, body, and spirit
(Comeaux & Steele-Moses, 2013; Sand-Jecklin &
Emerson, 2010). Music can effect positive changes
such as restoration of physical and mental health
(Lin et al., 2011). Listening to music can easily be
incorporated into nursing care, as it does not require
a physician’s order, and it has minimal legal and
ethical concerns (Simcock et al., 2008).
Unfortunately, music exposure is not used often
enough as an intervention in the acute hospital set-
ting due to a lack of awareness of its effectiveness
(Lukas, 2004). Inadequate pain control can lead to
a decrease in the patient’s overall satisfaction with
the hospital experience and interfere with patient
recovery.
Review of the Literature
A review of the literature revealed multiple stud-
ies that support the use of music as an adjunct to
pain management (see Table 1). In a majority of
these studies, researchers used the music interven-
tion in the postoperative period, although a few
examined the use of music during the preoperative
and intraoperative phases. Some studies concen-
trated on reduction of pain while others also looked
at analgesic use and patient anxiety levels. For exam-
Music and Pain / Schneider  25
ple, Allred et al. (2010) compared music listening to
quiet rest periods before the first ambulation in
patients having total knee arthroplasty, which dem-
onstrated a small decrease in pain/anxiety in the
music group. In multiple studies of various postop-
erative patients, Economidou et al. (2012) found
that music significantly reduced postoperative pain
in three of four studies. Sen et al. (2010) used music
via headphones to demonstrate a decreased use of
patient-controlled analgesia (PCA) in the first 4
hours after surgery, while Simcock et al. (2008) used
music played intraoperatively to lower pain scores in
the first 24 hours of the postoperative period.
Patients having spine surgery listened to music dur-
ing the period of the evening before surgery to post-
operative day 2 in a study by Lin et al. (2011). They
demonstrated positive effects on both pain and anxi-
ety with a decrease in patients’ heart rates and blood
pressure readings. A large systematic review by
Nilsson (2008) analyzed the results of music inter-
ventions for 42 randomized controlled trials (RCTs)
that included close to 4,000 subjects. A decrease in
pain was demonstrated in 59% of the studies cou-
pled with a decrease in anxiety in half of them.
McCaffrey and Good (2000) also discovered broader
benefits such as helping patients feel more comfort-
able in a strange environment and distracting them
from painful/fearful experiences.
The literature also contains information about
the importance of carefully considering the musical
selections and the most appropriate type of music
to use for best results. From previous studies, it has
been recommended that music for pain relief
include specific characteristics. It should be is har-
monious, repetitive, easy to listen to, and without
lyrics (Allred et al., 2010). The tempo of the music
is an important factor, and it should be slow and
flowing at 60 to 80 beats per minute or less without
strong rhythms or percussion (Chi & Young, 2011).
Music with beats per minute that are similar to the
heart rate has the most relaxing effect (Bjorkman
et al., 2013). It is best to use a single music player/
headphone set (e.g., compact disc [CD], cassette
tape, MP3) with recorded music (Joanna Briggs
Institute, 2011). This helps block out any extrane-
ous noise in the environment, and patients can
adjust the volume to suit their preference (Bjorkman
et al., 2013).
There are studies that support music selection
either by the provider or music selected by the
26  Journal of Holistic Nursing / Vol. 36, No. 1, March 2018

Table 1.  Literature Review Summary

Specific Patient Number of Study Design/
Study Population Subjects Limitations Type of Intervention Results Summary

Allred et al. Patients having 56 RCT/small sample Compared music listening Music group had small
(2010) total knee size, inconsistent to quiet rest period before decrease in pain/anxiety,
arthroplasty administration of and after first ambulation but not statistically
oral pain significant except over
medications time
Comeaux and Patients in the 41 Quasi-experimental/ Programmed MP3 players No statistical effect on
Steele-Moses postoperative anxiety tool tedious for intervention group, anxiety, but improved pain
(2013) period to use, not listened ×30 minutes management in music
randomized, small after pain medication group
sample size given
Economidou Various 866 One double-blinded Listening to music; Three of four studies—
et al. (2012) postoperative controlled trial; five selected by patients or music significantly
patients in six RCTs researchers reduced postoperative
separate studies pain; measured by VAS
Ignacio et al. Patients having 21 Prospective study with Patients listened to music No difference in analgesic
(2012) orthopedic two groups randomly selected by researchers use or anxiety; music
surgery assigned/small for 30 minutes on both group statistically
sample size PODs 1 and 2 different; ↓ in pain on
POD 2 only
Kleiber and Adolescent 8 Qualitative (structured Live music provided at Most frequent theme—
Adamek patients having phone interviews)/↓ bedside POD 1 Music therapy made state
(2012) spinal fusion participation rate, of mind more relaxed
not adults
Lin et al. (2011) Patients having 60 Quasi-experimental/↓ Listened to music evening Music had some positive
spine surgery number of females before surgery to POD 2 effects on pain/anxiety (↓
and advanced ages, BP and HR, but no
small sample size change in urine cortisol/
epinephrine levels)
Sen et al. Patients having 70 RCT Patients listened to own Decreased PCA use during
(2010) cesarean delivery music via headphones first 4 hours postoperative
first hour after surgery and ↓ pain in first 24
hours
Simcock et al. Patients having 30 Prospective RCT/some Patients preselected music Lower pain scores at 3 and
(2008) total knee patients aware of played intraoperatively; 24 hours in music group
arthroplasty music, not double pain assessed 3 and 24 but not statistically
blinded hours postoperative significant
Vaajoki et al. Patients having 168 Prospective study with Patients preselected music No effect on analgesic use
(2012) laparotomy two parallel groups/ played via portable or hospital LOS between
all data from one headphones 30 minutes two groups
hospital 3×/day

Note: RCT = randomized controlled trial; VAS = Visual Analogue Scale; POD = postoperative day; BP = blood pressure; HR = heart
rate; PCA = patient-controlled analgesia; LOS = length of stay.

patient. For example, in a study by Bjorkman et al.
(2013), 35% of the patients wanted to choose their
own musical selection. The idea of allowing the par-
ticipant to select his or her own music is encouraged
because response to music is very individualized and
dependent on the person’s previous experiences
(Bjorkman et al., 2013). The one drawback to allow-
ing the participant to select the music is that the
characteristics mentioned previously for best results
cannot be controlled. If individual selection is con-
sidered, it is suggested that a music “expert” guide
the choices as expert knowledge and research find-
ings should not be overlooked (Chi & Young, 2011).
In a review of 31 articles, Chi and Young (2011)
summarized that even though both options have
demonstrated positive results, the optimal choice

may be a combination—allowing the person to
choose from a group of selections predetermined to
meet the recommended characteristics. Although it
was not feasible for this study, the choice of using
“live” music is also an option. In a study using live
musicians, Sand-Jecklin and Emerson (2010) dem-
onstrated statistically significant decreases in scores
for pain, anxiety, and muscle tension.
There are differing opinions on the length of
time for patients to listen and the time frames vary
widely. A length of time between 20 and 30 minutes
for each listening session has been suggested, but
there is no agreement as to the number of sessions
that give the most consistent results (Chi & Young,
2011). Some researchers set up interventions where
patients listened to music at very specific points and
for set lengths of time (Ignacio et al., 2012; Vaajoki
et al., 2012). However, this has not been supported
in the literature as “best practice,” as patients have
had positive results even if the times varied. Even
though the patients enjoyed listening to the music in
the study by Vaajoki et al. (2012), results did not
demonstrate statistical significance for less analgesia
or shorter length of stay.
Purpose
The main purpose of this study was to determine
if listening to selected music via portable CD players
and individual headphones in the postoperative
period would decrease pain scores for patients hav-
ing orthopedic surgery. The researchers also col-
lected anecdotal data via a satisfaction survey at
discharge to ascertain the patients’ satisfaction with
the music intervention itself and overall pain con-
trol. In addition, the researchers hoped to promote
increased awareness and educate nurses as to the
value of listening to music as an adjunct to pain
management.
Method
This study was conducted in a 55-bed acute hos-
pital unit that includes an orthopedic and trauma
patient population. It was a quasi-experimental
design using a convenience sample of patients. The
researchers chose this method instead of separate
control/intervention groups to be able to offer all
eligible patients the opportunity to realize any possi-
ble benefits of the music intervention. Pain is very
Music and Pain / Schneider  27
subjective and each person reacts to and describes
pain differently. This makes it challenging to com-
pare groups, even if patients are having the exact
same surgical procedure. Using this descriptive,
comparative design with pre–post pain scores allowed
the researchers to look at individual patients instead
of groups.
Before starting data collection, the researchers
obtained approval from the hospital’s institutional
review board. They determined that the study had
minimal risk, and all patients received standard post-
operative care regardless of their participation sta-
tus. Signed informed consent forms were required
by the institutional review board and obtained from
all patients in the study. Patients who met the inclu-
sion criteria were approached on the first postopera-
tive day and offered the opportunity to participate in
the study. The researchers did not recruit any
patients before the procedure because there was no
contact with the patients until after surgery when
they were admitted from the recovery room. These
patients were selected from the unit admission list.
Inclusion criteria included the following: age 18 or
older, English-speaking, admitted for orthopedic
surgery, hospital stay more than 24 hours, and able
to understand/sign consent and complete listening
logs. The patients needed to be alert enough to be
able to understand the consent and complete the
logs, so patients still under the influence of anesthe-
sia could not be included immediately out of the
recovery room. For this reason, the majority of
patients were approached and signed up on postop-
erative day 1. This is also usually a time of increased
pain as the anesthesia from the operation has worn
off and the patients get up and out of bed to work
with physical therapy the morning of the first post-
operative day. A power analysis conducted by the
statistician from the research department deter-
mined that approximately 30 to 45 patients and 90
logs would be ideal to achieve a power of >0.8.
Individual CD players with headphones were
used for each patient in the study. Using personal
listening devices helped limit outside noise and
other distractions. The cost for these was much less
than MP3 players, and the CD players were easier
to operate. These were purchased with funds
obtained using a grant offered by the hospital’s
research department. Each CD player was loaded
with a prerecorded CD. Each CD had the same 10
musical selections of instrumental piano music (35
minutes) that met the requirements suggested by
28  Journal of Holistic Nursing / Vol. 36, No. 1, March 2018
the literature. Each selection individually lasted 3 to
4 minutes. These selections were reviewed and
picked by one of the researchers who had a strong
musical background and formal musical education
to ensure that the music met the recommendations.
The music pieces were selected because they each
had a slower tempo of 60 to 80 beats per minute,
flowing/repetitive rhythm without percussion, and
nonlyrical quiet instrumental qualities. Permission
was obtained from the composer to use the music
for the study. The researchers visited each partici-
pant personally and gave verbal instructions as to
the use of the CD player and how to fill out the logs.
The participants were provided with a large envelope
that contained printed instruction sheets, extra log
sheets, pens, and a satisfaction survey to be com-
pleted at discharge. To give patients additional feel-
ings of control, they were told that they could listen
to the CD at any time and that they should try to fill
out a log sheet each time they listened to the music.
Each time the patient used the music intervention,
he or she was instructed to fill out the log. The self-
reported log provided information on listening length
of time, pain number before and after the interven-
tion, and whether the patient took any additional
pain medicine during the listening period. The lis-
tening time was determined by the start and stop
times written down by the patient. Each room had a
large wall clock so the patient could easily see the
time. The pain was measured using the 0 to 10 pain
scale, with 0 being no pain and 10 being the worst
pain imaginable. This scale was selected because it
is the same one used at the facility, and the patients
were already familiar with it from the operative
period. This scale is quick, easy, and can be self-
reported by the patient. There was a question about
whether the patient needed additional pain medi-
cine where the person simply circled yes or no. The
patient could also add any comments about the
intervention to the sheet. A sample of the log can be
found in Figure 1. The researchers checked in with
the patients each day to remind them to fill out log
sheets and troubleshoot any problems with the CD
players (e.g., low batteries).
At discharge, the patient filled out a satisfaction
survey developed by the researchers (see Figure 2).
The purpose of this survey was to determine the ease
of using the intervention and patient’s satisfaction
with the overall pain control. Patients were also
asked if they would recommend the intervention to
DATE___________________________
TIME___________________________
PAIN SCORE BEFORE LISTENING TO MUSIC: ______
(Score 1 – 10 with 10 being the worst pain)
TIME STARTED LISTENED TO THE MUSIC:
________________________
PAIN SCORE AFTER LISTENING TO MUSIC: ______
(use zero if none)
TIME STOPPED LISTENED TO THE MUSIC:
________________________
DID YOU REQUIRE ADDITIONAL PAIN MEDICINE
DURING THIS TIME?
______ Yes ______ No
Figure 1.  Patient Log: Music Therapy
others. To inform the nurses, a reminder sheet was
placed on the charts of the patients in the study.
This was important because if the patients were dis-
charged at a time when the researchers were not on
the unit, the nurses had to collect the CD players,
packets, and logs.
Results and Discussion
At the conclusion of data collection, a total of 42
patients had participated in the study and 65 com-
pleted logs were collected. The total number of
signed consents was 44, but two packets were unac-
counted for so there were no data for these partici-
pants. The researchers believe that these two patients
accidentally took the packets home with their dis-
charge paperwork, and the research department was
aware of the missing packets. Patients were asked to
complete the log sheet each time they listened to the
music. Due to the fact that sometimes patients lis-
tened to the music and did not fill in the log (e.g.,
they forgot or they fell asleep while listening), the
number of total completed logs was less than pro-
jected. All the patients filled in at least one log (42);
in addition, 19 patients filled in a second log and 4
 Music and Pain / Schneider  29

1. How satisfied were you with your overall pain control during this hospital stay?

(Please grade your response 5 to 1 with 5 being most satisfied & 1 being very dissatisfied)

Very Satisfied 5 4 3 2 1 Very Dissatisfied

2. Did you find that listening to the music was helpful with your pain relief?

(Please grade your response 5 to 1 with 5 being very helpful & 1 being not helpful at all)

Very Helpful 5 4 3 2 1 Not helpful at all

3. Did you find the equipment easy to use?

(Please grade your response 5 to 1 with 5 being very easy to use & 1 being very difficult)

Very Easy 5 4 3 2 1 Very difficult

4. Would you recommend this music therapy to others?

Yes No

Please add any additional comments below.

Thank you for participating in our study – we wish you well in your recovery.

Figure 2.  Discharge Questionnaire: Music and Pain Study

patients filled in a third log. Of the 42 patients,
there were 33 females and 9 males with combined
average age of 61.75 years (range = 39-84 years).
The average length of stay was 2.96 days. The most
common surgery (79%) was total knee replacement,
which was the admitting diagnosis for 33 of the par-
ticipants. In addition, three patients were admitted
for total hip replacement, three for fractured hip
repair, one for an upper extremity fracture, and two
for repair of ankle fractures.
Data were analyzed using the SPSS statistical
analysis program (Version 21). The analysis was com-
pleted by the scientific support staff of the institu-
tion’s research center and included frequency and
percent determinations for all categorical parameters
as well as paired sample t tests. In comparing the data
from all of the logs, results indicated that pain was
significantly reduced—average pain scores went from
5.43 before listening to 3.97 after listening (see Table
2). This was based on the 0 to 10 pain scale. Only
four of the patients asked for additional pain medica-
tion during the music intervention. Patients listened
to music for varying amounts of time—from 10 min-
utes to 90 minutes with an average time listened at 28
minutes. Several patients stated that they fell asleep
while listening so were unsure of the end time. There
was a slight relationship between the time listened
and pain reduction, but listening time had no statisti-
cal effect. Many of the patients added comments to
the log sheets that gave some additional qualitative
data. Common comments included the following:
“the music helped me relax,” “it took my mind off of
the leg,” “it helped me forget about the pain,” and “it
helped me to fall asleep.” Several patients commented
that they found the music intervention helpful for
pain after physical therapy sessions.
Satisfaction surveys were returned for 34 of the
42 patients, giving an 81% return rate. There were
very few scores lower than 3 on the discharge sur-
veys—the majority of the scores and responses are
listed on Table 3. The responses were overwhelm-
ingly positive. The most notable finding was that
100% of the patients would recommend the music
intervention to others.
30  Journal of Holistic Nursing / Vol. 36, No. 1, March 2018

Table 2.  Pain Score Results Before and After which would lend support to outcomes with anxiety
Intervention reduction in previous studies.
Pain Score

  N M SD P
Limitations
Before 65 5.43 2.048 <.001 This study has several limitations. The sample size
After 65 3.97 2.137 — was small, and the participants were all recruited at
a single hospital on one unit so it is difficult to gen-
Note: N = number of participants.
eralize the results of this study. Adding a control
group with no intervention and randomization may
Table 3.  Satisfaction Scores at Discharge have contributed to a stronger study as this would
(5 = Very satisfied/helpful; 1 = Not satisfied/not helpful) have helped eliminate any potential extraneous vari-
(N = 34/42) ables. Although a quiet environment would probably
Satisfaction Score have been more beneficial while listening to the
music, in a busy hospital setting it was difficult to
  5 4 3 control interruptions during the listening period.
How satisfied with overall 56% 32% 12% The researchers would like to find a better process
pain relief? to encourage the patients to fill out the logs as there
Was listening to music 44% 26% 18% were quite a few instances where the patient would
helpful with pain relief? listen, but forget to fill in the log data. This may
Was equipment easy to use? 59% 24% 12% involve more data collectors so that the patients
Would you recommend to 100% would  
could be visited more frequently and assisted with
others? recommend
log completion. It might also be helpful to further
review the dosing variation/time listened as this
Nurses who participated in this study stated that could be significant in future studies. Another con-
it was easy to incorporate the music intervention sideration would be to use a licensed music therapist
into their nursing care. They were very encouraging for the study and allow patients to select from a list
to the patients in this study. Nurses continued to of musical selections to give them more of a choice.
suggest using the CD players and music listening to The researchers were unable to use comparative
patients even after the data collection for the study data for the satisfaction scores so this information
concluded. Interestingly enough, several nurses has to be looked at as anecdotal. Future studies
asked to use the CD players and music as a way to using a control group would also enable researchers
help calm agitated and/or confused patients. It was to compare satisfaction scores. Analgesic use was
satisfying to the researcher that the nurses realized self-reported by patients—it is suggested that actual
the value in this type of holistic intervention and a dosages and types of analgesics used before, during,
future initiative using music related to other types of and after the intervention be tracked more closely in
patients on the unit is being considered. future studies since pain can improve over time.
When reviewing the data, several comparisons Future studies could also look at the nurse satisfac-
with previous studies can be made. The decrease in tion aspect as in this study this information was
pain scores is similar to results in other studies purely anecdotal.
where postoperative pain also improved after listen-
ing to music. The specific characteristics of music Implications for Practice
used in the current study followed those suggested
in the literature. As seen in other studies, the aver- Pain is a big concern for patients as well as nurses,
age length of time that the patients listened to the and it can be challenging to control after orthopedic
music varied. While some reviewed studies also surgery. Both nurses and patients express frustration
looked at the effect of music on anxiety, this was not if pain levels remain high. It is important to have pain
specifically tracked in the current study. However, under control so patients are able to participate in
some patients stated in their comments that the therapy and other activities for healing. It is possible
music did help them “relax” and “feel less anxious,” that this intervention can help decrease opiod use,

which may work to prevent complications related to
immobility such as atelectasis, deep vein thrombosis,
and paralytic ileus. Hospitals are also concerned with
patient satisfaction scores, and patients express
increased satisfaction when pain is controlled.
Listening to music uses a holistic approach to
nursing care—pulling in aspects of mind, body, and
spirit. It is inexpensive, easy to use, poses no risk,
and can be done without a physician’s order. It can
be used autonomously with minimal instructions
and gives patients a sense of control over their pain.
The relaxed feelings that come with listening to
music also benefit the patients as tense muscles can
cause increased pain. Busy nurses can partner with
patients to work toward adequate pain control using
this method. Education of both patients and nurses
to alternative methods of pain control is important
to promote positive outcomes. Patients can even be
encouraged to bring in their own devices for listen-
ing to music and this intervention can easily be con-
tinued after discharge.
Conclusion
The results of this study contribute to the growing
body of evidence that supports listening to music as a
viable complementary therapy in pain control. The
majority of the patients found benefit using the music
and all the participants in this study would recom-
mend this intervention to others. Even more impor-
tant, this study exposed nurses on a medical-surgical
unit to a holistic nursing intervention that contributed
to an improvement in the overall hospital experience
for their patients. Nurses need to continue to be edu-
cated about nonpharmacological approaches to pain
control as pain management needs a multifaceted
approach. The researchers for this study hope that it
will inspire future studies on this topic and encourage
nurses to explore interventions such as listening to
music to give patients more control over their pain and
improve their care in the postoperative period.
References
Allred, K. D., Byers, J. F., & Sole, M. L. (2010). The effect of
music on postoperative pain and anxiety. Pain Management
Nursing, 11(1), 15-25. doi:10.1016/j.pmn.2008.12.002
American Holistic Nurses Association. (2016). Position state-
ments. Retrieved from http://www.ahna.org/Resources/
Publications/Position-Statements
Music and Pain / Schneider  31
American Music Therapy Association. (2015). Facts about
music therapy. Retrieved from http://www.musictherapy.org
Bernhofer, E. (2014). The pain management education gap:
A common reason for frustration in bedside nurses and
hospitalized patients with pain. Journal of Pain, 15(4
Suppl.), S38. doi:10.1016/j.pain.2014.01.156
Bjorkman, I., Karlsson, F., Lundberg, A., & Frisman, G. H.
(2013). Gender differences when using sedative music
during colonoscopy. Gastroenterology Nursing, 36(1), 14-
20. doi:10.1097/SGA.0b013e31827c4c80
Chi, G. C., & Young, A. (2011). Selection of music for induc-
ing relaxation and alleviating pain. Holistic Nursing Practice,
25(3), 127-135. doi:10.1097/HNP.0b013e3182157c64
Comeaux, T., & Steele-Moses, S. (2013). The effect of com-
plementary music therapy on the patient’s postoperative
state anxiety, pain control, and environmental noise satis-
faction. Medsurg Nursing, 22, 313-318.
D’Arcy, Y. (2011). New thinking about postoperative pain
management. OR Nurse, 5(6), 28-36.
Economidou, E., Klimi, A., Vivilaki, V. G., & Lykeridou, K.
(2012). Does music reduce postoperative pain? A review.
Health Science Journal, 6, 365-376.
Finnerty, R. (2011). Music therapy: A viable intervention for
pain control. Canadian Nursing Home, 22(1), 5-12.
Glowacki, D. (2015). Effective pain management and
improvements in patients’ outcomes and satisfaction.
Critical Care Nurse, 35(3), 33-43.
Good, M., Albert, J. M., Anderson, G. C., Wotman, S., Cong, X.,
Lane, D., & Ahn, S. (2010). Supplementing relaxation and
music for pain after surgery. Nursing Research, 59, 259-269.
Ignacio, J. J., Chan, M. F., Teo, S. H., Tsen, L. M., & Goy,
R. (2012). The effect of music on pain, anxiety, and anal-
gesic use on adults undergoing an orthopaedic surgery: A
pilot study. Singapore Nursing Journal, 39(4), 49-51.
Joanna Briggs Institute. (2011). Music as an intervention in
hospitals. Nursing and Health Science, 13(1), 99-102.
doi:10.1111/j.1442-2018.2011.00583.x
Kleiber, C., & Adamek, M. S. (2012). Adolescents’ percep-
tions of music therapy following spinal fusion surgery.
Journal of Clinical Nursing, 22, 414-422. doi:10.1111/
j.1365-2702.2012.04248.x
Lin, P.-C., Lin, M.-L., Huang, L.-C., Hsu, H.-C., & Lin, C.-
C. (2011). Music therapy for patients receiving spine sur-
gery. Journal of Clinical Nursing, 20, 960-968. doi:10.1111/
j.1365-2702.2010.03452.x
Lincoln, V., & Johnson, M. (2009). Staff nurse perceptions
of a healing environment. Holistic Nursing Practice, 23,
183-190.
Lukas, L. K. (2004). Orthopedic outpatients’ perception of
perioperative music listening as therapy. Journal of Theory
Construction & Testing, 8(1), 7-12.
McCaffrey, R. (2008). Music listening: Its effects in creating
a healing environment. Journal of Psychosocial Nursing,
46(10), 39-44.
32  Journal of Holistic Nursing / Vol. 36, No. 1, March 2018
McCaffrey, R. G., & Good, M. (2000). The lived experience
of listening to music while recovering from surgery.
Journal of Holistic Nursing, 18, 378-390.
Moucha, C. S., Weiser, M. C., & Levin, E. J. (2016). Current
strategies in anesthesia and analgesia for total knee arthro-
plasty. Journal of the American Academy of Orthopaedic
Surgeons, 24(2), 60-73. doi:10.5435/JAAOS-D-14-00259
Nilsson, U. (2008). The anxiety and pain reducing effects of
music interventions: A systematic review. AORN, 87, 780-
807.
Rose, J.-P., & Bartsch, H. H. (2009). Music as therapy.
Karger Gazatte, 70. Retrieved from http://misc.karger.
com/gazette/70/rose/art_3.htm
Sand-Jecklin, K., & Emerson, H. (2010). The impact of live
therapeutic music intervention on patients’ experience of
pain, anxiety, and muscle tension. Holistic Nursing Practice,
24(1), 7-15.
Sen, H., Yanarates, O., Sizlan, A., Kilic, E., Ozkan, S., &
Dagli, G. (2010). The efficiency and duration of the anal-
gesic effects of musical therapy on postoperative pain.
Journal of Turkish Society of Algology, 22, 145-150.
Simcock, X. C., Yoon, R. S., Chalmers, P., Geller, J. A.,
Kiernan, H. A., & Macaulay, W. (2008). Intraoperative
music reduces perceived pain after total knee arthro-
plasty: A blinded, prospective, randomized, placebo-con-
trolled trial. Journal of Knee Surgery, 21, 275-278.
Vaajoki, A., Kankkunen, P., Pietila, A., Kokki, H., & Vehvilainen-
Julkunen, K. (2012). The impact of listening to music on
analgesic use and length of hospital stay while recovering
from laparotomy. Gastroenterology Nursing, 35, 279-284.
doi:10.1097/SGA.0b013e3182608fc1
Vaajoki, A., Pietila, A., Kankkunen, P., & Vehvilainen-
Julkunen, K. (2013). Music intervention study in abdom-
inal surgery patients: Challenges of an intervention study
in clinical practice. International Journal of Nursing
Practice, 19, 206-213. doi:10.1111/ijn.12052
Woolley, J., Perkins, R., Laird, P., Palmer, J., Schitter, M. B.,
Tarter, K., . . . Woolsey, M. (2012). Relationship-based
care: Implementing a caring, healing environment.
Medsurg Nursing, 21, 179-184.
Melissa A. Schneider, is a clinical nurse educator on Tower 3
(ortho/neuro/trauma unit) at York Hospital, York, Pennsylvania
and a nursing faculty member at York College of Pennsylvania.
She has over 20 years experience with orthopedic patients.