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Music Therapy and Pain Management

Kanchana Allan
August 2018
Background
• Acute pain is common following surgical interventions
• 80% of patients complain of poorly managed post-operative
pain (Gan, 2017)
• Standard practice involves administration of analgesics
• Adverse effects should be considered
• Chronic use can also be an issue
(Mayo Clinic Staff, 2017)
• Use of analgesics does not always alleviate pain effectively
(Gan, 2017)
PICOT Question
Following post-general surgery in middle age adults (age 40-65
years) (P), does listening to music, along with pain medication
(standard of care) (I), compared to no music therapy (C), result
in an improved reduction in pain post-operatively as
measured by a numerical pain scale (O), while the patient is in
the hospital (T)?
Literature Review
• Methodology
• Randomized Controlled Trials, Quasi-Experimental study designs
• Sampling
• Inclusion: 18y/o+, post-surgery in-patient, alert and oriented to person, time,
place, situation; and no vision or hearing deficiencies
• Outcomes Measured
• Patient reported pain using a numerical pain scale or Faces pain scale
• Limitations
• Sample size, types of post-surgical patients across the studies, limited music
selection or patients not able to choose music
Key Findings

Music therapy illustrated significant improvement in


post-surgical pain management as well as improvement
in anxiety and mood
Hierarchy of Evidence
• Level I: Randomized Controlled Trial
• Gallagher et al, 2018; Jose, Verma, and Arora, 2012; Liu and
Petrini, 2015; Miladinia et al, 2017; Sfakianakis et al., 2017
• Level II: Quasi-Experimental Design
• Ajorpaz et al., 2014; Comeaux and Steele-Moses, 2013; Ozer et al.,
2013
Clinical Implications
• Research illustrated a significant improvement in pain management
following music therapy, which can be used as a supplement to
standard of care to help reduce the amount of analgesics prescribed
to patients
EBP Implementation Plan
• In-Patient Music Therapy Intervention Program
• Subjects will be randomly assigned to two a music intervention (plus standard of care) or an
analgesics only (control) group
• Trained RNs, LVNs, and CNAs will administer music therapy for 30 minute sessions following
surgery
• Patients will choose musical preference
• Music therapy will be administered each day the patient is in the hospital
• Music therapy group will be compared to a control group
• Observations will continue for 6 months
• Expected Outcomes
• Decreased pain following music therapy compared to control group
• Improved patient satisfaction
• Methods of measuring
• Numerical pain scale
• Patient satisfaction survey
Barriers to Implementation Plan
• Hospital’s unwillingness to commit staff to training and implementing
program
• Nurses and support staff not having time to conduct music therapy
intervention
• Patients refusing to participate
Ethical and Spiritual Implications
• Nonmaleficence
• Beneficence
• Cultural and religious considerations
Conclusions
• Research outcomes indicated the benefits of music therapy in
reducing acute, post-operative pain, as well as other potential
advantages.
• Implementing a longer term music therapy program can help
determine whether music therapy is a cost effective, non-invasive,
feasible approach to fighting the ongoing battle against acute, post-
surgical pain.
References
• Ajorpaz, N., Mohammadi, A., Najaran, H., & Khazaei, S. (2014). Effect of music on postoperative pain in patients under open heart surgery. Nursing and Midwifery
Studies, 3(3). doi:10.17795/nmsjournal20213

• Beauchamp, T. L. & Childress, J. F. (2009). Principles of biomedical ethics (7th ed.). New York, NY: Oxford University Press.

• Comeaux, T., & Steele-Moses, S. (2013). The effect of complementary music therapy on the patient's postoperative state anxiety, pain control, and environmental
noise satisfaction. Medsurg Nursing, 22(5), 313-319

• Convenience sampling - Research Methodology. (n.d.). Retrieved July 3, 2018, from https://research-methodology.net/sampling-in-primary-data-
collection/convenience-sampling/

• Davidson, J., (2018). Levels of evidence worksheet. Unpublished document by

• Evidence Based Practice Institute

• Gallagher, L. M., Gardner, V., Bates, D., Mason, S., Nemecek, J., DiFiore, J. B., … Bethoux, F. (2018). Impact of music therapy on hospitalized patients post-elective
orthopaedic surgery. Orthopaedic Nursing, 37(2), 124-133. doi:10.1097/nor.0000000000000432

• Gan, T. J. (2017). Poorly controlled postoperative pain: Prevalence, consequences, and prevention. Journal of Pain Research, Volume 10, 2287-2298.
doi:10.2147/jpr.s144066

• Jose, J., Verma, M., & Arora, S. (2012). An experimental study to assess the effectiveness of music therapy on the post operative pain perception of patients
following cardiac surgery in a selected hospital of New Delhi. International Journal of Nursing Education, 4(2), 198-201
References
• Liu, Y., & Petrini, M. A. (2015). Effects of music therapy on pain, anxiety, and vital signs in patients after thoracic surgery. Complementary Therapies in Medicine, 23(5), 714-718.
doi:10.1016/j.ctim.2015.08.002

• Mayo Clinic Staff. (2017). Pain medications after surgery. Retrieved from https://www.mayoclinic.org/pain-medications/art-20046452

• Miladinia, M., Pishgooie, A. H., Aliyari, S., & Elham, M. N. (2017). The comparison of the effect of two complementary medicine methods (music therapy and massage therapy) on
postoperative acute pain after abdominal surgery: A randomized clinical trial study. Iranian Red Crescent Medical Journal, 19(6) doi:http://0-
dx.doi.org.patris.apu.edu/10.5812/ircmj.14974

• Nilsson, U. (2008). The anxiety- and pain-reducing effects of music interventions: A systematic review. AORN Journal, 87(4), 780-807.
doi:http://0dx.doi.org.patris.apu.edu/10.1016/j.aorn.2007.09.013

• Özer, N., Karaman Özlü, Z., Arslan, S. and Günes, N. (2013). Effect of Music on Postoperative Pain and Physiologic Parameters of Patients after Open Heart Surgery. Pain
Management Nursing, 14(1), pp.20-28.

• Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Wolters Kluwer Health/lippincott Williams &
Wilkins.

• Richards, T., Johnson, J., Sparks, A., & Emerson, H. (2007). The Effect of Music Therapy on Patients’ Perception and Manifestation of Pain, Anxiety, And Patient Satisfaction.
Medsurg Nursing, 16(1), 7-14.

• Sfakianakis, M. Z., Karteraki, M., Panayiota, K., Christaki, O., Sorrou, Evangelia, Chatzikou, V., & Melidoniotis, E., (2017). Effect of music therapy intervention in acute
postoperative pain among obese patients. International Journal of Caring Sciences, 10(2), 937-945. Retrieved from:
http://www.internationaljournalofcaringsciences.org/docs/32_zografakis_original_10_2.pdfsearch.proquest.com.patris.apu.edu/docview/1933262949?accountid=8459